1. Shared Decision Making Professor Michelle Leech Deputy Dean Medicine Monash University Deputy-Director Monash Health Rheumatology

2. What is the evidence of shared decision making skill teaching at Monash University ?

3. What do we teach and assess ?  Communication.  Communication regarding procedures and medication, consent  Patient-centred care  Evidence-based practice/ assessing risk  Communicating risk

4. Teaching patient-centred care  How does it happen? –teaching by instruction –teaching by example  the patient comes first  communication is everything –embedded in course design

5. Teaching patient-centred care  Curriculum-long course objectives

6. Teaching patient-centred care - examples  Monash MBBS Final Year Student learning objectives –an understanding of the acute, chronic, ambulatory and psycho-social contexts of illness and how these influence the clinical presentation and management; –an understanding of the ‘continuum of care’ in patient management across diverse settings including rural health; –an ability to work as an effective member of a multidisciplinary health care team; –effective communication skills, advocacy skills and social understanding with patients of all ages and their families within diverse and multicultural contexts; –appropriate written and verbal communication skills with members of the health care team; –appropriate professional, ethical and gender competent behaviour with patients and members of the health care team; –familiarity with the medico-legal responsibilities of being an intern; –an awareness of health care quality improvement activities

7. Assessment

8. The ideal versus reality

9. 9 For patients, issues can be very different and not always uncovered “I can never remember” “Did I take it?” “The internet said…” “The medication makes me feel worse” “I keep losing it” “I think the doctor has it wrong” “I’m afraid of needles” “I feel better” Unintentional Non-Adherence Intentional Non-Adherence Beliefs and perceptions about treatment and disease

10. Attitudes to illness and management are important

11. Shared decision making tools can help

12. Requires multiple discrete skills Patient Centred Care Evidence-Based Practice Communication skills

13. to be brought together Patient Centred Care Evidence-Based Practice Advanced Communication skills Advanced Clinical skills and Knowledge Deep experience of clinical context