title: Code status discussion skill retention in internal medicine residents: one-year follow-up.
abstract: BACKGROUND
  Communicating with patients about goals of care is an important skill for internal medicine residents. However, many trainees are not competent to perform a code status discussion (CSD). A multimodality intervention improved skills in a group of first-year residents in 2011. How long these acquired CSD skills are retained is unknown.
  
  
  OBJECTIVE
  To study CSD skill retention one year after a multimodality intervention.
  
  
  METHODS
  This was a longitudinal cohort study.
  
  
  METHODS
  Thirty-eight second-year internal medicine residents in a university-affiliated internal medicine residency program participated in the study. Nineteen completed the intervention and 19 served as controls.
  
  
  METHODS
  Mean CSD clinical skills examination (CSE) scores using an 18-item checklist were compared after the intervention (2011) and one year later (2012).
  
  
  RESULTS
  Intervention group residents performed significantly better than residents in the control group (71.9% (standard deviation [SD]=16.0%) versus 54.7% (SD=17.1%; p<0.001) at one-year follow-up. Intervention group residents retained their CSD skills at one year as performance was 75.1% in 2011 and 71.9% in 2012 (p=0.46). Control group residents did not develop additional CSD skills as 2011 checklist performance was 53.2% and 2012 performance was 54.7% (p=0.78).
  
  
  CONCLUSIONS
  CSD skills taught in a rigorous curriculum are retained at one-year follow-up. Residents in the control group did not acquire new CSD skills despite an additional year of training and clinical experience. Further study is needed to link improved CSD skills to better patient care quality.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. dwayne@northwestern.edu
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
authors.forename: Farzad
authors.initials: F
authors.lastname: Moazed
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.forename: Rashmi K
authors.initials: RK
authors.lastname: Sharma
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
authors.forename: Eytan
authors.initials: E
authors.lastname: Szmuilowicz
mesh_terms: D057189:Checklist; D002641:Chicago; D003142:Communication; D005500:Follow-Up Studies; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency; D008137:Longitudinal Studies; D008505:Medical Staff, Hospital; D010358:Patient Participation; D010817:Physician-Patient Relations; D011361:Professional Competence; D013727:Terminal Care; D019452:Terminally Ill