PURPOSE: This study measured resident attitudes and skills, using a Likert scale, before and after a year of training on how to do code status discussions at Community Regional Medical Center as part of the University of California, San Francisco, Fresno Internal Medicine Medical Education Program.
METHODS: We used a 12 question form with a standard Likert scale. At the start of the intervention every resident completed the form and after one year of training the residents completed the same form again. During the year of training the program introduced 5 new lectures. We created 6 team-learning conferences titled. We also provided education to the attending physicians and had them directly observe code status discussions and provide feedback to the residents using an observed clinical skills exam format.
RESULTS: The residents were compared as individuals and as a group against their own original answers. We performed analysis of variance (ANOVA) with a Bonferonni multiple comparison post-hoc test (parametric test of means) we also ran the non-parametric Kruskal Wallace test to verify that they were concordant. Questions 1-5 and 9-10, which dealt with comfort and confidence all showed a significant improvement between all groups compared (1-5 and 9; p value less than or equal to 0.001, 10; p=0.016) while 6-8 and 11-12 were not significantly improved (p>0.05). Questions 6-7 dealt with familiarity with legal requirements and the End-of-Life Handbook. Question 8 dealt with adequacy of their residency training in code status discussions. Question 11 dealt with comfort speaking to a different ethnic group. Question 12, about the importance of training, had nearly 100% “Strongly Agree” before and after the year.
CONCLUSIONS: We were able to significantly improve the comfort level and skill of residents performing code status discussions—but the residents still self-reported inadequacy of the residency program in this specific area of training.
CLINICAL IMPLICATIONS: Overall this study provides some successful ways that teaching programs can use to improve resident comfort and skill performing code status or advance directive discussions but the additional instruction was unable to improve residents attitudes about the residency program’s training in this area.
DISCLOSURE: The following authors have nothing to disclose: Garrett Bird, Chitra Kandaswamy, Kathryn Bilello, Ivy Darden
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