Improving residents' code status discussion skills: a randomized trial

J Palliat Med. 2012 Jul;15(7):768-74. doi: 10.1089/jpm.2011.0446. Epub 2012 Jun 12.

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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Chicago
  • Clinical Competence / standards*
  • Communication*
  • Curriculum
  • Female
  • Humans
  • Internal Medicine / education
  • Internship and Residency*
  • Male
  • Physician-Patient Relations
  • Prospective Studies
  • Resuscitation Orders*