MedEdPORTAL (Jun 2015)
“Do You Want Us to Do Everything?”: Teaching Residents to Discuss Resuscitation with Hospitalized Patients
Abstract
Abstract Introduction Internal medicine residents feel that they receive little support or precepting in end-of-life decision making. Moreover, residents infrequently address code status or provide essential information about CPR to their patients. Developed for first-year internal medicine residents, this workshop is designed to provide faculty with important tools to enhance the teaching and evaluation of communication in end-of-life decision making and to help residents overcome the barriers to addressing code status. Methods PGY-1 residents are divided into groups of six to seven learners for each 3-hour workshop. The workshop includes an interactive presentation addressing the role of advanced care planning in the hospital setting, distinguishing actual outcomes of attempted resuscitation from commonly held misperceptions, developing a risk/benefit framework for code status discussions (CSDs), and discussing strategies for responding to patient emotions. The workshop also features a faculty demonstration of CSD (role-model role-play) and role-plays of resuscitation discussions in which the resident practices a CSD using the risk/benefit framework, participates in debriefing, and receives competency-based feedback. Results During the 2013-2014 academic year, 26 internal medicine interns participated in the workshop, and all completed the pre− and postintervention surveys that assessed their knowledge of CPR outcomes as well as attitudes toward conducting CSDs. On the preintervention knowledge test, average percentage correct was 59%, which increased to 74% correct on the postintervention knowledge test, reflecting at least a short-term improvement in knowledge of CPR outcomes. Prior to the session, in response to the statement, “I feel motivated to facilitate resuscitation/code discussions,” the mean Likert score with a 10-point Likert scale was 8.07 (SD = 1.76); after the session, the mean intern score for the same statement was 8.58 (SD = 1.25). In contrast, prior to the session, in response to the statement, “I feel confident in facilitating code status discussions,” the mean Likert score was 6.53 (SD = 2.08); after the session, the interns' mean score increased to 8.30 (SD = 1.30). In response to the postsession question, “How helpful did you find this workshop?” the mean score was 9.40 (SD = 1.60), reflecting a very high degree of satisfaction of participating learners. Discussion Based on participant feedback, we have added additional education regarding prognosis to our overall curriculum, expanded the role-play scenarios, and implemented direct observation of CSDs. The use of standardized patients, who are trained to produce a scripted clinical scenario with as little variability as possible, may create a more consistent experience for all residents during the role-play simulation and debriefing.
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