The rotational approach to medical education: time to confront our assumptions?
Article first published online: 14 DEC 2010
© Blackwell Publishing Ltd 2010
Volume 45, Issue 1, pages 69–80, January 2011
How to Cite
Holmboe, E., Ginsburg, S. and Bernabeo, E. (2011), The rotational approach to medical education: time to confront our assumptions?. Medical Education, 45: 69–80. doi: 10.1111/j.1365-2923.2010.03847.x
- Issue published online: 14 DEC 2010
- Article first published online: 14 DEC 2010
- Received 30 January 2010; editorial comments to authors 7 April 2010; accepted for publication 25 June 2010
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.