Original Publication
Open Access

“Do You Want Us to Do Everything?”: Teaching Residents to Discuss Resuscitation with Hospitalized Patients

Published: June 11, 2015 | 10.15766/mep_2374-8265.10122

Included in this publication:

  • Instructor's Guide.docx
  • Discussing Resuscitation Decisions with Hospitalized Adult Patients Powerpoint.pptx
  • Appendix A Role Plays for Discussing Resuscitation Workshop.doc
  • Appendix B Competency Based Evaluation of CPR Discussions.docx
  • Appendix C Code Discussion Workshop Pre Test.docx
  • Appendix D Code Discussion Workshop Post Test.docx
  • Appendix E Code Discussion Checklist.doc

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

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.


Educational Objectives

By the end of this workshop, learners will be able to:

  1. Understand the importance of conducting code status discussions with hospitalized patients.
  2. Distinguish actual outcomes of attempted resuscitation from common misperceptions.
  3. Develop a risk/benefit framework for code status discussions.
  4. Implement patient-centered communication strategies when addressing resuscitation status in hospitalized patients.

Author Information

  • Theresa Vettese, MD: Wayne State University School of Medicine
  • Jarrett Weinberger: Wayne State University School of Medicine
  • Neelima Thati: Wayne State University School of Medicine

Disclosures
None to report.

Funding/Support
None to report.

Prior Presentations
Vettese T, McNally P, Byker G. Do You Want Us to Do Everything? Teaching Residents to Discuss Resuscitation. Workshop presented at: National Meeting of the Society of General Internal Medicine; April 29, 2010; Minneapolis, Minnesota.



Citation

Vettese T, Weinberger J, Thati N. “Do you want us to do everything?”: teaching residents to discuss resuscitation with hospitalized patients. MedEdPORTAL. 2015;11:10122. https://doi.org/10.15766/mep_2374-8265.10122