Document Type
Conference Proceeding
Publication Date
3-20-2025
Publication Title
2025 ACS Surgical Simulation Summit Abstract Booklet
Abstract
Introduction: Intraoperative code status represents a complicated topic for patients and providers. Prior studies demonstrated a lack of understanding of intraoperative code status, specifically do not resuscitate (DNR) orders. This misunderstanding appears common despite clear professional recommendations. A recent survey of surgery residents at our institution showed variability in understanding of intraoperative code status policy despite clear institutional guidelines. Few studies utilized simulated education for surgeons and surgical residents to navigate intraoperative DNR status. This project aims to create a simulation-based program for residents to navigate intraoperative DNR status ethically and to assess its impact on learning, practice patterns and hospital outcomes. Methods: Surgery residents will be invited to participate in simulation-based training on discussing intraoperative code status. The simulation will include a patient who will request intraoperative continuation of DNR status. Following the encounter, residents will debrief with critical-care surgeons and a clinical ethicist. The Gather, Analyze, Summarize framework will guide debriefing. A slideshow of key points and references, including relevant hospital policy, will facilitate the debrief. Results: A simulation scenario was created in which residents will address 7 learning objectives. Two critical-care surgeons and a clinical ethicist at our institution reviewed these objectives, which will form the basis for the debrief. The objectives were also used to guide the development of a 7-item post-training survey, which will help determine the immediate effectiveness of this simulation. Conclusion: This simulation was created to meet the need for clear discussion of intraoperative DNR policy and navigation of difficult conversations while respecting autonomy. Next steps will focus on implementation of this training and evaluation of its effectiveness. Effectiveness will be evaluated using the first four levels of Kirkpatrick’s model. Learning will be assessed using the 7-item post-training survey, while changes in practice patterns will be assessed via a six-month follow-up survey
First Page
9
Last Page
9
Recommended Citation
Applegarth J, Morton JM, Novotny NM, Nguyen N, Brummett A. Intraoperative code status: moving from misinformation to respect for patient autonomy. Presented at: American College of Surgeons 2025 ACS Surgical Simulation Summit; 2025 Mar 20-12; Chicago, IL. Available from:https://www.facs.org/for-medical-professionals/conferences-and-meetings/surgical-simulation-summit/abstracts/ and Applegarth J, Brummett A, Morton J, Nguyen N, Novotny N. Intraoperative code status: moving from misinformation to respect for patient autonomy. Mich Med Ed Health Bull. 2025 Jun 30;3(2 Suppl):A107. doi:10.69735/001c.141308
Included in
Bioethics and Medical Ethics Commons, Internal Medicine Commons, Pediatrics Commons, Surgery Commons
Comments
American College of Surgeons 2025 ACS Surgical Simulation Summit, March 20-21, 2025, Chicago, IL and
Southeast Michigan Center for Medical Education (SEMCME) 47th Annual Research Forum, May 22, 2025, Troy, MI