title: Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills.
abstract: 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.
  
  
  
  The objective of this pilot randomized controlled trial was to develop and evaluate a CSD SBML intervention for hospitalists.
  
  
  
  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 six months later (post-test). Intervention group hospitalists received at least one two-hour training session featuring deliberate practice and feedback and were expected to meet a minimum passing score (MPS) on the post-test of 84% set by an expert panel.
  
  
  
  Only two of the 20 hospitalists met the MPS at pretest. Seventy percentage of intervention hospitalists achieved the MPS after a single training session. Post-test median checklist scores were higher for intervention hospitalists compared with controls (16.5 vs. 12.0, P = 0.0001). Intervention hospitalists were significantly more likely to ask about previous 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.
  
  
  
  Few hospitalists demonstrated mastery of CSD skills at baseline; SBML was an effective way to improve these skills.
authors.affiliation: Division of General Internal Medicine, University of Washington, Seattle, Washington, USA. Electronic address: rasharma@uw.edu.
authors.forename: Rashmi K
authors.initials: RK
authors.lastname: Sharma
authors.affiliation: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Eytan
authors.initials: E
authors.lastname: Szmuilowicz
authors.affiliation: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Adeboye
authors.initials: A
authors.lastname: Ogunseitan
authors.affiliation: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Sasha F
authors.initials: SF
authors.lastname: Jones
authors.affiliation: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Montalvo
authors.affiliation: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: O'Leary
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D004501:Education, Medical; D030141:Feedback, Psychological; D005260:Female; D020445:Hospitalists / Q000193:education*; D006801:Humans; D008297:Male; D015588:Observer Variation; D010166:Palliative Care; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011214:Practice, Psychological; D016414:Resuscitation Orders
keywords: Code status; mastery learning; medical education; palliative care; physician-patient communication; resuscitation