Time-Specific Recovery of Shared Decision-Making Willingness: A Dual-Role Simulation Evaluating Video-Assisted Patient Decision Aids in Postgraduate Medical Education

<title>Abstract</title> <p> <bold>Background:</bold> Shared decision-making (SDM) is a cornerstone of patient-centered care, yet a persistent gap separates its principles from routine clinical practice, with time constraints repeatedly cited as the dominant barrier. Grounded in Kolb’s Experiential Learning Theory, this study used a dual-role simulation to examine how postgraduate physicians evaluate traditional versus video-assisted patient decision aids (PDAs) and, critically, to identify the mechanism through which multimedia tools restore the willingness to implement SDM. <bold>Methods:</bold> In this mixed-methods study, 100 postgraduate-year (PGY) physicians evaluated PDAs for psoriasis management. Each participant adopted two roles: a healthcare provider assessing implementation feasibility, and a simulated patient experiencing the decision process. Implementation willingness was measured under three contexts (ideal, traditional-SDM, and video-assisted-SDM). PDA effectiveness was rated across 11 items. Paired <italic>t</italic> -tests with Cohen’s <italic>d</italic> , Spearman correlations, partial correlations, and linear regression were used; qualitative responses were analyzed by content analysis. <bold>Results:</bold> Of 108 physicians invited, 100 completed the survey (response rate 92.6%). Time consumption was the leading barrier (94%). Among 11 effectiveness items, only time management significantly favored the video-assisted PDA (4.15 vs 4.50, <italic>p</italic> = .0007). Implementation willingness fell from ideal conditions (3.93) to traditional SDM (3.26; <italic>p</italic> &lt; .0001) and was fully restored by the video-assisted PDA (3.94; vs ideal <italic>p</italic> = .93). The gain in perceived time management specifically predicted this recovery (Spearman <italic>ρ</italic> = 0.325; partial <italic>ρ</italic> = 0.298 after controlling for gains on the other ten items), whereas the other items showed no independent association. <bold>Conclusions:</bold> Video-assisted PDAs restored SDM implementation willingness to near-ideal levels, and this recovery was driven specifically by relief of the time bottleneck rather than by a general improvement in tool quality. The dual-role methodology offers a transferable framework for developing communication competencies while directly targeting the principal barrier to SDM implementation. </p>