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Education And Debate

Framework for teaching and learning informed shared decision makingCommentary: Competencies for informed shared decision makingCommentary: Proposals based on too many assumptions

BMJ 1999; 319 doi: (Published 18 September 1999) Cite this as: BMJ 1999;319:766

Framework for teaching and learning informed shared decision making

  1. Angela Towle, director, MD undergraduate programme (,
  2. William Godolphin, professorb
  1. a Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 4E3
  2. b Department of Pathology and Laboratory Medicine, University of British Columbia
  3. Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London N19 3UA
  4. 67 Brighton Cottages, Cuckfield RH16 1XT
  1. Correspondence to: A Towle

    Patients should be involved in making decisions about their health care. The ethical imperative of autonomy is reflected in legal trends that require a high standard of disclosure for informed consent, amounting to a principle of informed choice.13 Outcomes of care and adherence to treatment regimens improve when patients are more involved.4 5 Consumerism is part of the social spirit, and governments exhort citizens to take more responsibility.

    Models of doctor-patient encounters that result in increased involvement of patients and that are informed by good evidence have been termed, for example, “informed patient choice”68 but do not describe the interactive process clearly. We use the term informed shared decision making to describe decisions that are shared by doctor and patient and informed by best evidence, not only about risks and benefits but also patient specific characteristics and values. It occurs in a partnership that rests on explicitly acknowledged rights and duties and an expectation of benefit to both.

    Summary points

    Competencies for the practice of informed shared decision making by physicians and patients are proposed

    The competencies are a framework for teaching, learning, practice, and research

    Challenges to putting informed shared decision making into practice are perceived lack of time, physicians' predisposition and skill, and patients' inexperience with making decisions about treatment

    We propose that a demonstrated capacity to engage in informed shared decision making is characterised by a set of necessary and sufficient competencies. By competencies we mean the knowledge, skills, and abilities that represent the instructional intents of a programme, stated as specific goals.9 They are a framework for teaching, learning, practice, and investigation of what should be a coherent process and an accomplishment of any doctor-patient encounter in which a substantive decision is made about treatment or investigation for which reasonable …

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