Evidence-based medicine, shared decision making and the hidden curriculum: a qualitative content analysis

Perspectives on Medical Education

article

Braschi, Emélie¹  Stacey, Dawn²  Légaré, France³  Grad, Roland⁴  Archibald, Douglas¹ 

[1] Lamont Primary Health Care Research Centre;Faculty of Health Sciences, Ottawa Hospital Research Institute;Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University;Herzl Family Practice Centre

关键词: Evidence-based medicine;    Shared decision making;    Hidden curriculum;   

DOI  :  10.1007/s40037-020-00578-0

学科分类：医学（综合）

来源: Bohn Stafleu van Loghum B.V.

【 摘 要 】

Introduction Medical education should portray evidence-based medicine (EBM) and shared decision making (SDM) as central to patient care. However, misconceptions regarding EBM and SDM are common in clinical practice, and these biases might unintentionally be transmitted to medical trainees through a hidden curriculum. The current study explores how assumptions of EBM and SDM can be hidden in formal curriculum material such as PowerPoint slides. Methods We conducted a qualitative content analysis using a purposive sample of 18 PowerPoints on the management of upper respiratory tract infections. We identified concepts pertaining to decision making using theory-driven codes taken from the fields of EBM and SDM. We then re-analyzed the coded text using a constructivist latent thematic approach to develop a rich description of conceptualizations of decision making in relation to EBM and SDM frameworks. Results PowerPoint slides can relay a hidden curriculum, which can normalize: pathophysiological reasoning, unexplained variations in clinical care, the use of EBM mimics, defensive medicine, an unrealistic portrayal of benefits, and paternalism. Discussion Addressing the hidden curriculum in formal curricular material should be explored as a novel strategy to foster a positive attitude towards EBM and SDM and to improve patient outcomes by encouraging the use of these skills.

【 授权许可】

CC BY