Improving Residents' Code Status Discussion Skills: A Randomized Trial

• DOI: 10.1089/jpm.2011.0446
• Publication Date: 2012-06-12T18:52:03Z
• Authors: Eytan Szmuilowicz; Kathy J. Neely; Rashmi K. Sharma; Elaine R. Cohen; William C. McGaghie; Diane B. Wayne
• Keywords: Adult; Chicago; Male; Physician-Patient Relations; Communication; Internship and Residency; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Internal Medicine; Humans; Female; Clinical Competence; Curriculum; Prospective Studies; Resuscitation Orders

Inpatient Code Status Discussions (CSDs) are commonly facilitated by resident physicians, despite inadequate training. We studied the efficacy of a CSD communication skills training intervention for internal medicine residents.This was a prospective, randomized controlled trial of a multimodality communication skills educational intervention for postgraduate year (PGY) 1 residents. Intervention group residents completed a 2 hour teaching session with deliberate practice of communication skills, online modules, self-reflection, and a booster training session in addition to assigned clinical rotations. Control group residents completed clinical rotations alone. CSD skills of residents in both groups were assessed 2 months after the intervention using an 18 item behavioral checklist during a standardized patient encounter. Average scores for intervention and control group residents were calculated and between-group differences on the CSD skills assessment were evaluated using two-tailed independent sample t tests.Intervention group residents displayed higher overall scores on the simulated CSD (75.1% versus 53.2%, p<0.0001) than control group residents. The intervention group also displayed a greater number of key CSD communication behaviors and facilitated significantly longer conversations. The training, evaluation, and feedback sessions were rated highly.A focused, multimodality curriculum can improve resident performance of simulated CSDs. Skill improvement lasted for at least 2 months after the intervention. Further studies are needed to assess skill retention and to set minimum performance standards.