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

Emélie Braschi; Dawn Stacey; France Légaré; Roland Grad; Douglas Archibald

doi:10.1007/S40037-020-00578-0

Abstract

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.

References

1.
Wennberg JE Forty years of unwarranted variation—And still counting Health Policy 2014 114 1 2

Back to article
2.
Guyatt G Cairns J Churchill D Evidence-based medicine. A new approach to teaching the practice of medicine JAMA 1992 268 2420 2425

Back to article
3.
Sackett DL Rosenberg WMC Gray JAM Haynes RB Richardson WS Evidence based medicine: what it is and what it isn’t BMJ 1996 312 7023 71 72

Back to article
4.
Sheridan DJ Julian DG Achievements and limitations of evidence-based medicine J Am Coll Cardiol 2016 68 204 213

Back to article
5.
Elwyn G Laitner S Coulter A Walker E Watson P Thomson R Implementing shared decision making in the NHS and patients should be the first step in giving patients choice Br Med J 2010 341 971 975

Back to article
6.
Elwyn G Frosch D Thomson R Shared decision making: a model for clinical practice J Gen Intern Med 2012 27 1361 1367

Back to article
7.
Frank JR Snell L Sherbino J CanMEDS 2015 physician competency framework 2015 Ottawa Royal College of Physicians and Surgeons of Canada

Back to article
8.
Blanco MA Capello CF Dorsch JL Perry G Zanetti ML A survey study of evidence-based medicine training in US and Canadian medical schools J Med Libr Assoc 2014 102 160 168

Back to article
9.
Diouf NT Menear M Robitaille H Painchaud Guérard G Légaré F Training health professionals in shared decision making: update of an international environmental scan Patient Educ Couns 2016 99 1753 1758

Back to article
10.
Ahmadi S-F Baradaran HR Ahmadi E Effectiveness of teaching evidence-based medicine to undergraduate medical students: a BEME systematic review Med Teach 2015 37 21 30

Back to article
11.
Simmons L Leavitt L Ray A Fosburgh B Sepucha K Shared decision making in common chronic conditions: impact of a resident training workshop Teach Learn Med 2016 28 202 209

Back to article
12.
Hoffmann TC Del Mar C Clinicians’ expectations of the benefits and harms of treatments, screening, and tests JAMA Intern Med 2017 177 407 419

Back to article
13.
Buscaglia J Nagula S Yuan J The practice of evidence-based medicine (EBM) in gastroenterology: discrepancies between EBM familiarity and EBM competency Therap Adv Gastroenterol 2011 4 283 294

Back to article
14.
Gravel K Légaré F Graham ID Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals’ perceptions Implement Sci 2006 1 16

Back to article
15.
Légaré F Thompson-Leduc P Twelve myths about shared decision making Patient Educ Couns 2014 96 281 286

Back to article
16.
Thompson-Leduc P Turcotte S Labrecque M Legare F Prevalence of clinically significant decisional conflict: an analysis of five studies on decision-making in primary care BMJ Open 2016 6 6 e011490

Back to article
17.
Légaré F Labrecque M LeBlanc A Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial Heal Expect 2011 14 Suppl 1 96 110

Back to article
18.
Légaré F Labrecque M Cauchon M Castel J Turcotte S Grimshaw J Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial Can Med Assoc J 2012 184 E726 E734

Back to article
19.
Braschi E Don’t just blame the evidence: considering the role of medical education in the poor uptake of evidence-based medicine in clinical practice BMJ 2018 10.1136/bmjebm-2018-111014

Back to article
20.
Hafferty FW Beyond curriculum reform Acad Med 1998 73 403 407

Back to article
21.
Hoffmann TC Montori VM Del Mar C The connection between evidence-based medicine and shared decision making JAMA 2014 312 1295 1296

Back to article
22.
Lawrence C Mhlaba T Stewart KA Moletsane R Gaede B Moshabela M The hidden curricula of medical education Acad Med 2018 93 648 656

