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.

The authors created Geriatrics Connect (GeriConnect), a program for first-year medical students at NYU Grossman School of Medicine to learn about healthy aging by developing a 7-month long telephonic relationship with an older adult living in the community. Background and Objectives: Early exposure to geriatrics and older adults is instrumental to preparing future physicians to care for the aging population. The objective of this study was to evaluate how the GeriConnect program affected students' attitudes on aging and ageism. Design: Paired students conducted monthly telephone or video calls with a geriatric patient recruited from the NYU Internal Medicine outpatient practice and wrote required reflections on ageism. Participants: 99 first-year medical students at NYU Grossman School of Medicine. Measurements: Student reflection essays were descriptively coded by five independent reviewers. Results: Thematic analysis revealed that many students had limited exposure to older adults prior to starting medical school, and suggested that the longitudinal relationships developed in the program improved students' understanding of aging and ageism. Conclusion: Establishing longitudinal telephonic relationships with older adults may be an effective method of enhancing student exposure to geriatrics and fostering more positive attitudes toward older adults.

We evaluated community attitudes, perceptions, and experiences regarding access and use of health care systems in Northern Malawi. Through a qualitative descriptive approach, 12 focus group discussions were conducted in 2014 with community members (n=71) in Mzimba North, Malawi. Data were transcribed and analyzed for major themes. Both formal health care systems and traditional medicine were widely used as complementary. Health care-seeking behavior was governed by previous treatment history and by whether a disease was believed to be biological or spiritual in nature, the latter being best treated with traditional medicine. Barriers to using formal health care included cost, hospital resources/environment, socio-cultural beliefs, and transportation. Transportation was a significant barrier, often linked to increased mortality. Support of local strategies to address transportation, structural approaches to improve hospital capabilities and environment, and community education reconciling traditional beliefs and modern medicine may mitigate access issues and improve use of the health care system.