Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills

Rashmi K. Sharma*, Eytan Szmuilowicz, Adeboye Ogunseitan, Sasha F. Jones, Jessica A. Montalvo, Kevin J. O'Leary, Diane B. Wayne

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Context Although code status discussions (CSD) occur frequently in the hospital setting, discussions often lack content necessary for informed decision making. Simulation-based mastery learning (SBML) has been used to improve clinical skills among resident physicians and may provide a novel way to improve hospitalists' CSD skills. Objectives The objective of this pilot randomized controlled trial was to develop and evaluate a CSD SBML intervention for hospitalists. Methods Twenty hospitalists were randomized to control vs. a CSD SBML intervention. Hospitalists conducted a baseline standardized patient encounter (pretest) that was scored using a 19-item CSD checklist and controls completed a repeat standardized patient encounter six months later (post-test). Intervention group hospitalists received at least one two-hour training session featuring deliberate practice and feedback and were expected to meet a minimum passing score (MPS) on the post-test of 84% set by an expert panel. Results Only two of the 20 hospitalists met the MPS at pretest. Seventy percentage of intervention hospitalists achieved the MPS after a single training session. Post-test median checklist scores were higher for intervention hospitalists compared with controls (16.5 vs. 12.0, P = 0.0001). Intervention hospitalists were significantly more likely to ask about previous experiences with end-of-life decision making (70% vs. 20%, P = 0.03), explore values/goals (100% vs. 50%, P = 0.01), ask permission to make a recommendation regarding code status (60% vs. 0%, P = 0.003), and align recommendations with patient values/goals (90% vs. 40%, P = 0.02) than controls. Conclusion Few hospitalists demonstrated mastery of CSD skills at baseline; SBML was an effective way to improve these skills.

Original languageEnglish (US)
Pages (from-to)1066-1070
Number of pages5
JournalJournal of Pain and Symptom Management
Issue number6
StatePublished - Jun 2017


  • Code status
  • mastery learning
  • medical education
  • palliative care
  • physician-patient communication
  • resuscitation

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • General Nursing


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