Abstract
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 language | English (US) |
|---|---|
| Pages (from-to) | 1066-1070 |
| Number of pages | 5 |
| Journal | Journal of Pain and Symptom Management |
| Volume | 53 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2017 |
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Keywords
- Code status
- mastery learning
- medical education
- palliative care
- physician-patient communication
- resuscitation
ASJC Scopus subject areas
- Nursing(all)
- Clinical Neurology
- Anesthesiology and Pain Medicine
Cite this
}
Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills. / Sharma, Rashmi K.; Szmuilowicz, Eytan; Ogunseitan, Adeboye; Jones, Sasha F.; Montalvo, Jessica A.; O'Leary, Kevin J.; Wayne, Diane B.
In: Journal of Pain and Symptom Management, Vol. 53, No. 6, 06.2017, p. 1066-1070.Research output: Contribution to journal › Article
TY - JOUR
T1 - Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills
AU - Sharma, Rashmi K.
AU - Szmuilowicz, Eytan
AU - Ogunseitan, Adeboye
AU - Jones, Sasha F.
AU - Montalvo, Jessica A.
AU - O'Leary, Kevin J.
AU - Wayne, Diane B.
PY - 2017/6
Y1 - 2017/6
N2 - 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.
AB - 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.
KW - Code status
KW - mastery learning
KW - medical education
KW - palliative care
KW - physician-patient communication
KW - resuscitation
UR - http://www.scopus.com/inward/record.url?scp=85014518749&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85014518749&partnerID=8YFLogxK
U2 - 10.1016/j.jpainsymman.2016.12.341
DO - 10.1016/j.jpainsymman.2016.12.341
M3 - Article
C2 - 28063865
AN - SCOPUS:85014518749
VL - 53
SP - 1066
EP - 1070
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
SN - 0885-3924
IS - 6
ER -