C56-19 Beyond Verification: Exploring Resident Attitudes and Behaviors in Code-Status Discussions

Abstract Rationale Code-status discussions are critical components of ICU admissions which are frequently led by internal medicine residents. These discussions are meant to ensure goal-concordant care, though patients admitted to the ICU in a variety of clinical circumstances often receive uniform, order-focused, and scripted conversations that risk misunderstanding and may not reflect individual goals. Despite guideline recommendations for personalized discussions, little is known about what drives residents to conduct code-status verifications (solely confirming prior decisions) versus code-status explorations (using shared decision-making to establish new or revised decisions). To better understand residents’ current practices and guide potential educational opportunities, we surveyed internal medicine residents’ current practices, confidence, and perceived barriers to conducting each type of discussion. Methods We conducted a cross-sectional, anonymous electronic survey of all internal medicine and medicine-pediatrics residents at a large urban academic medical center between October and November 2025. The survey included five-point Likert-scale and open-ended items assessing the frequency with which residents conduct code-status verifications versus explorations, comfort and preparedness for each, and perceived barriers. Answers were summarized descriptively as proportions, and trends in responses by postgraduate year (PGY) were evaluated using the Cochran-Mantel-Haenszel (CMH) test. Results Thirty-seven residents (28%) completed the survey. Most (81.0%) believed code-status explorations rather than verifications should “often” or “always” be part of ICU admissions, though fewer reported doing so in practice (62.2% when admitting from the emergency department, 48.6% for transfers from another hospital, and 27.0% for transfers from the same facility’s medical floors). Senior residents (PGY2-4) were numerically more likely than interns (PGY1) to report conducting explorations across all settings. Interns were less likely to feel confident conducting explorations than senior residents (28.6% vs. 87.0%) and were more likely to agree that additional training would improve ICU care (85.7% vs. 52.2%). Nearly all residents (94.1%) cited time constraints as a barrier to conducting code-status explorations, and 38.3% reported at least occasionally conducting explorations because they felt it was required rather than clinically indicated. Conclusion Residents distinguish between code-status verifications and explorations and vary in their use of each depending on clinical context, training level, and time constraints. Although residents value exploration, practical and educational barriers limit its consistent implementation. Targeted didactic or point-of-care interventions may help residents triage conversations more effectively: verifying when prior orders are clearly aligned with goals and exploring when uncertainty or discordance exists. This abstract is funded by: None