Perceptions of Code Status

By: Anne PausJenssen, Amanda Oro, & Dwip Parekh

Code Status Discussions (CSD) are essential for patient-centred care. Residents are often responsible for conducting these conversations with patients upon admission. To ensure that these conversations are compatible with patient values and their clinical context, it is vital for residents to receive a comprehensive education in this area. Residents in the Internal Medicine program at the University of Saskatchewan do not currently receive formal training in CSDs. The purpose of this study is to examine the residents' perceptions of these discussions at the University of Saskatchewan’s Internal Medicine program.

A survey was sent to the cohort. Out of 67, 49 residents responded (73%). The goal of the survey was to sample the residents for their understanding of a CSD. The survey was anonymous and consisted of multiple choice and written answers.

Of 49 residents, only 22 had formal training in CSDs (45%). Three residents had neither formal nor informal training (6%). Twenty-five residents listed their ability for a CSD as “confident” (51%), while nineteen residents were only “somewhat” confident (39%). None of the residents were able to list all of the key components of a complete CSD, creating a discrepancy in residents’ perceptions and their abilities. When asked to identify limitations of leading a CSD, lack of education was not mentioned, despite 27 residents (55%) having no formal training in this vital skill.

In teaching hospitals, most admissions and CSDs are done by residents. It is imperative to standardize and formally teach this vital skill to our doctors in training as evidenced by this pilot survey of Internal Medicine residents at the University of Saskatchewan. We present evidence of inequality in the true versus perceived competency in conducting CSDs and highlight the importance of this skill in the context of the growing complexity in medicine today.

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