Faculty Bibliography

INTRODUCTION/BACKGROUND: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/CONCLUSIONS: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.

There has been increased use of telemedicine in clinical practice, but telemedicine curricula are not standard in pediatric residency training. We developed a 2-case, Virtual Objective Structured Clinical Exam (VOSCE) for pediatric residents with telemedicine learning objectives. Resident competency was assessed using a behaviorally anchored checklist, and residents completed a pre/post self-assessment. Less than half of the residents met mastery for the following behaviors: confirmation of patient identifiers, optimization of technical aspects and partnering with the patient to perform a physical exam. Resident self-assessment improved after participating in the VOSCE but remained low in key domains such as virtual physical exam and mental health issue identification and guidance. Most pediatric residents have not mastered all the skills needed for a successful telemedicine encounter. Incorporating a curriculum focused on telemedicine best practices into residency training is highly merited.

BACKGROUND/UNASSIGNED:The transition from hospital discharge to home is a critical period prone to gaps in care. Telemedicine has potential to smooth this transition; however, few educational interventions assess the unique skills required for high-quality telemedicine care at this critical juncture. OBJECTIVE/UNASSIGNED:standardized patient (SP) encounters in internal medicine residents' actual clinics to assess telemedicine skills in the post-discharge period. METHODS/UNASSIGNED:We developed 2 cases portraying recently discharged patients, designed behaviorally anchored assessment checklists, created mock electronic health record entries, and scheduled telemedicine visits in residents' clinics throughout the 2023-2024 academic year. SPs assessed skills as "not done," "partly done," or "well done" across 5 skill domains: Information Gathering, Relationship Development, Education and Counseling, Telemedicine-Specific Skills, and Care Transition Skills. We analyzed differences in the percentage of "well done" items, fit an ordinal mixed-effects model to assess for performance by case and postgraduate year (PGY) level, and surveyed residents. RESULTS/UNASSIGNED:All 42 (100%) PGY-1s and PGY-2s in our program participated in 79 total encounters. Residents performed well in core communication domains but struggled with Telemedicine-Specific Skills, Care Transition Skills, and Education and Counseling skills. PGY-2 performance was stronger than PGY-1 performance in these domains. Among residents who completed both cases, performance in case 2, which took place 6 months after case 1, was stronger; this effect was driven by PGY-1 performance. Twenty-nine of 31 residents (94%) reported this intervention improved their telemedicine skills. CONCLUSIONS/UNASSIGNED:We report a high-fidelity strategy that captures telemedicine skill development in the context of patient care.

PURPOSE/UNASSIGNED:Understanding medical students' readiness to perform basic entrustable professional activities (EPAs) informs tailored support during transition to residency. METHODS/UNASSIGNED:Night-onCall (NOC) was developed to assess medical student readiness to perform core EPAs on day one of internship. NOC is a complex, integrated simulation centered around three clinical cases. Assessments include standardized patient (SP), nurse (SN), physician attending (SA), and resident (SR) perspectives using clinical competency rating instruments mapped to EPAs and scored as Well Done (WD), Partly Done (PD) or Not Done (ND). Faculty rate clinical reasoning using a rubric evaluating written post-encounter notes as poor, beginning, competent, or strong. The ability to recognize lapses in patient safety is assessed based on written case responses. Medical librarians evaluate students' ability to formulate a clinical question and search for evidence. RESULTS/UNASSIGNED:Data was collected from 'near-graduates' from seven USA medical schools from 2020 to 2023 (n = 1116). Overall, SPs rated 75.0% of overall communication skills and only 56% of patient education items as WD. SNs rated interprofessional communication 57.0% WD, and SRs rated intraprofessional communication 61.0% WD. History gathering and physical exam skills varied by case. Faculty rated clinical reasoning as beginning (45%) or competent (44%) and librarians rated 16% of literature searches as WD. CONCLUSION/UNASSIGNED:Most near-graduates demonstrated competent basic patient communication skills but performed less well on patient education, communication with other team members, clinical reasoning, and accessing the evidence base to answer clinical questions. These overall trends, consistent across schools and year, provide benchmarks for clinical training.

