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Intraoperative code status: Moving from misinformation to respect for patient autonomy.

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A simulation curriculum improved surgical residents' understanding and confidence in discussing intraoperative do not resuscitate (DNR) status. This training reduced misconceptions about DNR orders needing rescission before surgery, respecting patient autonomy.

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Area of Science:

  • Medical Education
  • Surgical Training
  • Patient Autonomy

Background:

  • Intraoperative code status, specifically do not resuscitate (DNR) status, presents challenges for patients and providers.
  • Existing research indicates a deficit in understanding intraoperative DNR policies among healthcare professionals.
  • Limited studies have utilized simulation-based education to train surgical residents in managing patient requests regarding intraoperative DNR status.

Purpose of the Study:

  • To implement a simulation-based curriculum for surgical residents.
  • To enhance residents' ability to navigate discussions about intraoperative DNR status.
  • To uphold patient autonomy while addressing intraoperative DNR concerns.

Main Methods:

  • A needs assessment survey was administered to anesthesiology and surgery residents regarding intraoperative code status practices and policies.
  • A simulation-based curriculum was developed, involving surgery residents interacting with standardized patients requesting intraoperative DNR status.
  • Post-training surveys were used to evaluate the curriculum's effectiveness.

Main Results:

  • Needs assessment revealed significant misconceptions: 56.5% of surgery residents believed DNR must be rescinded for elective surgery, and 52.1% for emergent surgery.
  • Post-training surveys showed a statistically significant increase in residents' confidence in discussing intraoperative DNR status (P < .001).
  • A statistically significant reduction in the misconception that DNR orders must be rescinded before surgery was observed (P < .01).

Conclusions:

  • A simulation-based curriculum effectively addressed the need for clear communication regarding intraoperative DNR policy.
  • The curriculum enhanced residents' confidence and understanding of intraoperative DNR status and related ethics.
  • Future research will evaluate the curriculum's impact on clinical practice and patient outcomes through follow-up surveys.