Code Status Discussion Skill Retention in Internal Medicine Residents: One-Year Follow-Up

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. Design: This was a longitudinal cohort study. Setting/Subjects: 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. Measurements: 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.