Back to article
23.
Brien BCO Harris IB Beckman TJ Reed DA Cook DA Standards for reporting qualitative research Acad Med 2014 89 1245 1251

Back to article
24.
Dawes M Summerskill W Glasziou P Sicily statement on evidence-based practice BMC Med Educ 2005 5 1 7

Back to article
25.
Durand MA Witt J Joseph-Williams N Minimum standards for the certification of patient decision support interventions: feasibility and application Patient Educ Couns 2015 98 462 468

Back to article
26.
Joseph-Williams N Newcombe R Politi M Toward minimum standards for certifying patient decision aids: a modified Delphi consensus process Med Decis Making 2013 34 699 710

Back to article
27.
Elwyn G O’Connor A Stacey D Developing a quality criteria framework for patient decision aids: online international Delphi consensus process BMJ 2006 333 417

Back to article
28.
Labrecque M Lafortune V Lajeunesse J Do continuing medical education articles foster shared decision making? J Contin Educ Health Prof 2010 30 44 50

Back to article
29.
Zipkin DA Umscheid CA Keating NL Evidence-based risk communication: a systematic review Ann Intern Med 2014 161 270 280

Back to article
30.
Helgevold N Moen V Three approaches to qualitative content analysis Qual Health Res 2015 15 1277 1288

Back to article
31.
Braun V Clarke V Using thematic analysis in psychology Qual Res Psychol 2006 3 77 101

Back to article
32.
Creswell JW Miller DL Determining validity in qualitative inquiry Theory Pract 2000 39 124 130

Back to article
33.
Matthys J De Meyere M Van Driel ML De Sutter A Differences among international pharyngitis guidelines: not just academic Ann Fam Med 2007 5 5 436 443

Back to article
34.
Spinks A Glasziou P Del Mar C Antibiotics for sore throat Cochrane Database Syst Rev 2011 11 CD000023

Back to article
35.
Lemiengre MB van Driel ML Merenstein D Young J De Sutter AI Antibiotics for clinically diagnosed acute rhinosinusitis in adults Cochrane Database Syst Rev 2012 10 CD006089

Back to article
36.
Smith S Fahey T Smucny J Becker L Antibiotics for acute bronchitis Cochrane Database Syst Rev 2004 3 CD000245

Back to article
37.
Ramis M-A Chang A Nissen L Undergraduate health students’ intention to use evidence-based practice after graduation: a systematic review of predictive modeling studies Worldviews Evid Based Nurs 2017 15 2 140 148

Back to article
38.
Haidet P Kelly A Chou C Characterizing the patient-centeredness of hidden curricula in medical schools: development and validation of a new measure Acad Med 2005 80 44 50

Back to article
39.
Martimianakis MA Hafferty FW Exploring the interstitial space between the ideal and the practised: humanism and the hidden curriculum of system reform Med Educ 2016 50 278 280

Back to article
40.
Simons MR Zurynski Y Cullis J Morgan MK Davidson AS Does evidence-based medicine training improve doctors’ knowledge, practice and patient outcomes? A systematic review of the evidence Med Teach 2018 41 5 532 538

Back to article
41.
Balmer DF Quiah S Dipace J Paik S Ward MA Richards BF Learning across the explicit, implicit, and extra-curricula: An exploratory study of the relative proportions of residents’ perceived learning in clinical areas at three pediatric residency programs Acad Med 2015 90 1547 1552

Back to article
42.
Bandini J Mitchell C Epstein-Peterson ZD Student and faculty reflections of the hidden curriculum: how does the hidden curriculum shape students’ medical training and professionalization? Am J Hosp Palliat Care 2017 34 57 63

Back to article
43.
Maggio LA Educating physicians in evidence based medicine: current practices and curricular strategies Perspect Med Educ 2016 5 358 361

Back to article

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

Abstract

Paradigm

My account