Ready for SDM: evaluating a train-the-trainer program to facilitate implementation of SDM training in Norway

Abstract

Background: Healthcare providers need training to implement shared decision making (SDM). In Norway, we developed “Ready for SDM”, a comprehensive SDM curriculum tailored to various healthcare providers, settings, and competence levels, including a course targeting interprofessional healthcare teams. The overall aim was to evaluate a train‐the‐trainer (TTT) program for healthcare providers wanting to offer this course within their hospital trust. Methods: Our observational descriptive design was informed by Kirkpatrick ́s Model of Educational Outcomes. The South‐Eastern Regional Health Authority invited healthcare providers from all health trusts in its jurisdiction to attend. The TTT consisted of a one‐day basic course with lectures on SDM, exercises and group reflections followed by a two‐day advanced course including an SDM observer training. Immediately after each of the two courses, reaction and learning (Kirkpatrick levels 1 and 2) were assessed using a self‐administered questionnaire. After the advanced course, observer skills were operationalized as accuracy of the participants’ assessment of a consultation compared to an expert assessment. Within three months post‐training, we measured number of trainings conducted and number of healthcare providers trained (Kirkpatrick level 3) using an online survey. Qualitative and quantitative descriptive analysis were performed. Results: Twenty‐one out of 24 (basic) and 19 out of 22 (advanced) healthcare providers in 9 health trusts consented to participate. The basic course was evaluated as highly acceptable, the advanced course as complex and challeng‐ ing. Participants identified a need for more training in pedagogical skills and support for planning implementation of SDM‐training. Participants achieved high knowledge scores and were positive about being an SDM trainer. Observer skills regarding patient involvement in decision‐making were excellent (mean of weighted t = .80). After three months, 67% of TTT participants had conducted more than two trainings each and trained a total of 458 healthcare providers. Conclusion: Findings suggest that the TTT is a feasible approach for supporting large‐scale training in SDM. Our study informed us about how to improve the advanced course. Further research shall investigate the efficacy of the training in the context of a comprehensive multifaceted strategy for implementing SDM in clinical practice. Trial registration: Retrospectively registered at ISRCTN (99432465) March 25, 2020.