The rotational approach to medical education: time to confront our assumptions?

Holmboe, Eric; Ginsburg, Shiphra; Bernabeo, Elizabeth

doi:10.1111/j.1365-2923.2010.03847.x

Cited by 154Innovations in Medical EducationHospital Admissions and OutcomesHealth and Medical Education

The rotational approach to medical education: time to confront our assumptions?

Holmboe, Eric, Ginsburg, Shiphra, Bernabeo, Elizabeth·2011·Medical Education

DOI 10.1111/j.1365-2923.2010.03847.x

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Abstract

Medical Education 2011: 45 : 69–80 Context Trainees in undergraduate and postgraduate medical education engage in multiple transitions as part of the educational process, including many transitions that occur on both periodic and daily bases within medical education programmes. The clinical rotation, based on either a medical discipline or clinical care setting and occurring over a predetermined, short period of time, is a deeply entrenched educational approach with its roots in Abraham Flexner’s seminal report. Many assumptions about the presumed benefits of clinical rotations have become pervasive despite a lack of empirical evidence on their optimal timing and structure, and on how transitions between clinical rotations should occur. Methods In this paper, we examine the issue of rotational transitions from the three perspectives of sociology, learning theory, and the improvement of quality and safety. Results Discussion from the sociological perspective addresses the need for much greater attention to interprofessional relationships and professional development, whereas that from the learning theory perspective examines the gap between what is known from pedagogical and cognitive science and what is currently practised (learning theory). Discussion from the perspective of improving quality and safety refers to the critical need to embed trainees in functional clinical microsystems as meaningful participants. Conclusions Research is urgently needed on the effects of transitions on trainees, faculty staff, non‐doctor health care providers and patients in order to optimise future competency‐based training models and confirm or refute current assumptions.

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These activities are best achieved through longitudinal relationships with faculty who assimilate various sources of information and provide customized appraisal and feedback.
“Collectively, these activities are best achieved through longitudinal relationships with faculty who assimilate various sources of information (e.g., direct observation, multisource feedback) and provide customized appraisal and feedback, facilitating an exploration to identify improvement areas [13–20].”
From A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program (2019) · cites this paper as [15]
Residents' interactions with faculty supervisors are often fragmented in rotations, limiting sustained working relationships that allow for customized improvement of clinical skills.
“Ideally, direct observation would be performed by supervisors in clinical settings, but as has been previously identified, residents’ interactions with faculty supervisors are often fragmented in rotations, limiting sustained working relationships that allow for customized improvement of clinical skills [14,15].”
From A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program (2019) · cites this paper as [15]

