Laura Alexandra van der Woude, Gera A Welker, Paul L P Brand, Suzanne Festen
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This study aimed to explore the perceptions, beliefs and behaviors of Dutch residents and medical specialists regarding SDM and to identify potential barriers to its integration into postgraduate medical education.</p><p><strong>Methods: </strong>A mixed-method study was conducted, involving a survey (comprising control preference scale (CPS) and iSHARE) and focus group interviews among residents and medical specialists from seven Dutch teaching hospitals.</p><p><strong>Results: </strong>SDM was supported by 93% (292/315) of survey respondents, with 89% (280/315) agreeing that it should be an integral part of postgraduate medical education. Seven residents (6%) and 33 medical specialists (18%) indicated they had followed an SDM training. Thematic analysis of the focus group interviews identified four disease-centered beliefs that influenced clinical thinking and decision-making among both residents and medical specialists. This disease-centeredness emerged as the primary barrier to the successful implementation of SDM.</p><p><strong>Discussion: </strong>While SDM is widely endorsed, its practical implementation is constrained by disease-centered thinking. Achieving sustainable integration of SDM in postgraduate medical education requires a fundamental paradigm shift, in which residents and medical specialists become aware of their disease-centered beliefs and instead learn to think and act in a more person-centered manner.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"436-446"},"PeriodicalIF":3.9000,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12292059/pdf/","citationCount":"0","resultStr":"{\"title\":\"Barriers to Implementing Shared Decision-Making in Postgraduate Medical Education: The Role of Disease-Centered Beliefs.\",\"authors\":\"Laura Alexandra van der Woude, Gera A Welker, Paul L P Brand, Suzanne Festen\",\"doi\":\"10.5334/pme.1465\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Despite the well-documented benefits of shared decision-making (SDM), its implementation in practice remains limited. Efforts to promote SDM often fail to produce lasting behavioral change among physicians. Underlying conscious or unconscious beliefs may shape their decision-making processes, influencing the extent to which SDM is applied. This study aimed to explore the perceptions, beliefs and behaviors of Dutch residents and medical specialists regarding SDM and to identify potential barriers to its integration into postgraduate medical education.</p><p><strong>Methods: </strong>A mixed-method study was conducted, involving a survey (comprising control preference scale (CPS) and iSHARE) and focus group interviews among residents and medical specialists from seven Dutch teaching hospitals.</p><p><strong>Results: </strong>SDM was supported by 93% (292/315) of survey respondents, with 89% (280/315) agreeing that it should be an integral part of postgraduate medical education. Seven residents (6%) and 33 medical specialists (18%) indicated they had followed an SDM training. Thematic analysis of the focus group interviews identified four disease-centered beliefs that influenced clinical thinking and decision-making among both residents and medical specialists. This disease-centeredness emerged as the primary barrier to the successful implementation of SDM.</p><p><strong>Discussion: </strong>While SDM is widely endorsed, its practical implementation is constrained by disease-centered thinking. Achieving sustainable integration of SDM in postgraduate medical education requires a fundamental paradigm shift, in which residents and medical specialists become aware of their disease-centered beliefs and instead learn to think and act in a more person-centered manner.</p>\",\"PeriodicalId\":48532,\"journal\":{\"name\":\"Perspectives on Medical Education\",\"volume\":\"14 1\",\"pages\":\"436-446\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12292059/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Perspectives on Medical Education\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5334/pme.1465\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"EDUCATION, SCIENTIFIC DISCIPLINES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perspectives on Medical Education","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5334/pme.1465","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"EDUCATION, SCIENTIFIC DISCIPLINES","Score":null,"Total":0}
Barriers to Implementing Shared Decision-Making in Postgraduate Medical Education: The Role of Disease-Centered Beliefs.
Introduction: Despite the well-documented benefits of shared decision-making (SDM), its implementation in practice remains limited. Efforts to promote SDM often fail to produce lasting behavioral change among physicians. Underlying conscious or unconscious beliefs may shape their decision-making processes, influencing the extent to which SDM is applied. This study aimed to explore the perceptions, beliefs and behaviors of Dutch residents and medical specialists regarding SDM and to identify potential barriers to its integration into postgraduate medical education.
Methods: A mixed-method study was conducted, involving a survey (comprising control preference scale (CPS) and iSHARE) and focus group interviews among residents and medical specialists from seven Dutch teaching hospitals.
Results: SDM was supported by 93% (292/315) of survey respondents, with 89% (280/315) agreeing that it should be an integral part of postgraduate medical education. Seven residents (6%) and 33 medical specialists (18%) indicated they had followed an SDM training. Thematic analysis of the focus group interviews identified four disease-centered beliefs that influenced clinical thinking and decision-making among both residents and medical specialists. This disease-centeredness emerged as the primary barrier to the successful implementation of SDM.
Discussion: While SDM is widely endorsed, its practical implementation is constrained by disease-centered thinking. Achieving sustainable integration of SDM in postgraduate medical education requires a fundamental paradigm shift, in which residents and medical specialists become aware of their disease-centered beliefs and instead learn to think and act in a more person-centered manner.
期刊介绍：
Perspectives on Medical Education mission is support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices.
Official journal of the The Netherlands Association of Medical Education (NVMO).
Perspectives on Medical Education is a non-profit Open Access journal with no charges for authors to submit or publish an article, and the full text of all articles is freely available immediately upon publication, thanks to the sponsorship of The Netherlands Association for Medical Education.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
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