Medical students’ knowledge and attitudes towards shared decision-making: results from a multinational cross-sectional survey

Introduction: We aimed to conduct a multinational cross-sectional online survey of medical students' attitudes towards, knowledge of, and experience with shared decision-making (SDM). Methods: We conducted the survey from September 2016 until May 2017 using: 1) a convenience sample of students from four medical schools each in Canada, the US, and the Netherlands (n=12), and 2) all medical schools in the UK through the British Medical School Council (n=32). We also distributed the survey through social media. Results: 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range:18.8%-100%; 95% CI 82.8%-84.5%). US students had the highest knowledge scores (86.2%, 95% CI 84.8%-87.6%). The mean risk communication score was 57.4% (range: 0%-100%; 95% CI 57.4%-60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, p<.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% vs. 48.8%). 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion: SDM knowledge is high among medical students in all four countries. Risk communication is less well-understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula.