Improving residents' code status discussion skills: a randomized trial Journal Article


Authors: Szmuilowicz, E; Neely, K. J.; Sharma, R. K.; Cohen, E. R.; McGaghie, W. C.; Wayne, D. B.
Article Title: Improving residents' code status discussion skills: a randomized trial
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%, p0.0001) 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.
Keywords: Adult; Female; Humans; Prospective Studies; Leischner Institute; Male; Curriculum; Internal Medicine/education; Chicago; Communication; Physician-Patient Relations; Internship and Residency; Clinical Competence/standards; Resuscitation Orders
Journal Title: Journal of palliative medicine
Volume: 15
Issue: 7
ISSN: 1557-7740; 1557-7740
Publisher: Unknown  
Journal Place: United States
Date Published: 2012
Start Page: 768
End Page: 774
Language: eng
DOI/URL:
Notes: ID: 12716; LR: 20130416; JID: 9808462; OID: NLM: PMC3387757 [Available on 07/01/13]; PMCR: 2013/07/01 00:00; 2012/06/12 [aheadofprint]; ppublish