Improving Code Status Discussions on the General Internal Medicine Ward with Simulation-Based Resident Education
Bibliographic record
Abstract
Code status discussions (CSDs) address patient wishes regarding resuscitation. At teaching hospitals, CSDs are often conducted by junior residents. However, residents often omit the prognosis and outcomes during these conversations. Our aim was to develop a brief educational intervention to improve resident skills in leading CSDs. Twenty-four junior internal medicine residents participated in our study. This intervention consisted of three parts: a simulated CSD, an educational session, and a second simulated CSD. Simulations were evaluated by faculty using a 15-item checklist and senior residents were trained as standardized patients. Resident checklist scores improved significantly after our intervention from 8.8 to 11.1 ( p = 0.012). Resident comfort with leading and documenting CSDs also improved. This intervention is easily repeatable, and can be implemented for trainees of different levels and different departments. Our next educational session will be improved based on feedback, as well as areas of weakness identified by our checklists.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".