Quality Improvement of Pediatric Residents’ Preparedness for Code Status Discussions

Purpose/Objectives: Objectives
1. To assess the preparedness for code status discussions of second-year pediatric residents before and after a compulsory end-of-life care workshop.
2. To measure the self-reported effect of educational interventions for that cohort.

Background: Unlike residents caring for adult patients, pediatric residents do not routinely discuss code status with their patients or families. This lack of experience makes it difficult for pediatricians to feel confident leading code status discussions during or after training.

Aim Statement: To assess preparedness for and provide training on leading code status discussions with pediatric residents.

Design/Methods: Palliative medicine providers led pediatric residents at an academic children’s hospital in a didactic and role play educational session on code status discussions including simulated parents within a compulsory end-of-life care workshop. Pre- and post-surveys assessed knowledge, attitudes, and practice of code status discussions, evaluating changes on preparedness and agreement using a Likert scale (1-not at all to 5-extremely/strongly).

Results: All 34 residents who participated in the workshop completed the pre-survey. The majority were female (91%), Caucasian (76%), and in a categorical program (88%). Many (41%) reported never having assessed code status or observed a discussion. Half (50%) felt unprepared to assess code status. Although only 8 (24%) anticipate regularly discussing code status after residency, every respondent (100%) agreed/strongly agreed all pediatric residents should be trained in the skill. Most (82%) felt barriers existed to discussing code status to include minimal training, comfort, time, and opportunity.

After the workshop, 27 of the 34 residents (79%) completed the post-survey. 96% felt the experience prepared them to discuss a child’s code status with a patient/family; 96% felt simulated parent interactions were an effective learning modality. In contrast to the pre-survey, only 2 (7%) felt unprepared to assess code status. Mean scores of self-reported preparedness increased from 2.4 to 3.6 (p < 0.001).

Conclusion/Discussion: This study demonstrates that training for pediatric physicians in assessing code status is needed, feasible, and well-received. Pediatric residency programs should provide dedicated education and practice on leading code status discussions.