Evaluation of off-service rotations at National Guard Health Affairs: Results from a perception survey of off-service residents

Designing the learning of intraprofessional collaboration among medical residents

BACKGROUND

To preserve quality and continuity of care, collaboration between primary-care and secondary-care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design-Principles guide the design and development of educational activities when theory-driven Design-Principles are tailored into context-sensitive Design-Principles. The aim of this study was to develop and substantiate a set of theory-driven and context-sensitive Design-Principles for intraPC learning during hospital placements.

METHODS

Based on our earlier research, we formulated nine theory-driven Design-Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design-Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design-Principles.

RESULTS

The theoretical Design-Principles were discussed and modified iteratively. Two new Design-Principles were added during focus group 1, and one more Design-Principle was added during focus group 2. The Design-Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design-Principles in the Culture cluster were prerequisites to facilitate intraPC learning.

CONCLUSION

This study led to the development of 12 theory-driven and context-sensitive Design-Principles that may guide the design of educational activities to support intraPC learning during hospital placements.

An Evaluation of Off-Service Rotations in Podiatric Medicine and Surgery Residency Training

Residency training in podiatric medicine and surgery includes 3years of comprehensive training. Complementing their podiatric medicine and surgery training, residents complete a series of required nonpodiatric, or off-service, rotations in a range of specialties. However, there has been a lack of formal investigation of these off-service rotation experiences. An online survey was developed and distributed to both program directors and residents nationwide. The survey instrument covered various aspects of off-service rotations, including rotation value, length, goals and objectives, activities, feedback, and resident satisfaction. In total, 122 of 222 directors responded and 151 of 243 residents responded. Resident responses reflected the impact of podiatric responsibilities during off-service rotations and the importance of hands-on, interactive, and dedicated learning opportunities during these rotations. Both similarities and differences were appreciated with regard to perceived rotation value between resident and director perspectives. Perceived satisfaction of certain rotations was correlated with rotation length, feedback, specific rotation activities, and whether residents received goals and objectives. Though perhaps neglected, the off-service rotation experience is an important part of the podiatric medical and surgical residency experience. Considering the perspectives of both directors and residents can be helpful in directing these experiences and in considering future changes.