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Developing the Master Learner
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How and what do medical students learn in clerkships? Experience based learning (ExBL)
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Faculty staff perceptions of feedback to residents after direct observation of clinical skills
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Work‐Based Learning
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Lost in Transition: The Experience and Impact of Frequent Changes in the Inpatient Learning Environment
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Competency-Based, Time-Variable Education in the Health Professions: Crossroads
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Time to Trust: Longitudinal Integrated Clerkships and Entrustable Professional Activities
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“It’s just not the culture”: A qualitative study exploring residents’ perceptions of the impact of institutional culture on feedback.
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What would happen to education if we take education evidence seriously?
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Students’ workplace learning in two clerkship models: a multi‐site observational study
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Exploring the transition of undergraduate medical students into a clinical clerkship using organizational socialization theory
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Conceptions of how a learning or teaching curriculum, workplace culture and agency of individuals shape medical student learning and supervisory practices in the clinical workplace
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Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade
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A “Safe Space” for Learning and Reflection: One Schoolʼs Design for Continuity With a Peer Group Across Clinical Clerkships
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Building the Bridge to Quality: An Urgent Call to Integrate Quality Improvement and Patient Safety Education With Clinical Care
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How Supervisor Experience Influences Trust, Supervision, and Trainee Learning: A Qualitative Study
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Relationships as the Backbone of Feedback: Exploring Preceptor and Resident Perceptions of Their Behaviors During Feedback Conversations
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Uncovering the unknown: A grounded theory study exploring the impact of self-awareness on the culture of feedback in residency education
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Contextual Competence: How residents develop competent performance in new settings
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Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education
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Perspective
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Will Any Road Get You There? Examining Warranted and Unwarranted Variation in Medical Education
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Graduate Medical Education
Aschenbrener, C. A., Ast, C., & Kirch, D. G. (2015) · Academic Medicine · doi:10.1097/acm.0000000000000829 · Cited by 45 · see citing works
Ending student mistreatment: early successes and continuing challenges
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Professional identity formation within longitudinal integrated clerkships: A scoping review
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Learners, performers, caregivers, and team players: Descriptions of the ideal medical student in longitudinal integrated and block clerkships
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Workplace learning through peer groups in medical school clerkships
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A review of longitudinal clinical programs in US medical schools
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A Best Evidence Medical Education (BEME) systematic review of: What works best for health professions students using mobile (hand-held) devices for educational support on clinical placements? BEME Guide No. 52
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Residency Program Factors Associated With Depressive Symptoms in Internal Medicine Interns: A Prospective Cohort Study
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A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program
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Articulating the ideal: 50 years of interprofessional collaboration in Medical Education
Paradis, E., Pipher, M., Cartmill, C., Rangel, J. C., & Whitehead, C. R. (2017) · Medical Education · doi:10.1111/medu.13331 · Cited by 38 · see citing works
On learning in the clinical environment
Liljedahl, M. (2018) · Perspectives on Medical Education · doi:10.1007/s40037-018-0441-x · Cited by 37 · see citing works
Living in a World of Change: Bridging the Gap From Competency-Based Medical Education Theory to Practice in Canada