BACKGROUND:Moral distress, which occurs when the ethically correct action cannot be taken because of internal or external constraints, is associated with depression, burnout, and the desire to leave the healthcare profession among healthcare workers. This study compares internal medicine (IM) residents’ experiences of moral distress while caring for patients with COVID-19 in the year prior to and during the first year of the COVID-19 pandemic. METHODS:This is a mixed methods prospective observational cohort study that enrolled IM residents on a rolling basis beginning December 2018. Moral distress was evaluated via the validated Moral Distress Score-Revised (MDS-R) and Measure of Moral Distress for Healthcare Professionals (MDD-HP) and open-ended questions every 4-months via online surveys and through five resident focus groups. The moral distress scores (MDS) before and during the COVID-19 pandemic were compared using paired t-tests. Transcripts and free text were independently coded by investigators and analyzed by major themes and sub-themes. RESULTS: < .05). Qualitive findings included the exacerbation of existing moral distress and the emergence of new drivers of moral distress, including personal protective equipment, visitor policies, lack of moral framework, and tension between protecting one’s own health and caring for others. CONCLUSIONS:The results of this preliminary analysis suggest that the COVID-19 pandemic exacerbated pre-existing experiences of moral distress and brought to light new and different morally distressing situations for trainees. This analysis of the impact of the pandemic is valuable not only for identifying leverage points for intervention, but also for informing future crisis preparedness and cultivating moral resilience in trainees and the healthcare workforce. SUPPLEMENTARY INFORMATION:The online version contains supplementary material available at 10.1186/s12910-025-01274-6.

PURPOSE/OBJECTIVE:To evaluate outcomes from the Trainers in Oncofertility Reproductive Communication and Health (TORCH) program, which trains Allied Health Professionals (AHPs) to become leaders in counseling AYA cancer patients on reproductive health. METHODS:ECHO-TORCH was developed for alumni of the Enriching Communication Skills for Health Professionals in Oncofertility (ECHO) program. It included web-based modules on evidence-based content, adult learning principles, and a simulation exercise for skill practice. Evaluation involved pre/post-tests, skills assessments during simulation via standardized learners (SLs) and faculty observers, and online focus groups. RESULTS:ECHO-TORCH learners (n = 10) showed improved knowledge, from 76% on pre-test to 86% on post-test (p < 0.01). Both SLs (86%) and faculty observers (90%) showed high likelihood of inviting learners back for future presentations. In online focus groups, participants described the modules as clear, relevant, and highly satisfying. Learners appreciated the opportunity for practice and structured review of the ECHO content. CONCLUSIONS:The ECHO-TORCH program improved AHPs' knowledge and skills in teaching reproductive health content to AYA cancer patients. The train-the-trainer model empowers AHPs to disseminate knowledge within their institutions, ultimately improving care quality and empowering AYA patients to make informed decisions about reproductive health. IMPLICATIONS FOR CANCER SURVIVORS/CONCLUSIONS:Continued development of professionals in reproductive healthcare will significantly enhance cancer survivors' quality of life by supporting informed decision-making regarding their reproductive health.

In this introduction, the guest editors of the "Next Era in Assessment" special collection frame the invited papers by envisioning a next era in assessment of medical education, based on ideas developed during a summit that convened professional and educational leaders and scholars. The authors posit that the next era of assessment will focus unambiguously on serving patients and the health of society, reflect its sociocultural context, and support learners' longitudinal growth and development. As such, assessment will be characterized as transformational, development-oriented and socially accountable. The authors introduce the papers in this special collection, which represent elements of a roadmap towards the next era in assessment by exploring several foundational considerations that will make the next era successful. These include the equally important issues of (1) focusing on accountability, trust and power in assessment, (2) addressing implementation and contextualization of assessment systems, (3) optimizing the use of technology in assessment, (4) establishing infrastructure for data sharing and data storage, (5) developing a vocabulary around emerging sources of assessment data, and (6) reconceptualizing validity around patient care and learner equity. Attending to these priority areas will help leaders create authentic assessment systems that are responsive to learners' and society's needs, while reaping the full promise of competency-based medical education (CBME) as well as emerging data science and artificial intelligence technologies.

