Medical Student Training on Code Status Discussions: How Far Have We Come?

OBJECTIVES

It is unclear to what extent the recently increased focus on patient-provider education and patient-centered care has affected education on communication at the undergraduate medical education (UME) level. This study aimed to investigate graduating students' exposure to and comfort with techniques surrounding the code status discussion, an important and ubiquitous component of patient-provider communication.

METHODS

We surveyed fourth-year medical students who had recently matched to our internal medicine residency program on their medical school experiences with code status discussions, self-confidence with these conversations, and desire for further education.

RESULTS

We obtained surveys from 56 students from 32 medical schools (89% response rate). Students had varying experience observing and conducting code status discussions, infrequently received guidance or feedback on these discussions, and did not know guidelines for best practices surrounding the conversations. Despite reporting moderate self-confidence with these conversations, most felt they required at least partial supervision conducting these discussions; all requested further formal instruction.

CONCLUSIONS

Despite increased attention on the importance of physicians' communication with patients, including surrounding end-of-life care, students at many top medical schools continue to feel underprepared and underconfident to engage in code status discussions with their patients upon the start of residency.