Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills.
J Pain Symptom Manage
; 53(6): 1066-1070, 2017 06.
Article
en En
| MEDLINE
| ID: mdl-28063865
ABSTRACT
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 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.RESULTS:
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.CONCLUSION:
Few hospitalists demonstrated mastery of CSD skills at baseline; SBML was an effective way to improve these skills.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Relaciones Médico-Paciente
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Órdenes de Resucitación
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Competencia Clínica
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Comunicación
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Médicos Hospitalarios
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Educación Médica
Tipo de estudio:
Clinical_trials
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Guideline
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Prognostic_studies
Aspecto:
Ethics
Límite:
Adult
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Female
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Humans
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Male
Idioma:
En
Revista:
J Pain Symptom Manage
Asunto de la revista:
NEUROLOGIA
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PSICOFISIOLOGIA
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TERAPEUTICA
Año:
2017
Tipo del documento:
Article