What makes or breaks a rotation? An analysis of rotation evaluations from pediatric residents

Inpatient clinical rotations are central to residency training. Studies have examined aspects of the inpatient learning environment, but few have characterized factors that differentiate exemplary from problematic rotations from the resident perspective. This study aimed to understand what distinguishes rotations through analysis of resident-generated evaluations across inpatient and acute-care specialties in a residency program.

Residents in a large pediatric residency program complete anonymous end-of-rotation evaluations, rating rotations on a 5-point scale with optional free-text commentary. This study analyzed inpatient and acute-care rotation evaluations submitted July 2019-June 2024 with a "very highly" or "very poorly" rating and an associated free-text response. Two investigators inductively coded a subset of evaluations to develop a codebook, which was applied to the remaining evaluations. Codes were organized into subthemes and themes, which aligned with self-determination theory (SDT). SDT was used as a guiding framework, and thematic saturation was confirmed.

A total of 712 "very highly" rated and 106 "very poorly" rated rotation evaluations met the inclusion criteria. Subthemes impacted one or more domains of SDT: autonomy, competence, and relatedness. Autonomy was shaped by ownership of patient care, supervisor oversight, and leadership. Competence was fostered by high-quality teaching, educational context, and patient-based learning. Relatedness was enhanced by communication, team culture, and role clarity. Psychological safety and trainee team inclusion impacted all SDT domains.

Autonomy, competence, and relatedness, promoted by psychological safety and trainee integration, are central to the resident experience. Educators should consider these factors when designing inpatient rotations.