Rotational training structures and national employment in public health education: an organizational perspective

Postgraduate medical education (PGME) relies on structured training rotations and workplace-based learning (WBL) to provide comprehensive clinical training and professional development. Emphasizing WBL, PGME integrates theoretical knowledge with practical skills through direct patient care involvement, underscoring the pivotal role of training institutes in supporting these initiatives. While curricular changes in PGME have been extensively studied in clinical teaching hospitals, PGME programs in public health (PGME-PH) remain underexplored, yet their multidisciplinary nature post-COVID-19 underscores the urgency for effective curricular reforms. This study explores how training institutions offering PGME-PH navigate the adoption of structured training rotations and a transition to a national employer by examining organizational perspectives to enhance sustainability and integration of educational innovations in this unique context.

Semistructured interviews were conducted with 14 participants from 8 training institutions offering PGME-PH in the Netherlands between October and November 2022 to explore their experiences with the implementation of a rotational training structure. The interviews were guided by the Consolidated Framework for Implementation Research (CFIR).

The analysis identified three pivotal themes influencing sustainable implementation and ownership: influence, communication, and motivation. Participants expressed concerns about reduced influence in organizing PGME-PH and noted significant communication challenges, such as ambiguity in roles, program frameworks, and financial aspects. Despite these obstacles, participants showed strong motivation for education and underscored the importance of collaboration and shared responsibility.

The successful implementation of structured training rotations was negatively impacted by training institutions' experience of limited influence and communication challenges. This led to diminished ownership of the new PGME-PH curriculum, potentially affecting its long-term sustainability. Despite these challenges, participants maintain high motivation for educational delivery. Enhancing sustainable implementation requires fostering ownership, promoting collective responsibility, establishing clear communication channels, and nurturing motivation. These factors are crucial for ensuring the success and longevity of educational programs such as PGME-PH.