Dagnone, D., Chan, M., Meschino, D. D. C., Bandiera, G. W., den Rooyen, C., Matlow, A., McEwen, L. A., Scheele, F., & Croix, R. S. (2020) · Academic Medicine · doi:10.1097/acm.0000000000003216 · Cited by 37 · see citing works
Medical students’ reactions to an experience-based learning model of clinical education
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How biased are you? The effect of prior performance information on attending physician ratings and implications for learner handover
Shaw, T., Wood, T. J., Touchie, C., Pugh, D., & Humphrey-Murto, S. M. (2020) · Advances in Health Sciences Education · doi:10.1007/s10459-020-09979-6 · Cited by 36 · see citing works
Better learning, better doctors, better community: how transforming clinical education can help repair society
Hirsh, D. A., & Worley, P. (2013) · Medical Education · doi:10.1111/medu.12278 · Cited by 36 · see citing works
Content and timing of feedback and reflection: a multi-center qualitative study of experienced bedside teachers
Gonzalo, J. D., Heist, B. S., Duffy, B. L., Dyrbye, L. N., Fagan, M. J., Ferenchick, G. S., Harrell, H. E., Hemmer, P. A., Kernan, W. N., Kogan, J. R., et al. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-212 · Cited by 36 · see citing works
Using Complexity Theory to Guide Medical School Evaluations
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The Influence of Prior Performance Information on Ratings of Current Performance and Implications for Learner Handover: A Scoping Review
Humphrey-Murto, S. M., LeBlanc, A., Touchie, C., Pugh, D., Wood, T., Cowley, L., & Shaw, T. (2019) · Academic Medicine · doi:10.1097/acm.0000000000002731 · Cited by 35 · see citing works
It takes a community to train a future physician: social support experienced by medical students during a community-engaged longitudinal integrated clerkship
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International students in speech-language pathology clinical education placements: Perceptions of experience and competency development
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Learn+Fun! Social Media and Gamification sum up to Foster a Community of Practice during an Emergency Medicine Rotation
Grangeia, T. D. A. G., de Jorge, B., Cecílio‐Fernandes, D., Tio, R. A., & Filho, C. (2018) · Health Professions Education · doi:10.1016/j.hpe.2018.11.001 · Cited by 35 · see citing works
Learning in Practice: A Valuation of Context in Time-Variable Medical Training
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Preparing to prescribe: How do clerkship students learn in the midst of complexity?
McLellan, L., Yardley, S. J., Norris, B., de Bruin, A. B. H., Tully, M. P., & Dornan, T. (2015) · Advances in Health Sciences Education · doi:10.1007/s10459-015-9606-0 · Cited by 31 · see citing works
How Residents Develop Trust in Interns: A Multi-Institutional Mixed-Methods Study
Sheu, L. C., O’Sullivan, P., Aagaard, E., Tad‐y, D., Harrell, H. E., Kogan, J. R., Nixon, L. J., Hollander, H., & Hauer, K. E. (2016) · Academic Medicine · doi:10.1097/acm.0000000000001164 · Cited by 30 · see citing works
Overcoming the Challenges of Direct Observation and Feedback Programs: A Qualitative Exploration of Resident and Faculty Experiences
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Competency-based veterinary education: an integrative approach to learning and assessment in the clinical workplace
Bok, H. G. J. (2015) · Perspectives on Medical Education · doi:10.1007/s40037-015-0172-1 · Cited by 29 · see citing works
Putting the Pediatrics Milestones Into Practice: A Consensus Roadmap and Resource Analysis
Schumacher, D. J., Spector, N. D., Calaman, S., West, D. C., Cruz, M., Frohna, J. G., del Rey, J. A. G., Gustafson, K., Poynter, S. E., Rosenbluth, G., et al. (2014) · PEDIATRICS · doi:10.1542/peds.2013-2917 · Cited by 29 · see citing works
Mobile technologies to support workplace-based assessment for entrustment decisions: Guidelines for programs and educators: AMEE Guide No. 154
Marty, A., Linsenmeyer, M., George, B. C., Young, J. Q., Breckwoldt, J., & ten Cate, O. (2023) · Medical Teacher · doi:10.1080/0142159x.2023.2168527 · Cited by 28 · see citing works
Peer influence on students’ estimates of performance: social comparison in clinical rotations
Raat, A. N. (., Kuks, J. B. M., van Hell, E. A., & Cohen‐Schotanus, J. (2013) · Medical Education · doi:10.1111/medu.12066 · Cited by 36 · see citing works
Revolution or evolution? Putting the Flexner Report in context
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Training medical students for the twenty-first century: Rationale and development of the Utrecht curriculum “CRU+”
ten Cate, O., Borleffs, J. C. C., van Dijk, M. R., Westerveld, T., & reforms, O. B. O. N. F. M. A. S. I. I. T. S. U. C. (2018) · Medical Teacher · doi:10.1080/0142159x.2018.1435855 · Cited by 26 · see citing works
Longitudinal training models for entrusting students with independent patient care?: A systematic review
Bonnie, L. H. A., Cremers, G. R., Nasori, M., Kramer, A. W. M., & van Dijk, N. (2021) · Medical Education · doi:10.1111/medu.14607 · Cited by 24 · see citing works
