American Board of Internal Medicine, Philadelphia, Pennsylvania 19106, USA.
Med Educ. 2011 Jan;45(1):69-80. doi: 10.1111/j.1365-2923.2010.03847.x.
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.
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.
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.
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.
本科和研究生医学教育中的学员在教育过程中会经历多次转变，包括在医学教育计划中定期和日常发生的许多转变。临床轮转是一种根深蒂固的教育方法，基于医学学科或临床护理环境，在预定的短时间内进行，其根源可以追溯到 Abraham Flexner 的开创性报告。尽管缺乏关于临床轮转最佳时间和结构的经验证据，以及关于临床轮转之间应如何过渡的证据，但许多关于临床轮转假定好处的假设已经变得普遍。
在本文中，我们从社会学、学习理论和提高质量和安全的角度来考察轮转转变的问题。
从社会学的角度讨论需要更加关注专业间关系和专业发展，而从学习理论的角度则探讨了从教育学和认知科学中已知的内容与当前实践（学习理论）之间的差距。从提高质量和安全的角度讨论是指将学员作为有意义的参与者嵌入功能临床微观系统的迫切需要。
迫切需要研究转变对学员、教师、非医生医疗保健提供者和患者的影响，以便优化未来基于能力的培训模式，并确认或反驳当前的假设。
