Shared decision making and
Australian general practitioner training
Dr Ronald McCoy, Education Strategy Senior Advisor,
Royal Australian College of General Practitioners
Are general practitioners trained
in shared decision making?
•
•
•
General practitioners in Australian are
trained according to the Royal Australian
College of General Practitioners (RACGP)
Curriculum for Australian General Practice.
Challenge for curriculum development is to:
• incorporate relevant attributes, skills
and knowledge each of these into
general practice training in a coordinated fashion to meet the health
needs of the Australian community.
Also sets the agenda for lifelong learning
including continuing professional
development
Diversity of general practice
•
•
•
•
•
•
GPs have to deal with a
wide range of health
problems
Reviewed every three years
Currently undergoing review
Stakeholder consultation for
in the next few weeks
Will be available for
comment for about 2
months.
Provides an important
opportunity to review the
role of shared decision
making in the curriculum.
Shared decision making in general practice
“Shared decision making is the process of clinician and patient jointly
participating in a health decision after discussing the options, the benefits and
harms, and considering the patient’s values, preferences, and circumstances.”1
Historically:
• Australian general practice and general
practice training has a long history of patient
centred community
• Until recently, general practice has not been
seen as a place of research, yet this is where
the majority of the health care in the community
occurs
• Resulted in a disconnect between evidence
based medicine and the clinic, where the
majority of people are treated within the
community
• The role of this evidence base is key for
implementing shared decision making for
optimal patient care
1. Hoffman TC et al. JAMA 312:1295
RACGP Curriculum and shared
decision making
Shared decision making does appear in the RACGP Curriculum in two
ways:
• Explicit: as “shared decision making”
• Quality use of medicines, Chronic disease
• Use negotiation and problem solving skills in shared decision
making with
• patients from culturally and linguistically diverse backgrounds.
• Women’s health
• Implicit
• Shared decision making skills without being named
• Attributes, skills, knowledge behaviours for shared decision
making
RACGP Curriculum and shared decision making
“Shared decision making is the process of clinician and patient jointly participating in a health decision after discussing
the options, the benefits and harms, and considering the patient’s values, preferences, and circumstances.” 1
Definition
Training outcome examples from RACGP Curriculum for Australian General Practice
Shared decision making
…
Patient-centred skills

is the process of clinician 
and patient jointly

participating in a health
decision…


after discussing the
options, the benefits and
harms,…

and considering the
patient’s values,
preferences, and
circumstances



Evidence-based medicine skills
Demonstrate respect for patient autonomy.
Work in partnership with the patient as determined by the needs
of the patient.
Negotiate patient centred management plans that consider the
patient’s preference of treatment and priority of treatments.
Use communication skills to underpin effective diagnosis and
management of the patient (eg. listening, reassuring, explaining,
interpreting).
Use communication skills to build and maintain a therapeutic
relationship between patient and doctor.

Use problem solving skills to collaborate with patients on
acceptable management plans.
Integrate scientific evidence and other relevant factors when
problem solving.

Have a holistic perspective, taking into account the
patient’s social, psychological, cultural and existential
dimensions.
Elicit and take into account a patient’s sociopolitical,
economic, work, spiritual, linguistic and cultural
background and needs, as well as their relationships with
family and significant others in relation to their health.







1. Hoffman TC et al. JAMA 312:1295
Communicate the evidence for management, diagnosis or
screening to patients in a manner that is both understandable to
the patient and is patient centred.
Involve the patient in the evidence based decision making
process about their health and acknowledge the informed
patient’s right to choose to accept or decline new interventions
based on research evidence.
Have well developed skills in reflective practice and critical
thinking in order to identify and formulate questions as they arise
in clinical practice
Integrate scientific evidence and other relevant factors when
problem solving.
Have sound skills in critical appraisal of different types of
evidence sources.
Be aware of and use, where appropriate, relevant written
materials.
Understand how educational background and literacy levels may
be difficult to assess when there is a language barrier.
Understand that the relevance of educational materials will vary
for each individual, eg. some people speak one language but
read in another – this will have implications when determining
which resources are appropriate for the patient.
Be aware of the impact of a patient's own cultural lens. This
includes beliefs about disease, health and healthcare; the impact
of faith and religious beliefs; and pharmacology differences in
different ethnicities.
Challenges for incorporating shared decision
making into general practice training - 1
Efficacy of shared decision making approaches
• Ensure having good methods and processes are taught to GPs
• having sufficient evidence, tools and guidelines for the
diversity and generalisability of general practice settings
• GPs have a lot of experience with using clinical guidelines, but
perhaps less with decision making tools
Application of methods
• ensuring that share decision making situations are identified
• processes are implemented for each situation
Challenges for incorporating shared decision
making general practice training - 2
GP attitudinal barriers (highly variable!)
• “I already do this”
• “I don’t feel confident too…“
• “I do not enough time to..”
• Makes patients anxious by increasing uncertainty
• patients just want to be told what to do
• Most people don’t know how to participate in shared decision making
• Some patients may find this difficult to negotiate eg patients with
disability
Patient barriers
• Cultural eg patients form doctor centred cultures
• Health literacy
Challenges for incorporating shared decision
making general practice training - 3
Accessibility
• Ensuring diversity of access of benefits of shared decision making
• GPs treat the entire community
• Shared decision making involves issues of empowerment
• Need to involve advocates and consumers in women’s health,
multicultural health, Aboriginal and Torres Strait Islander
health etc. when developing shared decision making processes
• Issues for those in rural and remote areas
• Accessibility of support materials e.g. decision making tools
Summary: shared decision making
and general practitioner training
Shared decision making:
• has many benefits for optimising patient care in the general practice setting
• has made some inroads into general practitioner training, but needs to be
strengthened in general practice training,
• Needs to be strengthened in in the RACGP Curriculum for Australian
General Practice
• Good news: Not starting from scratch
• There is already a strong skill base is there
• Rise of teaching of critical thinking and research skills in medical
schools
• Increased availability of decision making tools
Also need to look at what supports for need to be developed for the
implementation of shared decision making into general practice training.
RACGP Curriculum Review
All contributions are welcome
• Please contact the RACGP is
you would like to provide input
into the next RACGP Curriculum
for Australian general Practice
• Place you on the stakeholder list
• Also tell your colleagues and
other organisations
• Open to all organisations and
the entire community