See One, Do One, Teach One?

BACKGROUND: Medical residents commonly discuss resuscitation with hospitalized patients. Previous studies suggest that the of these discussions is poor. OBJECTIVE: To learn about residents' with do-not-resuscitate (DNR) discussions and their attitudes them. METHODS: Medical house officers on the wards of three teaching were eligible to participate. A subset had previously audiotaped DNR discussions as part of a study that described the quality of. In a self-administered questionnaire, house officers rated their conducting a recent DNR discussion, stated their attitudes, and their experience learning to talk to patients about these issues.: One hundred one (88%) of 115 residents responded to the survey. -six (90%) of 96 stated they had done a good job with the discussion and78 (77%) of 101 reported feeling comfortable discussing the topic with. Ninety-four (94%) of 100 residents said they discuss code status all seriously ill patients and while on the medical wards they conduct a of one DNR discussion per week. On average, they had observed four conducted by more senior clinicians. One third of the residents never been observed talking to patients about DNR decisions and 71% had observed two or fewer times. CONCLUSIONS: These findings help explain observations about the quality of DNR discussions. House staff "see" and"do" these discussions, but are not taught through observation and feedback. recommend that communication about end-of-life treatment decisions be as a medical skill to be taught with the same rigor as other clinical.