Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills.
J Pain Symptom Manage. 2017 Jan 04;:
Authors: Sharma RK, Szmuilowicz E, Ogunseitan A, Jones SF, Montalvo JA, O'Leary KJ, Wayne DB
CONTEXT: Although code status discussions (CSD) occur frequently in the hospital setting, discussions often lack content necessary for informed decision making. Simulation-based mastery learning (SBML) has been used to improve clinical skills among resident physicians and may provide a novel way to improve hospitalists' CSD skills.
OBJECTIVES: The objective of this pilot randomized controlled trial was to develop and evaluate a CSD SBML intervention for hospitalists.
METHODS: Twenty hospitalists were randomized to control vs. a CSD SBML intervention. Hospitalists conducted a baseline standardized patient encounter (pretest) that was scored using a 19-item CSD checklist and controls completed a repeat standardized patient encounter 6 months later (posttest). Intervention group hospitalists received at least one 2-hour training session featuring deliberate practice and feedback, and were expected to meet a minimum passing score (MPS) on the posttest of 84% set by an expert panel.
RESULTS: Only 2 of the 20 hospitalists met the MPS at pretest. Seventy-percent of intervention hospitalists achieved the MPS after a single training session. Posttest median checklist scores were higher for intervention hospitalists compared to controls (16.5 vs. 12.0, p=0.0001). Intervention hospitalists were significantly more likely to ask about prior experiences with end-of-life decision making (70% vs. 20%, p=0.03), explore values/goals (100% vs. 50%, p=0.01), ask permission to make a recommendation regarding code status (60% vs. 0%, p=0.003), and align recommendations with patient values/goals (90% vs. 40%, p=0.02) than controls.
CONCLUSION: Few hospitalists demonstrated mastery of CSD skills at baseline; SBML was an effective way to improve these skills.
PMID: 28063865 [PubMed - as supplied by publisher]