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BMJ Open. 2017 Jun 23;7(6):e015945. doi: 10.1136/bmjopen-2017-015945.

Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis.

Author information

The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA.
Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada.
Department of Brighton and Sussex Medical School, Dean's Office, Brighton, UK.
CHU de Québec Research Center, Saint-François d'Assise Hospital, Quebec, Canada.



Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries.


The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data.


The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide.


Medical education & training; Patient-centered care; Shared decision making

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: Financial: M-AD is a consultant to Access Community Health Network, Chicago. GE has been a consultant to: (1) Emmi Solutions LLC who develop patient knowledge tools; (2) National Quality Forum on certification of patient knowledge tools; (3) Washington State Health Department on certification of patient knowledge tools; (4) PatientWisdom LLC, (5) SciMentum, Amsterdam, and (6) Access Community Health Network, Chicago. GE has edited / published books that provide royalties on sales by the publishers: the books have been on Shared Decision Making (Oxford University Press) and Groups (Radcliffe Press). Non-Financial: Many authors are authors of SDM and communication training programs in medical schools. However, they get no financial benefits from it. GE initiated and leads the Option Grid TM patient decision aids Collaborative, which produces and publishes patient knowledge tools in the form of comparison tables (, and has part ownership of the registered trademark. GE owns copyright in CollaboRATE, IntegRATE, and Observer OPTION measures of shared decision making and care integration. These measures are freely available for use. PJB owns copyright in CollaboRATE.

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