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Cited by 152Hospital Admissions and OutcomesInnovations in Medical EducationHealthcare professionals’ stress and burnout

Lost in Transition: The Experience and Impact of Frequent Changes in the Inpatient Learning Environment

Bernabeo, Elizabeth C., Holtman, Matthew C., Ginsburg, Shiphra, Rosenbaum, Julie R., Holmboe, Eric S.·2011·Academic Medicine
DOI 10.1097/acm.0b013e318212c2c9
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Abstract

PURPOSE: The traditional "rotating" model of inpatient training remains the gold standard of residency, moving residents through different systems every two to four weeks. The authors studied the experience and impact of frequent transitions on residents. METHOD: This was a qualitative study. Ninety-seven individuals participated in 12 focus groups at three academic medical centers purposefully chosen to represent a range of geographic locations and structural characteristics. Four groups were held at each site: residents only, faculty only, nurses and ancillary staff only, and a mixed group. Grounded theory was used to analyze data. RESULTS: Perceived benefits of transitions included the ability to adapt to new environments and practice styles, improved organization and triage skills, increased comfort with stressful situations, and flexibility. Residents primarily relied on each other to cope with and prepare for transitions, with little support from the program or faculty level. Several potentially problematic workarounds were described within the context of transitions, including shortened progress notes, avoiding pages, hiding information, and sidestepping critical situations. Nearly all residents acknowledged that frequent transitions contributed to a lack of ownership and other potentially harmful effects for patient care. CONCLUSIONS: These findings challenge the value of the traditional "rotating" model in residency. As residents adapt to frequent transitioning, they implicitly learn to value flexibility and efficiency over relationship building and deep system knowledge. These findings raise significant implications for professional development and patient care and highlight an important element of the hidden curriculum embedded within the current training model.

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Authors
Bernabeo, E. C., Holtman, M. C., Ginsburg, S., Rosenbaum, J. R., & Holmboe, E. S.
Affiliations
American Board of Internal Medicine (US)
Corresponding author
Bernabeo, Elizabeth C.
ORCID
Venue
Academic Medicine
Publisher
Oxford University Press (OUP)
Published
2011-05
Volume
86
Issue
5
Pages
591-598
ISSN
1040-2446 (ISSN-L)
DOI
10.1097/acm.0b013e318212c2c9
OpenAlex
W2065599922
Cited by
152
References
30
Citations by year
2026: 7 · 2025: 6 · 2024: 7 · 2023: 10 · 2022: 17 · 2021: 10 · 2020: 10 · 2019: 8 · 2018: 12 · 2017: 14 · 2016: 10 · 2015: 14 · 2014: 10 · 2013: 9 · 2012: 4
FWCI
9.46
Type
journal article
Language
en
Open access
closed
Locations
  • Academic Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Keywords
rotating internship, learning environment, hidden curriculum, professional development, workarounds, faculty support, medical education
MeSH terms
Academic Medical Centers, Adaptation, Psychological, Adult, Education, Medical, Graduate, Environment, Female, Patient Care, Humans, Inpatients, Internal Medicine, Internship and Residency, Interprofessional Relations, Job Satisfaction, Learning, Male, Medicine, Quality of Health Care, Time Factors, United States, Focus Groups, Risk Assessment, Qualitative Research

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