3 Pre-training clinician survey to assess prior experience

Pre-training clinician survey to assess prior experience with SDM:

Demographics

1. Today’s date:__________________________________________________

2. Your name (please print legibly): ___________________________________

3. Your email address:_____________________________________________

4. Location of your practice: ________________________________________

5. What is your age (in years)?

____ years

6. What is your degree?

____ DO (Doctor of Osteopathic Medicine)

____ MD (Doctor of Medicine)

____ NP (Nurse Practitioner)

____ PA (Physician Assistant)

____ Other; Please specify: ___________________________

7. In what year did you receive this degree? _________

8. What is your gender?

____ Female

____ Male

____ Transgender: Identify as female

____ Transgender: Identify as male

____ Other

____ Prefer not to answer

9. What is your race? Please mark all that apply.

____White

____Black or African-American

____Asian

____Native Hawaiian or other Pacific Islander

____American Indian or Alaskan Native

____Other, please specify:

____Prefer not to answer

10. Are you of Hispanic, Latinx, or Spanish origin?

____Yes

____No

____Prefer not to answer

11. What is your medical specialty (e.g., Family Medicine, Internal Medicine, Cardiology, etc.). Please list all: ______________________________________________________________

12. How many days (or half days) do you see patients in a typical week? ___ days per week

13. How many patients do you see in a typical day? _______ patients per day

14. Sometimes medical action is clearly necessary, and sometimes it is clearly not necessary. Other times, reasonable people differ in their beliefs about whether medical action is needed. In situations where it’s not clear, do you tend toward taking action or do you tend toward waiting and seeing if action is needed?

I strongly lean toward waiting and seeing 1

2

3

4

5

I strongly lean toward taking action 6

Prior Experience with Shared Decision Making

15. Have you ever received any additional training beyond residency in how to engage in shared decision making with your patients?

___ Yes

___ No

10b. If you said ‘Yes’ to #10, briefly describe the training you received and where/how you received it: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________

16. How confident are you that you understand what shared decision making is?

___ Not at all confident

___ Slightly confident

___ Somewhat confident

___ Fairly confident

___ Completely confident

17. How confident are you in your ability to engage in shared decision making with your patients?

___ Not at all confident

___ Slightly confident

___ Somewhat confident

___ Fairly confident

___ Completely confident

18. How often do you currently engage in shared decision making with your patients?

___ Almost always

___ Often

___ Sometimes

___ Rarely

___ Never

19. Excluding emergency situations, how often do you think patients’ preferences should be taken into account when making clinical decisions?

___ Almost always

___ Often

___ Sometimes

___ Rarely

___ Never