Background: Shared Decision-making (SDM), a medical decision-making model, was popularized in the late 1980s in reaction to then predominate paternalistic decision-making, aiming to better meet the needs of patients. Extensive research has been conducted internationally examining the benefits of SDM implementation; however, existing theory on how SDM works, for whom, in which circumstances, and why is limited. While literature has shown positive patient, health care provider, and system benefits (SDM outputs), further research is required to understand the nuances of this type of decision-making.
View Article and Find Full Text PDFBackground: The practicality of applying evidence to healthcare systems with the aim of implementing change is an ongoing challenge for practitioners, policy makers, and academics. Shared decision- making (SDM), a method of medical decision-making that allows a balanced relationship between patients, physicians, and other key players in the medical decision process, is purported to improve patient and system outcomes. Despite the oft-mentioned benefits, there are gaps in the current literature between theory and implementation that would benefit from a realist approach given the value of this methodology to analyze complex interventions.
View Article and Find Full Text PDFIntroduction: Despite the widespread use of physician return-for-service (RFS) programs in Canada, few have been evaluated. We examined two types of RFS agreements (Family Medicine Bursary and Special Funded Residency Position) and (a) describe the proportion of RFS physicians who complete their service obligation and identify the predictors of completion and (b) compare the retention of RFS physicians to that of non-RFS physicians.
Methods: Using administrative data on physicians with RFS agreements in Newfoundland and Labrador (NL), Memorial University's Postgraduate Medical Education Office and the Physician and Medical Practice Database, we calculated the proportion of RFS physicians (1997-2009) who fulfilled their service obligation and also identified predictors of completion.
Return-for-service (RFS) bursaries for physicians have been in use in Canada for many years, yet little is known about the programs that are currently available or the features of the RFS bursary that are particularly important to potential participants. Using document analysis, we found that RFS programs were available in nearly all provinces and territories. A survey of medical trainees from Memorial University showed that the most important factors in their decision to accept an RFS bursary were the location they would be required to work, the monetary value of the bursary and the return time required to repay the service commitment.
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