Orthopedic surgery, particularly in the realm of elective procedures such as total joint arthroplasty (TJA), has increasingly shifted its focus from purely technical and radiological success to the enhancement of patient-centric outcomes. Quality of life, functional capacity, and overall well-being are now recognized as the definitive markers of therapeutic efficacy (1, 2). This paradigm shift necessitates robust methods to capture the patient’s subjective experience, a domain where clinician-reported metrics alone are insufficient. Patient-reported outcome (PRO)—rigorously developed and validated instruments completed directly by patients—have thus emerged as a methodological cornerstone in outcomes research and value-based healthcare (3, 4). Furthermore, PRO play a critical role in clinical practice, as evidenced by their formal incorporation into clinical guidelines and national programs, where they serve as pivotal evidence for evaluating surgical success and benchmarking healthcare performance (5, 6). Despite their established utility in clinical and research settings, a significant educational gap persists. Formal instruction on PRO—covering its conceptual foundations, psychometric properties, and clinical application—remains markedly absent from the core curricula of most medical schools and residency programs (7). This discrepancy creates a critical chasm: physicians are increasingly expected to utilize and interpret PRO data in practice, yet they receive little to no structured training. Evidence from Florentino et al. (7) substantiates this gap, demonstrating limited awareness and knowledge of PRO among medical students. Compounding this issue, the effective use of PRO requires understanding the broader context of patient care. For instance, social determinants of health significantly influence both the utilization of orthopedic procedures and subsequent PRO, as socioeconomic deprivation is associated with lower TJA rates and often diminished postoperative outcome improvements (8, 9). Therefore, a foundational understanding of PRO is essential not only for delivering patient-centered care but also for recognizing and addressing pervasive health disparities (8). The integration of PRO education is supported by studies showing its positive role in enhancing clinical reasoning and patient-centered care across diverse settings (10, 11); however, such integration in surgical training, particularly in orthopedics, remains notably lacking. To address this unmet educational need, we propose that integrating structured PRO instruction into standardized residency training represents a necessary step in modernizing surgical education. This pilot study was consequently designed to evaluate the feasibility and preliminary impact of a novel, structured PRO curriculum within an orthopedic surgery residency program. We hypothesized that this integrated educational intervention, compared to traditional training alone, would significantly improve residents’ PRO-related knowledge and foster more favorable attitudes toward their clinical implementation.

This pilot study found that integrating a structured PRO curriculum into orthopedic residency training significantly improved residents’ PRO knowledge and attitudes. While both groups gained knowledge, the experimental group showed greater improvement, highlighting the value of formal PRO education. At baseline, both groups performed poorly on the PRO knowledge assessment, indicating a general lack of prior exposure or instruction in this area. This systemic deficit can be directly traced to the current national training curriculum for orthopedic residency in China, which, upon review, does not include PRO education within its required competencies. Our findings, therefore, not only align with global reports but also highlight a curriculum-specific gap within this standardized training system (7). Our findings, consistent with Florentino et al. (7), confirm that this educational gap persists in the critical early stage of postgraduate surgical training. Although PRO is increasingly emphasized in clinical practice and health policy, it is not currently a requirement in the Liaison Committee on Medical Education (LCME) or Accreditation Council for Graduate Medical Education (ACGME) curriculum (16, 17).

Interestingly, the control group also showed substantial post-rotation improvement despite the absence of formal instruction. This suggests that clinical exposure in orthopedic surgery—where functional outcomes like pain reduction and range of motion are routinely tracked—can naturally promote familiarity with PRO-related concepts. However, the knowledge acquired through clinical experience alone appears unsystematic and less comprehensive, as evidenced by the significantly lower post-test scores of the control group compared to the intervention group (58.68 vs. 70.56, p < 0.001). This disparity underscores that a structured curriculum is essential for delivering a comprehensive and uniform understanding of PRO, covering both conceptual foundations and the application of specific instruments like PROMIS, OKS, and OHS. Residents in the experimental group participated in a full clinical cycle, from preoperative assessment using validated PRO scales to postoperative care and follow-up evaluation. This hands-on involvement not only reinforced theoretical knowledge but also enhanced their appreciation for patient-centered care. These trainees noted substantial variation in subjective patient experiences following similar surgical interventions, especially in terms of pain perception and functional recovery. Such observations stimulated critical thinking and encouraged the incorporation of both patient-reported and physician-reported outcomes in clinical decision-making (18, 19).

