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

Improving residents' code status discussion skills: a randomized trial.

Author information

1
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. eszmuilo@nmh.org

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.

PMID:
22690890
PMCID:
PMC3387757
DOI:
10.1089/jpm.2011.0446
[Indexed for MEDLINE]
Free PMC Article
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