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22-04-2020 | Original Article | Uitgave 3/2020 Open Access

Perspectives on Medical Education 3/2020

Evidence-based medicine, shared decision making and the hidden curriculum: a qualitative content analysis

Tijdschrift:
Perspectives on Medical Education > Uitgave 3/2020
Auteurs:
Emélie Braschi, Dawn Stacey, France Légaré, Roland Grad, Douglas Archibald
Belangrijke opmerkingen

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s40037-020-00578-0) contains supplementary material, which is available to authorized users.

Abstract

Introduction

Medical education should portray evidence-based medicine (EBM) and shared decision making (SDM) as central to patient care. However, misconceptions regarding EBM and SDM are common in clinical practice, and these biases might unintentionally be transmitted to medical trainees through a hidden curriculum. The current study explores how assumptions of EBM and SDM can be hidden in formal curriculum material such as PowerPoint slides.

Methods

We conducted a qualitative content analysis using a purposive sample of 18 PowerPoints on the management of upper respiratory tract infections. We identified concepts pertaining to decision making using theory-driven codes taken from the fields of EBM and SDM. We then re-analyzed the coded text using a constructivist latent thematic approach to develop a rich description of conceptualizations of decision making in relation to EBM and SDM frameworks.

Results

PowerPoint slides can relay a hidden curriculum, which can normalize: pathophysiological reasoning, unexplained variations in clinical care, the use of EBM mimics, defensive medicine, an unrealistic portrayal of benefits, and paternalism.

Discussion

Addressing the hidden curriculum in formal curricular material should be explored as a novel strategy to foster a positive attitude towards EBM and SDM and to improve patient outcomes by encouraging the use of these skills.
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