This shift in clinical perspective is significant. Furthermore, residents in the experimental group expressed a stronger belief in the value of PRO for patient evaluation (Table 3), suggesting that the training may foster an attitude more conducive to integrating subjective and objective data in clinical practice. The positive shift in attitudes among our trainees mirrors the outcomes observed by Florentino et al. (7), where a curriculum intervention led to increased student recognition of PRO’s importance. Our study extends this finding by demonstrating that even within a demanding surgical residency, a relatively brief intervention can effectively foster a more patient-centric mindset. These findings are consistent with international initiatives—such as a multicenter German cohort study—that emphasize involving medical students in real-world clinical research using PRO (20, 21). Orthopedic elective procedures primarily aim to improve quality of life (22). However, discrepancies often exist between physician expectations and patient experiences. Prior studies have noted that patients’ satisfaction and perceived benefit from surgery do not always align with clinical indicators (23, 24). Training residents to understand and value PRO may help bridge this gap, encouraging them to assess outcomes from the patients’ perspective and ultimately leading to more empathetic, evidence-informed care.

Feedback from both groups indicated broad recognition of PRO’s relevance in evaluating medical interventions. Even participants in the control group—who received no structured PRO instruction—supported the inclusion of PRO-related content in the curriculum, likely reflecting the implicit influence of clinical exposure during residency. These results are in line with previous studies suggesting that structured PRO training enhances learners’ clinical insight and supports broader implementation in medical education (7, 25).

First, the selection of OKS and OHS as focal PRO instruments was intentional, as they represent classic and commonly used tools in orthopedic arthroplasty. The primary aim was to equip residents with the fundamental principles and processes of PRO application through these exemplars. Consequently, the core outcomes assessed were the learners’ PRO knowledge level and attitudes, rather than a comprehensive evaluation of multiple PRO tools. Trainees in the experimental group engaged deeply with patient OKS/OHS data, which served as critical mediators for achieving educational objectives, such as understanding the variability of patient subjective experiences. The aggregate patient data, while central to the learning process, was not a pre-specified efficacy outcome measure for this educational study.

Second, the definition of PRO emphasizes the direct assessment of health status from the patient’s perspective. The educational innovation here was to operationalize this definition by having residents personally collect and interpret OKS/OHS—instruments designed to capture “patients’ subjective feelings/experiences.” The trainees’ reported observation of “substantial variation in subjective patient experiences” underscores how engagement with real patient-derived data, as opposed to theoretical or simulated cases, fostered a tangible understanding of PRO’s value. This experiential learning was fundamental in shifting attitudes toward patient-centered care. Future research should build on this foundation to examine downstream effects, such as the quality of PRO utilization in clinical practice and the long-term impact on patient care experiences following such educational interventions.

A pertinent consideration is the distinction between the structured curriculum received by the experimental group and the informal, remedial overview provided to the control group. Our pilot study was designed to evaluate the feasibility of integrating a structured PRO curriculum into the existing clinical training framework, which inherently coupled the curricular structure (modular, spaced learning) with clinical integration over a 2-month rotation. The control group’s exposure, in contrast, was a single, isolated session without integrated practice. A future experiment designed to strictly control for both total teaching time and clinical exposure duration—for instance, comparing a structured, integrated curriculum against a consolidated lecture of equal total length—would be invaluable to isolate the specific effect of the curricular structure itself. While our current design cannot definitively disentangle these factors, the significant gains observed in the experimental group strongly suggest that the structured, integrated approach is a feasible and potent strategy for PRO education. The positive outcomes likely stem from the synergistic effect of repeated theoretical exposure and immediate clinical application, a core component of our structured intervention.

While this study evaluated immediate educational outcomes, the integration of PRO into residency training may have important long-term implications for clinical practice. By establishing familiarity and positive attitudes early in training, such a curriculum could encourage the habitual use of PRO in future independent practice, contributing to more systematic outcome monitoring and patient-centered care models. Furthermore, the structured approach—combining concise didactics with supervised clinical application—demonstrates a scalable model that could be adapted to other surgical or procedural specialties where patient-reported experience and functional recovery are key outcomes, such as neurosurgery, plastic surgery, or interventional cardiology.

Also, future research should build upon these promising findings by employing longitudinal designs to determine whether improved knowledge and positive attitudes translate into sustained changes in clinical behavior, such as the routine integration of PRO into patient assessments in independent practice. Additionally, investigating the potential impact of such training on patient-clinician communication, shared decision-making, and long-term patient-reported outcome would further delineate the educational value chain.

This study demonstrates that integrating PRO into standardized orthopedic surgery residency training can significantly enhance resident engagement, deepen PRO-related knowledge, and foster the development of clinical reasoning skills. The curriculum not only encouraged the practical application of theoretical knowledge to clinical contexts but also improved residents’ understanding of patient-centered care and heightened their awareness of clinical outcomes beyond traditional metrics. By aligning with global trends in PRO implementation, this educational innovation provides a valuable framework for more comprehensive outcome evaluation and supports the continued reform and advancement of orthopedic education and curriculum development.