Learner Handover: Who Is It Really For?
Humphrey-Murto, S. M., Lingard, L., Varpio, L., Watling, C., Ginsburg, S., Rauscher, S., & LaDonna, K. A. (2020) · Academic Medicine · doi:10.1097/acm.0000000000003842 · Cited by 22 · see citing works
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“You Have to Know the End of the Story”: Motivations to Follow Up After Transitions of Clinical Responsibility
Bowen, J. L., Ilgen, J. S., Irby, D. M., ten Cate, O., & OʼBrien, B. C. (2017) · Academic Medicine · doi:10.1097/acm.0000000000001919 · Cited by 22 · see citing works
Learning to interact and interacting to learn: a substantive theory of clinical workplace learning for diverse cohorts
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Designing the learning of intraprofessional collaboration among medical residents
Looman, N., Graaf, J. D., Thoonen, B. P. A., van Asselt, D., GROOT, E. D., Kramer, A. W. M., Scherpbier, N. D., & Fluit, C. R. M. G. (2022) · Medical Education · doi:10.1111/medu.14868 · Cited by 20 · see citing works
Developmental aspects of medical competency and training: issues of curriculum design
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Clinical education in the osteopathy program at Victoria University
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Orientation of medical trainees to a new clinical environment (the ready-steady-go model): a constructivist grounded theory study
Wiese, A., & Bennett, D. M. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03105-3 · Cited by 20 · see citing works
Improvement of quality and safety in health care as a new interprofessional learning module – evaluation from students
Gjessing, K., Hammar, M. L., Dahlberg, J., Torgé, C. J., & Faresjö, T. (2014) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s62619 · Cited by 20 · see citing works
Faculty and Resident Engagement With a Workplace-Based Assessment Tool: Use of Implementation Science to Explore Enablers and Barriers
Young, J. Q., Sugarman, R., Schwartz, J., & O’Sullivan, P. (2020) · Academic Medicine · doi:10.1097/acm.0000000000003543 · Cited by 20 · see citing works
Seeking trust in entrustment: shifting from the planning of entrustable professional activities to implementation
Hauer, K. E. (2019) · Medical Education · doi:10.1111/medu.13920 · Cited by 20 · see citing works
Work‐based Learning
Morris, C. (2018) · Wiley eBooks · doi:10.1002/9781119373780.ch12 · Cited by 22 · see citing works
Competency-based medical education: The spark to ignite healthcare’s escape fire
Schumacher, D. J., Kinnear, B., Carraccio, C. L., Holmboe, E. S., Busari, J. O., van der Vleuten, C. P. M., & Lingard, L. (2023) · Medical Teacher · doi:10.1080/0142159x.2023.2232097 · Cited by 19 · see citing works
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Differences Between Attendings’ and Fellows’ Perceptions of Futile Treatment in the Intensive Care Unit at One Academic Health Center
Neville, T. H., Wiley, J. F., Holmboe, E. S., Tseng, C., Vespa, P. M., Kleerup, E. C., & Wenger, N. S. (2014) · Academic Medicine · doi:10.1097/acm.0000000000000617 · Cited by 19 · see citing works
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Keystone: Exploring Pediatric Residents’ Experiences in a Longitudinal Integrated Block
Michelson, C. D., Dzara, K., Ramani, S., Vinci, R. J., & Schumacher, D. J. (2018) · Teaching and Learning in Medicine · doi:10.1080/10401334.2018.1478732 · Cited by 19 · see citing works
Foundation doctors’ induction experiences
Miles, S., Kellett, J. E., & Leinster, S. (2015) · BMC Medical Education · doi:10.1186/s12909-015-0395-1 · Cited by 18 · see citing works
Barriers to workplace-based learning in the intensive care unit: A qualitative description of internal medicine residents’ and intensivists’ perspectives
Robillard, N., & Vincelette, C. (2021) · Medical Teacher · doi:10.1080/0142159x.2021.2015533 · Cited by 16 · see citing works
Descriptive analysis of junior doctor assessment in the first postgraduate year
Carr, S., Celenza, A., & Lake, F. (2014) · Medical Teacher · doi:10.3109/0142159x.2014.918255 · Cited by 16 · see citing works
Continuity of Care as an Educational Goal but Failed Reality in Resident Training: Time to Innovate
Ellman, M. S., Tobin, D. G., Stepczynski, J., & Doolittle, B. R. (2016) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-15-00278.1 · Cited by 15 · see citing works
Acting wisely in complex clinical situations: ‘Mutual safety’ for clinicians as well as patients
Dornan, T., Lee, C., Findlay‐White, F., Gillespie, H., & Conn, R. (2021) · Medical Teacher · doi:10.1080/0142159x.2021.1951693 · Cited by 14 · see citing works
Exploring the Teaching Motivations, Satisfaction, and Challenges of Veterinary Preceptors: A Qualitative Study
Hashizume, C. T., Myhre, D. L., Hecker, K. G., Bailey, J. V., & Lockyer, J. (2016) · Journal of Veterinary Medical Education · doi:10.3138/jvme.0715-120r · Cited by 14 · see citing works
Improving clerkship preparedness: a hospital medicine elective for pre-clerkship students
