TOP 5 - Building Shared Decision-Making in Pediatric Residency: Development and Pilot Testing of a Competency-Based Curriculum

Publication Number: 1765.TOP 5

Vanessa Ivonne Orellana Villazon, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer DeSante-Bertkau, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ruby Hyland-Brown, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ellen Lipstein, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Shared decision-making (SDM) is essential to patient-centered care and is recognized as a key milestone in residency education. SDM fosters trust, promotes equity, and improves communication and outcomes for families. Residency represents an ideal stage to develop these skills, as trainees are still shaping their communication style and approach to clinical decisions. Yet few programs include structured SDM training, and most existing curricula were designed for adult medicine, overlooking the unique dynamics of pediatrics, where clinicians must decide when and how to involve children alongside their parents

Objective: To design, implement, and pilot test a pediatric SDM curriculum using a competency-based framework for pediatric SDM and a multi-pronged evaluation approach

Design/Methods: The curriculum was based on a previously developed framework of 32 pediatric SDM competencies organized into six domains. We first conducted competency mapping to identify which competencies should be introduced, practiced, and reinforced during residency. Based on this mapping, we developed specific learning objectives and designed corresponding educational activities.
Drawing on this foundation and findings from a prior needs assessment, we created a two-session program delivered during protected educational time. Grounded in adult learning theory, the curriculum emphasizes demonstration and modeling of SDM behaviors, guided reflection, and experiential learning. It also provides practical tools and incorporates reminders and reinforcers to encourage continued application of SDM behaviors in clinical practice.
Evaluation tools were developed in alignment with the competency framework and the first three levels of the Kirkpatrick model (Reaction, Learning, and Behavior). Reaction was assessed through post-session surveys on satisfaction and perceived relevance. Learning was measured using retrospective pre-post surveys administered after training to evaluate changes in SDM knowledge, confidence, and self-rated competence. Behavior was evaluated through video-recorded clinical encounters collected before and after training, independently rated by two evaluators using a competency-based rubric (Figure 1)
To date, 35 residents have participated, completing 35 surveys, with 15 pre- and 18 post-training recordings collected. We expect that analysis of pre- and post-training encounters will demonstrate improvements in residents' SDM knowledge, confidence, and demonstration of key communication behaviors. Findings will guide curriculum refinement and future implementation and evaluation.

Curriculum development and evaluation flow
This figure illustrates the development and evaluation of a competency-based pediatric shared decision-making curriculum