Erschienen:
Springer Science and Business Media LLC, 2020
Erschienen in:Journal of General Internal Medicine
Sprache:
Englisch
DOI:
10.1007/s11606-019-05420-w
ISSN:
0884-8734;
1525-1497
Entstehung:
Anmerkungen:
Beschreibung:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Risk 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).</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To 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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A 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.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Sixty-three medical students in their fourth or fifth year.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Participants received either a newly developed 15-h curriculum or a course manual adapted from teaching as usual.</jats:p></jats:sec><jats:sec><jats:title>Main Measures</jats:title><jats:p>Primary outcome: change in risk communication performance in a video-observed structured clinical examination (VOSCE).</jats:p></jats:sec><jats:sec><jats:title>Key Results</jats:title><jats:p>Participants 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’s<jats:italic>d</jats:italic>of 2.35 (95% confidence interval (CI) 1.62 to 3.01,<jats:italic>p</jats:italic>< 0.01) and of 1.83 (CI 1.13 to 2.47,<jats:italic>p</jats:italic>< 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 (<jats:italic>d</jats:italic>between 0.91 and 2.04 (<jats:italic>p</jats:italic>< 0.001)).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our 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.</jats:p><jats:p><jats:bold>Trial Registration:</jats:bold>The trial is registered in the International Clinical Trials Registry with the trial number DRKS00010890.</jats:p></jats:sec>