Connor, D. M., Conlon, P. J., OʼBrien, B. C., & Chou, C. L. (2017) · Medical Education Online · doi:10.1080/10872981.2017.1307082 · Cited by 14 · see citing works
It's not just what you know: junior trainees' approach to follow‐up and documentation
Cadieux, D. C., & Goldszmidt, M. A. (2017) · Medical Education · doi:10.1111/medu.13286 · Cited by 14 · see citing works
Evaluating clinical teaching through cognitive apprenticeship
Stalmeijer, R. E. (2011) · doi:10.26481/dis.20110707rs · Cited by 14 · see citing works
Advancing Workplace-Based Assessment in Psychiatric Education
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Medical Students’ Socialization Tactics When Entering a New Clinical Clerkship: A Mixed Methods Study of Proactivity
Atherley, A., Hu, W. C.-Y., Dolmans, D. H. J. M., Teunissen, P. W., & Hegazi, I. (2022) · Academic Medicine · doi:10.1097/acm.0000000000004627 · Cited by 14 · see citing works
Exploring aspects of medical students’ professional identity through their reflective expressions
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The Influence of Environment on Clinical Practice: Unspoken Rules
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Medical education in an age of complexity, uncertainty and reflection. A coda to the Flexner centenary
Dornan, T., McKendree, J., & Robbé, I. (2010) · Medical Education · doi:10.1111/j.1365-2923.2010.03893.x · Cited by 12 · see citing works
Male(Volent) Medicine: Tensions and Contradictions In The Gendered Re/Construction of The Medical Profession in South Africa
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‘It’s more like checking in with an old friend’: A qualitative study of medical students’ experiences with longitudinal coaches throughout medical school
Charondo, L. B., Sheu, L. C., Bakke, B., & Hauer, K. E. (2023) · Medical Teacher · doi:10.1080/0142159x.2023.2284659 · Cited by 13 · see citing works
How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study
Penner, J. C., Hauer, K. E., Julian, K. A., & Sheu, L. C. (2021) · Perspectives on Medical Education · doi:10.1007/s40037-021-00694-5 · Cited by 11 · see citing works
Work‐based learning
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Residents, Responsibility, and Error: How Residents Learn to Navigate the Intersection
Shepherd, L. G., Chilton, S., & Cristancho, S. (2023) · Academic Medicine · doi:10.1097/acm.0000000000005267 · Cited by 10 · see citing works
The emotions experienced by family medicine residents and interns during their clinical trainings: a qualitative study
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Using Backward Design for Competency-Based Undergraduate Medical Education
Joyce, B., & Swanberg, S. M. (2016) · Advances in medical education, research, and ethics (AMERE) book series · doi:10.4018/978-1-5225-2098-6.ch003 · Cited by 9 · see citing works
Getting the balance just right: Desirable difficulty in health professions education
Kinsey, H. (2022) · Medical Education · doi:10.1111/medu.14989 · Cited by 9 · see citing works
Improving end-of-rotation transitions of care among ICU patients
Denson, J. L., Knoeckel, J., Kjerengtroen, S., Johnson, R. L., McNair, B. K., Thornton, O., Douglas, I. S., Wechsler, M. E., & Burke, R. E. (2019) · BMJ Quality & Safety · doi:10.1136/bmjqs-2019-009867 · Cited by 9 · see citing works
The Effect of Resident Duty-Hours Restrictions on Internal Medicine Clerkship Experiences: Surveys of Medical Students and Clerkship Directors
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Through patient eyes: Can third-year medical students deliver the care patients expect?
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Authors: Holmboe, E., Ginsburg, S., & Bernabeo, E.
Affiliations: American Board of Internal Medicine (US)
Corresponding author: Holmboe, Eric
ORCID: Holmboe, Eric
Ginsburg, Shiphra
Venue: Medical Education
Publisher: Wiley
Published: 2010-12-14
Volume: 45
Issue: 1
Pages: 69-80
ISSN: 0308-0110 (ISSN-L)
1365-2923
DOI: 10.1111/j.1365-2923.2010.03847.x
OpenAlex: W1602196365
Semantic Scholar: 480b3d7bd63f03c8d6c4c41ced709e3e9dbbd883
Cited by: 154
References: 97
Citations by year: 2026: 2 · 2025: 5 · 2024: 9 · 2023: 10 · 2022: 11 · 2021: 11 · 2020: 9 · 2019: 19 · 2018: 14 · 2017: 8 · 2016: 10 · 2015: 10 · 2014: 14 · 2013: 9 · 2012: 3
FWCI: 6.97
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Medical Education (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
Health Sciences › Health Professions › General Health Professions › Health and Medical Education
Keywords: clinical rotations, rotational transitions, undergraduate medical education, graduate medical education, interprofessional relations, professional development, learning theory, cognitive science, quality and safety, clinical microsystems, competency-based training, trainee experiences
MeSH terms: Competency-Based Education, Education, Medical, Graduate, Education, Medical, Undergraduate, Humans, Students, Medical

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The rotational approach to medical education: time to confront our assumptions?

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