Evaluating shared decision-making in periviable counseling using objective structured clinical examinations

Objectiveto develop and test an objective structured clinical examination to evaluate the use of shared decision-making (sdm) in periviable counseling among fourth-year ob/gyn residents.methodsresidents counseled a standardized patient presenting with preterm premature rupture of membranes at 23 weeks’ gestation. braddock’s 9-item measure of sdm was adapted to a 10-item scoring rubric; rating each: 0 (absent), 1 (partial), or 2 (complete).resultstwenty-six residents participated. all provided “complete” discussions of the clinical issue and “complete” or ‘partial’ ratings for informing the woman of her prognosis (62 and 38%, respectively) and addressing her role in decision-making (42 and 50%). discussions of her goals and preferences were often absent (69 and 62%). only 42% discussed uncertainties.conclusioncritical elements of sdm related to a woman’s values, goals and preferences were not explored when counseling about periviable delivery. training in sdm is needed to advance communication skills for complex clinical decision-making.