JAAOS - 2026-09-11 - Journal Article
Assessing Informed Consent in Orthopaedic Surgery Trainees: Does Quality or Comfort Level Vary by Training Year?
Ruff G, Blachman NL, Zabar SR, Phillips DP, Lazarus R, Karamitopoulos M, Strauss EJ, Aggarwal VK
Topics
Key Takeaway
Across 23 orthopaedic trainees, assessing patient comprehension was completed by only 13% and shared decision-making by only 39%, with no performance improvement across PGY levels despite all trainees rating informed consent as extremely important.
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Summary
This OSCE-based study evaluated informed consent quality in 23 orthopaedic trainees (PGY-1, 3, 5, and fellows) using a standardized TKA consent scenario scored on a 0–2 rubric. Mean performance was 16.2/20, but assessing patient comprehension was completed by only 13% of trainees and shared decision-making by 39%. Training level did not predict performance; however, prior formal consent education significantly improved procedure explanation scores (1.7 vs. 1.2 out of 2.0, P=0.013).
Key Limitation
The sample of 23 trainees from a single academic institution limits generalizability and statistical power to detect true performance differences across training levels.
Original Abstract
INTRODUCTION
Obtaining adequate informed consent is a fundamental component of surgical care, often conducted by trainees at academic medical centers. However, the quality of trainees' informed consent remains unclear. To guide future instruction, this study assessed trainees' confidence and performance with the informed consent process, stratified by postgraduate year and previous consent education.
METHODS
An objective structured clinical examination (OSCE) was developed to assess informed consent discussions between housestaff trainees and standardized patients undergoing primary total knee arthroplasty. A total of 18 orthopaedic residents (six each in postgraduate years [PGYs] 1, 3, and 5) and five clinical fellows in adult reconstruction (PGY-6) participated. Quality of informed consent was assessed with an objective rubric, scored 0 to 2 ("not addressed," "attempted," and "completed"). Trainees completed a post-OSCE survey assessing their confidence and previous training in obtaining informed consent.
RESULTS
All 23 trainees considered informed consent "extremely important," and 96% thought that formal training would be "very" or "extremely beneficial." Yet, only 30% recalled receiving consent education, and 39% had never received clinical feedback on their consent process. Average OSCE performance was 16.2/20 (range: 11-19). Common deficiencies were assessing patient comprehension (13% completed) and facilitating shared decision making (39% completed). Only 35% of trainees identified assessing patient comprehension as critical. Performance did not differ significantly by training level. Previous consent education significantly improved trainees' ability to explain procedures (1.7/2.0 vs. 1.2/2.0; P = 0.013) and was associated with better shared decision-making facilitation (1.4/2.0 vs. 1.0/2.0; P = 0.255), although not statistically significant.
CONCLUSION
Orthopaedic trainees value formal informed consent training but lack structured education and informal feedback. While overall performance was strong, consistent deficiencies in assessing comprehension and shared decision making were noted. Seniority alone did not improve performance, while previous formal education improved procedure explanations. These findings support the implementation of structured informed consent curricula across all levels of orthopaedic training.