Research report: Shared decision-making: longitudinal changes in medical student knowledge, attitudes, and skills following an educational intervention

First-year medical students who received a four-hour shared decision-making session showed little change in knowledge and attitudes, but improved in selected behaviors during standardized-patient encounters. Researchers found stronger performance in exploring patients’ expectations and concerns and in explaining the benefits and drawbacks of available options. The study used a convergent mixed-methods design to evaluate an intervention built around the Agency for Healthcare Research and Quality’s SHARE approach: Seek, Help, Assess, Reach and Evaluate.

Participation involved a four-hour educational session followed by immediate and delayed encounters with standardized patients. Surveys assessed students’ knowledge, attitudes and preferred decision-making styles, while researchers analyzed standardized-patient encounters quantitatively with the OPTION scale and qualitatively through reflexive thematic analysis. Enrolled students were in their first year of medical school and were followed as a longitudinal open cohort from 2023 to 2024.

The targeted class size was 60 students per year, with 17 unique standardized patients and four faculty members taking part across simulation iterations. The cohort design allowed the investigators to examine how students developed over time, although the educational study was limited to preclinical learners in the participating program. Students began with high baseline knowledge of shared decision-making, and average post-session knowledge scores differed only minimally from those recorded beforehand.

Attitudes also remained generally positive. Within those attitudes, most students said that successful implementation depends on patients having confidence and receiving education. The survey results therefore point to a relatively stable conceptual understanding and broadly favorable views rather than major changes following the session.

The standardized-patient assessments provided a more detailed picture of practical performance. Researchers conducted true within-subject longitudinal analyses by following individual students and repeating their assessments over time. Compared with baseline encounters, students demonstrated improvements in two specific areas: exploring patients’ expectations and concerns, and explaining the advantages and disadvantages of different options.

Most other core interviewing and shared decision-making behaviors showed little difference between assessment points. Qualitative analysis of the encounters identified three recurring themes. The first concerned the importance of building rapport.

The second distinguished communication from true collaboration. The third captured variation in students’ ability to convey information in patient-centered terms. Together, these themes show that the simulation exercises did not represent a uniform progression toward effective shared decision-making; students displayed improvement in some observable skills while other aspects of their encounters remained limited.

The study also differed in the strength of evidence available for its components. The initial knowledge survey was anonymous, preventing investigators from matching each student’s pretest responses to the same student’s posttest responses. Knowledge and attitude changes were therefore assessed through an independent-groups comparison.

By contrast, the simulation component used repeated within-subject assessments, allowing direct longitudinal comparisons of students’ performance in standardized-patient encounters. These distinctions limit what can be concluded from the results. The knowledge and attitude findings should not be described as changes within the same students, while the simulation findings concern measured behaviors in a defined educational setting rather than clinical practice.

Its clearest reported result is a selective improvement in two shared decision-making behaviors during standardized-patient encounters, alongside limited change in knowledge and attitudes and little change in the remaining assessed skills. The authors concluded that preclinical learners generally possessed a strong conceptual understanding of shared decision-making but would benefit from more opportunities to practice and apply it. This interpretation is consistent with the observed pattern: a brief educational intervention accompanied by immediate and delayed simulation encounters was associated with stronger performance in eliciting concerns and explaining option trade-offs, but not with broad improvement across every measured outcome.

The study identifies a focused instructional challenge for medical educators—supporting repeated application of shared decision-making skills—without establishing a universal effect for simulation-based training or a direct change in patient-centered care delivered in clinical settings.

Subject of Research: Longitudinal evaluation of shared decision-making education and simulation skills among first-year medical students

Article Title: Shared decision-making: longitudinal changes in medical student knowledge, attitudes, and skills following an educational intervention

Article References: Chavez, S., De La Roche, L., Elder, W., Gullion, K., Xu, T., & Grissom, M. (2026). Shared decision-making: longitudinal changes in medical student knowledge, attitudes, and skills following an educational intervention. BMC Medical Education. https://doi.org/10.1186/s12909-026-10619-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10619-7

Keywords: medical education, shared decision-making, medical students, standardized patients, simulation training, knowledge assessment, attitudes, clinical skills, mixed-methods research, patient engagement, Shared, decision-making