Rotation sites: Focal vs. diffuse

[deschutes]

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I am wondering about programs with rotation sites/hospitals spread throughout a city versus programs that are either concentrated at one site or have all rotation sites in close proximity to one another.

Variation in rotation sites offer good exposure to different practicing styles. But I heard concerns expressed that one can potentially miss a fair bit of teaching/conferences what with driving from one site to another. And that it's hard to build esprit de corps if residents are scattered at several different hospitals, or even get to work with one particular faculty member for long.

Comments? What other things should I be asking about?

 

[yaah]

I had a few reservations when these issues came up - one program I visited I think had no less than four sites at which residents rotated through (this is just for surg path), and generally there were only one or two residents at these sites each rotation. They said that sometimes they don't see each other very much.

That kind of bothered me - kind of felt like being an itinerant farmer. The different practicing styles is nice, but I don't think it offers as much advantage as becoming comfortable with one style and refining your skills and techniques that way. While it is nice to learn different ways of signing out cases, different frozen section machines, etc, these are things that one can pick up fairly easily when familiar with a general way of doing things.

Here - we have two months first assigned to the VA surg path, which is a 5 minute shuttle ride/drive away but with all different faculty. Things are done differently, but it's only two months and it also is less busy and serves as an introduction, so I think it's reasonable because it is limited. We still can go to the conferences in the morning but have to leave right after that and often miss noon conferences, if there are any, or afternoon conferences, if there are any. So you do feel somewhat isolated. If this happened more than a couple of months I might get more irritated about it.

During my PSF, we basically split our time 50/50 on AP at two different hospitals. It was slightly different because the attendings did as well, as did most of the support staff. So it didn't really feel that different. Conferences took place at both sites. Again, the travel time could be frustrating at times but it didn't come up all the time as an issue. And there were enough residents rotating so you still got to work with everyone.

So I think that simply having multiple sites isn't necessarily a bad thing, but it isn't necessarily a good thing either. I would ask lots of questions about how this impacts resident education (from attending and resident perspective) and cameraderie. Do they spend the first week of every rotation just trying to get acclimated? Do attendings at some sites not teach much because their residents are always changing?

 

[Doctor B.]

At IU, we have 5 different hospitals at which we rotate at different times. All are easily accesible via walking or the famous people mover. There are enough conferences and other residents rotating at all the hospitals, excepting the VA, that one doesn't feel too isolated. At the VA, there is only one resident on surg path. That gets a little too isolated for me but it only lasts for a month. And honestly, there are times when it's nice to get away from the central hub of activity at Uni. This issue will be moot in a few years, though, when we have our new pathology building in which most rotations will be housed.