American Board of Internal Medicine, Philadelphia, Pennsylvania 19106-3699, USA.
Acad Med. 2011 May;86(5):591-8. doi: 10.1097/ACM.0b013e318212c2c9.
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.
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.
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.
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.
传统的住院医师培训“轮转”模式仍然是住院医师规范化培训的金标准，每隔两到四周将住院医师分配到不同的科室。本研究旨在探讨频繁转科对住院医师的体验和影响。
这是一项定性研究。97 名参与者在三个学术医疗中心参加了 12 个焦点小组，这些中心是有目的地选择的，以代表不同的地理位置和结构特征。每个地点都有四个小组：住院医师组、教师组、护士和辅助人员组以及混合组。采用扎根理论对数据进行分析。
转科的好处包括适应新环境和实践风格的能力、提高组织和分诊技能、对紧张情况的适应能力和灵活性。住院医师主要依靠彼此来应对和准备转科，很少得到项目或教师层面的支持。在转科的背景下，描述了几种潜在的有问题的解决方法，包括缩短病程记录、避免接听电话、隐藏信息和回避关键情况。几乎所有的住院医师都承认，频繁的转科导致他们缺乏归属感，并对患者护理产生其他潜在的有害影响。
这些发现对住院医师培训中的传统“轮转”模式提出了挑战。随着住院医师适应频繁的转科，他们会在潜意识中学会重视灵活性和效率，而不是建立关系和深入了解系统。这些发现对专业发展和患者护理提出了重大影响，并突出了当前培训模式中隐含课程的一个重要组成部分。
