When See One, Do One, Teach One Isn't Enough: Assessing Internal Medicine Residents' Code Status Communication Training Needs (S734)

Abstract

•Explain the lack of training that residents have with regards to code status communication.•Describe the approaches that residents utilize and the obstacles they face when conducting code status discussions. While resident physicians may independently elicit a patient's code status preference starting on their first day of training, limited prior research has examined residents' code status discussion training and approaches. 1.) Describe residents' code status communication training and readiness to lead a code status discussion. 2.) Assess residents' communication approaches when discussing code status. All residents in the internal medicine and medicine-pediatrics program at one academic medical center received an online, anonymous survey in March 2019 with two follow-up prompts and without incentives. Eighty-one residents (79%) completed the survey. Sixty-eight percent did not receive code status training during medical school, and on their first day of residency, 13% felt prepared to discuss code status on the day of admission. Three quarters of residents received no formal training during residency and less than half (39%) were observed and received feedback from a supervising physician after conducting a discussion. Eighty percent agree that additional training would be beneficial. While the majority (53%) of residents agree that physicians should offer code status recommendations to patients, 56% rarely or never give recommendations themselves on the day of admission. Most (81%) rarely or never estimate the in-hospital survival rate after a code. Specific language used by residents in the majority of their code status discussions includes “tube down the throat” (87%) and “re-starting your heart” (77%). Residents cited risk of “rib-breaking” (33%) and “painful shocks” (28%) less frequently. There were no significant differences in communication associated with residents' year of training. Most physicians begin training unprepared to conduct code status discussions and do not receive skills-based education with direct observation during residency. Residents' code status communication practices fail to promote shared decision-making due to language that risks misinforming or coercing patients and families.