Shared Decision-Making: Longitudinal Changes in Medical Student Knowledge, Attitudes, and Skills Following an Educational Intervention

Introduction Shared decision-making (SDM) promotes patient engagement and collaboration in healthcare decisions and improved patient outcome. Despite its recognized value and inclusion in LCME and ACGME competencies, limited evidence exists regarding effective strategies for teaching SDM in undergraduate medical education. Methods This study evaluated first-year medical students’ knowledge, attitudes, and application of SDM following a four-hour educational session grounded in the AHRQ SHARE approach and reinforced through immediate and delayed standardized patient (SP) encounters. Students completed pre- and post-session surveys assessing knowledge, attitudes, and preferred decision-making style. Qualitative and quantitative data from SP encounters were also analyzed using the OPTION scale and reflexive thematic analysis. Results Students demonstrated high baseline SDM knowledge with minimal change post-session, suggesting that the best use of time may be in assisting students in how to apply these skills. Attitudes generally remained positive, though students were more likely to believe SDM requires patient confidence and education. Immediate and delayed SP assessments revealed improvements in exploring patient expectations, concerns, and in explaining benefits and drawbacks of options; however, other core interviewing and SDM behaviors showed little change. Qualitative analysis identified three themes: the importance of rapport-building, distinctions between communication and true collaboration, and variability in students’ ability to convey knowledge in patient-centered terms. Conclusion Our findings suggest pre-clinical learners possess strong conceptual understanding of SDM but require expanded opportunities for skills practice and application. SDM is expected to become increasingly tied to clinical reimbursement and quality metrics, identifying effective instructional methods remains essential to preparing future physicians for patient-centered care. Trial Registration: Ethical approval was obtained from the University of Houston Institutional Review Board (IRB #: STUDY00004173) and a waiver of informed consent was granted. This study adhered to principles outlined in the Declaration of Helsinki.