Barriers to Implementing Shared Decision-Making in Postgraduate Medical Education: The Role of Disease-Centered Beliefs.

Introduction: Despite the well-documented benefits of shared decision-making (SDM), its implementation in practice remains limited. Efforts to promote SDM often fail to produce lasting behavioral change among physicians. Underlying conscious or unconscious beliefs may shape their decision-making processes, influencing the extent to which SDM is applied. This study aimed to explore the perceptions, beliefs and behaviors of Dutch residents and medical specialists regarding SDM and to identify potential barriers to its integration into postgraduate medical education. Methods: A mixed-method study was conducted, involving a survey (comprising control preference scale (CPS) and iSHARE) and focus group interviews among residents and medical specialists from seven Dutch teaching hospitals. Results: SDM was supported by 93% (292/315) of survey respondents, with 89% (280/315) agreeing that it should be an integral part of postgraduate medical education. Seven residents (6%) and 33 medical specialists (18%) indicated they had followed an SDM training. Thematic analysis of the focus group interviews identified four disease-centered beliefs that influenced clinical thinking and decision-making among both residents and medical specialists. This disease-centeredness emerged as the primary barrier to the successful implementation of SDM. Discussion: While SDM is widely endorsed, its practical implementation is constrained by disease-centered thinking. Achieving sustainable integration of SDM in postgraduate medical education requires a fundamental paradigm shift, in which residents and medical specialists become aware of their disease-centered beliefs and instead learn to think and act in a more person-centered manner.