Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial

• DOI: 10.1007/s11606-019-05420-w
• Publication Date: 2020-02-13T21:02:40Z
• Authors: Cora Koch; Nadine Dreimüller; Janosch Weißkircher; Nicole Deis; Eva Gaitzsch; Stefanie Wagner; Marlene Stoll; Franziska Bäßler; Klaus Lieb; Jana Jünger
• Keywords: Adult; Male; Students, Medical; Conflict of Interest; Communication; 610; 02 engineering and technology; Interessenkonflikt; 3. Good health; 617; 0202 electrical engineering, electronic engineering, information engineering; Humans; Female; Curriculum; Medizinische Ausbildung; Decision Making, Shared; Original Research

AbstractBackgroundRisk communication is a core aspect of a physician’s work and a fundamental prerequisite for successful shared decision-making. However, many physicians are not able to adequately communicate risks to patients due to a lack of understanding of statistics as well as inadequate management of conflicts of interest (COI).ObjectiveTo evaluate the effects of an integrated curriculum encompassing COI and shared decision-making on the participants’ risk communication competence, that is, their competence to advise patients on the benefits and harms of diagnostic or therapeutic interventions.DesignA rater-blind randomized controlled trial with a 30 (± 1)-week follow-up conducted from October 2016 to June 2017 at two German academic medical centers.ParticipantsSixty-three medical students in their fourth or fifth year.InterventionsParticipants received either a newly developed 15-h curriculum or a course manual adapted from teaching as usual.Main MeasuresPrimary outcome: change in risk communication performance in a video-observed structured clinical examination (VOSCE).Key ResultsParticipants were 25.7 years old on average (SD 3.6); 73% (46/63) were female. Increase in risk communication performance was significantly higher in the intervention group with post-intervention Cohen’sdof 2.35 (95% confidence interval (CI) 1.62 to 3.01,p< 0.01) and of 1.83 (CI 1.13 to 2.47,p< 0.01) 30 (± 1) weeks later. Secondary outcomes with the exception of frequency of interactions with the pharmaceutical industry also showed relevant improvements in the intervention as compared with the control group (dbetween 0.91 and 2.04 (p< 0.001)).ConclusionsOur results show that an integrated curriculum encompassing COI and risk communication leads to a large and sustainable increase in risk communication performance. We interpret the large effect sizes to be a result of the integration of topics that are usually taught separately, leading to a more effective organization of knowledge.Trial Registration:The trial is registered in the International Clinical Trials Registry with the trial number DRKS00010890.