Improving Resident Skills In Code Status Discussions: A Randomized Controlled Trial (319-A)

Abstract

1.Describe the impact of an educational intervention on resident code status discussion skills.2.Identify specific clinical skills examination items in which trained residents performed better than control group residents.3.Describe resident satisfaction levels with an educational intervention on code status discussion skills. Although internal medicine residents frequently discuss code status with their hospitalized patients, they often lack the confidence and skills to effectively carry out these conversations. We evaluated the effect of an educational intervention on code status discussion skills. PGY1 residents at an academic medical center were randomized into two groups in July 2010. The control group completed traditional clinical training alone. The intervention group completed traditional clinical training and received an educational intervention on code status discussions. The intervention included didactic instruction, role play, journal entries, and online training modules. To assess the impact of the intervention, all control and intervention group PGY1 residents completed a code status discussion clinical skills examination with a standardized patient in Jan 2011. Two raters scored each videotaped discussion in the following categories: patient-centered interviewing skills, discussing code status, and responding to emotion. Scores were compared between the intervention and control group using t-tests. Fifty-six PGY1 residents were randomized to the intervention (n = 25) or control group (n = 31). Intervention group residents had higher total communication skills scores (74.4% ± 12.8% vs. 52.8% ± 14.7% p < 0.001) than control group residents. Trained residents also had significantly higher scores than controls on individual items including: exploring patient understanding of illness (100% vs. 58%), exploring patient values/goals (84% vs. 45%), proposing a care plan that respects patient values/goals (60% vs. 10%), and exploring emotion (48% vs. 16%). Trained residents reported high satisfaction with the curriculum: 100% reported that training boosted their skills to perform code status discussions with real patients and 92% said training helped prepare them for code status discussions more than clinical experience alone. A multimodality educational intervention improves resident code status discussion skills.