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Am J Hosp Palliat Care. 2018 Apr;35(4):724-730. doi: 10.1177/1049909117733436. Epub 2017 Sep 26.

Educational Intervention to Improve Code Status Discussion Proficiency Among Obstetrics and Gynecology Residents.

Author information

1
1 Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
2
2 New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA.
3
3 Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
4
4 Department of Gynecologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
5
5 Division of Geriatric and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
6
6 Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
7
7 Department of Gynecologic Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
8
8 Stony Brook University Health Sciences Center School of Medicine, Department of Gynecologic Oncology, Stony Brook, NY, USA.
9
9 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

Abstract

BACKGROUND:

Obstetrics and gynecology (OB/GYN) residents receive little formal training in conducting code status discussions (CSDs).

OBJECTIVE:

We piloted an educational intervention to improve resident confidence and competence at conducting CSDs.

DESIGN:

The OB/GYN residents at a single institution participated in a 3-part educational program. First, participants reviewed a journal article and completed an online module. Second, they received a didactic lecture followed by a resident-to-resident mock CSD. Finally, participants had a videotaped CSD with a standardized patient (SP). Pre- and postintervention surveys and performance evaluations were analyzed. A subgroup analysis was performed on those with completed data sets.

RESULTS:

Participants included 24 residents in postgraduate years (PGY) 1 to 4: 85% were female with a mean age of 29 years; 83% completed the entrance survey; 63% completed the SP CSD; and 42% completed of all parts of the intervention. Residents initially felt most prepared to discuss treatment options (3.3/5 on a Likert scale) and less prepared to discuss hospice, end-of-life care, and code status (2.2/5, 2.2/5, and 2.3/5, respectively). Performance during the resident-to-resident CSD was variable with scores (% of skills achieved) ranging from 27% to 93% (mean 64%). Performance at the SP encounter was similar with scores ranging from 40% to 73% (mean 56%). After intervention, residents felt more prepared for CSDs (3.7/5) and end-of-life care (3.9/5). The subgroup analysis failed to show a significant change in skill performance from the first to the second CSD.

CONCLUSION:

Participants found the components of this intervention helpful and reported improved confidence at conducting CSDs.

KEYWORDS:

code status discussion; education; evaluation; intervention; obstetrics and gynecology; resident

PMID:
28950726
DOI:
10.1177/1049909117733436
[Indexed for MEDLINE]

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