Improving residents' code status discussion skills: A randomized trial

Eytan Szmuilowicz*, Kathy J. Neely, Rashmi K. Sharma, Elaine R. Cohen, William C. McGaghie, Diane B. Wayne

*Corresponding author for this work

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)768-774
Number of pages7
JournalJournal of palliative medicine
Volume15
Issue number7
DOIs
StatePublished - Jul 1 2012

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

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