Shared decision-making training in general practice: a rapid review.

Introduction: Although shared decision-making (SDM) is key to providing patient-centred care, SDM is lacking in primary care. Training programmes seeking to improve GP SDM have yet to be reviewed. Therefore, a rapid review of the literature was conducted to evaluate GP SDM training methods and their outcomes. Methods: MEDLINE, EMBASE and CENTRAL were systematically searched. Results of the studies included were synthesised narratively. Study quality was appraised using the Medical Education Research Study Quality Instrument (MERSQI). Results: Seven studies were identified. Study quality was high, with a mean MERSQI score of 17.2/18 (range 16-18). Theory/presentation was the most prevalent training method (n=6). Of the five studies assessing the impact of SDM training on patient outcomes, only one yielded positive results. Contrastingly, both studies assessing clinician behaviour produced positive results. Conclusions: SDM training improved GP behaviour but the effects on patient outcomes were lacking. SDM training programmes that utilised teaching methods targeting practical SDM skills, such as role play, observed some positive findings. However, because their prevalence was lacking, further research into these methods, and their cost-effectiveness, are needed.

GPs' perceptions of teaching methods in shared decision-making training: a qualitative study.

BACKGROUND: Although shared decision making (SDM) is key to delivering patient-centred care, there are barriers to GPs implementing SDM in practice. SDM training is undergoing development by organisations, including the Royal College of General Practitioners. However, GPs' perceptions of the delivery of SDM training in general practice remain largely unexplored. AIM: To explore GPs' perceptions of teaching methods in SDM training. DESIGN AND SETTING: Qualitative study of GPs with teaching roles at the University of Exeter Medical School. METHOD: Purposive sampling recruited 14 GPs. Semi-structured interviews explored their SDM educational experiences. Data were analysed using thematic framework analysis. RESULTS: Three themes were identified. The GPs described role-play, receiving feedback, and on-the-job learning as modes of delivering SDM training that mostly informed their SDM in clinical practice positively. Learning from knowledgeable individuals and using realistic patient cases were perceived as beneficial components of SDM learning, although most learning occurred implicitly through reflections on their clinical experiences. The GPs identified that their training on SDM should reflect the uncertainty that is present when sharing decisions with patients in real-life general practice consultations. GPs also identified the targeting of individual GPs' SDM learning needs and explanation of the potential benefits of SDM on consultation outcomes as important methods to facilitate the implementation of SDM in practice. CONCLUSION: To the authors' knowledge, this is the first UK study to explore GPs' perceptions of SDM training and provide recommendations for practice. As SDM occurs in partnership with patients, further research should obtain and incorporate patients' views alongside those of GPs in the evaluation of future programmes.

Dual mobility hip arthroplasty: iatrogenic intraprosthetic dislocation of a 22 mm head.

We describe the first intraprosthetic dislocations of a 22 mm head in a dual mobility hip replacement in the literature. This case emphasises the importance of information gathering and planning when dealing with arthroplasty complications. Furthermore, it highlights the necessity of adequate muscle relaxation and analgesia when dealing with hip dislocations. A 78-year-old patient presented to the emergency department (ED) with a spontaneous dislocation of her left dual-mobility total hip replacement 3 months after first-stage revision surgery for infection. Reduction via manipulation under analgesia was then attempted in the ED but was ultimately unsuccessful; an iatrogenic intraprosthetic dislocation of the polyethylene liner was sustained. Several factors may have contributed to liner dislocation: a failure to appreciate the implant type, multiple manipulations in ED were attempted under analgesia, but no sedation or muscle relaxation was administered to the patient. The patient subsequently underwent revision surgery.

An evaluation of educational interventions aimed at preparing medical students for discharge summary writing: a rapid review of the literature.

Whilst discharge summaries are important for ensuring patient continuity of care, they often lack important information. Medical students and newly qualified doctors have attributed this to insufficient teaching, thereby indicating a need to improve discharge summary education within the undergraduate medical curriculum. The aim was to review educational approaches used to prepare undergraduate medical students for discharge summary writing, and their effectiveness Medline and Scopus were systematically searched using keywords, for studies published between 2009 and 2019. Narrative synthesis was used to integrate the findings of the included studies. Study quality was appraised using the Medical Education Research Study Quality Instrument. Six studies were included in this review. Allowing students to write a discharge summary following a real patient encounter and receive written feedback was the most common educational approach used (n = 4). Three of these studies improved student attitudes towards discharge summary writing. One study described the use of a mobile application, which improved discharge summary quality. Another study utilized interprofessional learning but the effect was statistically insignificant. Medical Education Research Study Quality Instrument scores were satisfactory (mean = 12, range = 8.4-15). The literature concerning this topic is limited. The results indicate that providing written feedback to students can positively influence attitudes towards discharge summary writing. Optimisation of the quality of discharge summaries written by medical students using feedback and checklists requires further investigation, as does the use of interprofessional learning. Future studies would additionally benefit from including participant baseline data and control groups, being multicentred and measuring behavioural or patient/healthcare outcomes.