BACKGROUND:Unannounced standardized patients (USPs) have long been used to measure clinical performance in situ. These incognito actors capture data on clinician skills during an encounter, as well as patient experience more broadly. A robust USP program requires extensive preparation and standardization efforts. Given the widespread expansion of USPs for education, research, and improvement efforts, we conducted a systematic review with the goal of capturing the breadth of uses of USPs across settings, along with the standardization measures employed across studies. METHODS:In collaboration with a medical librarian, we conducted systematic searches across six databases. Two independent researchers screened each report for inclusion. Three coders extracted and reviewed study characteristics and data from the studies deemed eligible for inclusion. We extracted data on: target population, setting, and assessed skills. We also captured the reliability and fidelity measures described in each study, including USP detection, USP training methods, and assessment measures. RESULTS:128 articles were included. Individual clinicians were the most frequently targeted population (n = 114, 89 %). Common clinician roles included physicians (n = 92, 72 %) and pharmacists (n = 12, 9 %). The collective care team was the target in two studies (2 %), and systems and larger healthcare facilities were targeted in only 1 (1 %) and 13 (10 %) studies, respectively. Studies were primarily conducted in ambulatory settings (n = 118, 92 %). History gathering (n = 76, 59 %), communication (n = 55, 43 %), counseling (n = 51, 40 %), and patient education (n = 49, 38 %) were commonly assessed, as were correct diagnosis (n = 34, 27 %), appropriate ordering of labs/tests (n = 30, 23 %), referrals (n = 35, 27 %), and prescriptions (n = 36, 28 %). USP detection reporting was variable across studies; however, no detection information was provided for 48 studies. 62 % of articles reported incorporating a measure of reliability or fidelity into their study, while the remainder either failed to provide adequate information on use of these measures. CONCLUSIONS:We explored USP use across settings and describe the scope and limitations of the literature. USPs capture a range of data domains but a lack uniform report of reliability measures can potentially undermine findings. Future studies should incorporate and uniformly report out on detection, training, and assessment.

BACKGROUND:Suboptimal support for colleagues experiencing discrimination can adversely impact clinician well-being and patient care. AIM/OBJECTIVE:To describe resident performance and experience during an Objective Structured Clinical Examination (OSCE) case centered on supporting a trainee facing discrimination to inform enhanced, supportive learning environments. SETTING/METHODS:Formative, internal medicine OSCE at a simulation center. PARTICIPANTS/METHODS:148 second-year residents across 2018, 2019, 2021, 2022. PROGRAM DESCRIPTION/METHODS:Residents had 10 min to support a Muslim standardized intern (SI) experiencing discrimination from a patient. The SI rated resident performance across Supervision, Relationship Development, and Support domains and provided written feedback. Post-OSCE evaluations elicited resident reflections on case challenges. PROGRAM EVALUATION/RESULTS:Proficient residents (≥ 80% average score across domains, n = 85) performed better in all items, except in not acting defensive and collaborating with SI to develop follow-up plan, compared to non-proficient residents (n = 65). The SI described effective approaches to feeling supported, including using empathetic statements, stating personal stance on discrimination, exhibiting supportive body language, and verbalizing support. Stating knowledge of situation upfront was an area of improvement. Residents found engaging the distressed SI difficult. DISCUSSION/CONCLUSIONS:Use of an explicit discrimination OSCE case can help identify effective approaches to supporting targets of discriminatory patients to inform future training.