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J Pain Symptom Manage · Feb 2024
Preparing Preclinical Medical Students for Routine Code Status Discussions: A Mixed-Methods Study.
- Katherine A Rowe, Kei Ouchi, Maura Kennedy, Anthony Breu, Dorothy W Tolchin, and Andrea Wershof Schwartz.
- Department of Surgery (K.A.R.), Massachusetts General Hospital, Boston, MA, USA. Electronic address: krowe6@mgh.harvard.edu.
- J Pain Symptom Manage. 2024 Feb 1; 67 (2): 138146138-146.
ContextMedical students are expected to gain competency in inquiring about patients' goals of care, per the Association of American Medical Colleges' Entrustable Professional Activities. While students may be part of teams that conduct routine code status discussions (CSDs), formal training in this skill prior to clinical clerkships is lacking.ObjectivesWe aimed to address this training gap by designing a curriculum to teach preclinical medical students about routine CSDs.MethodsWe designed and conducted an interactive workshop for preclinical medical students to learn about routine CSDs and practice this skill, using Kern's Six Steps to Curriculum Design. A qualitative and quantitative pre- and postsurvey was administered. A convergent, parallel, mixed methods analysis was performed.ResultsStudents (n = 135) named more options for code status following the workshop (presurvey 1.3 vs. postsurvey 4.3, P < 0.01). There was an increase in the proportion of students reporting that they felt "somewhat comfortable" or "extremely comfortable" conducting a CSD (presurvey 19% vs. postsurvey 64%, P < 0.01), and a decrease in those reporting that they felt "extremely uncomfortable" or "somewhat uncomfortable" (presurvey 53% vs. postsurvey 18%, P < 0.01). Thematic analysis revealed that students were concerned about knowledge gaps, communication tools, personal discomfort, and upsetting patients or family.ConclusionA workshop to train medical students to conduct routine CSDs can be included as part of a preclinical medical education curriculum. Students reported that the workshop increased their confidence in conducting CSDs and demonstrated an increase in corresponding knowledge, preparing them to deliver person-centered care on their clerkships.Copyright © 2023 American Academy of Hospice and Palliative Medicine. All rights reserved.
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