The Educational Experience Improvement Collective for Inpatient Medicine Healthcare Professional Trainees at a University-Affiliated Veterans Affairs Medical Center

Rotation evaluations reflect the resident-perceived value of clinical experiences in graduate medical education. In this study, we sought to improve the quality of education for internal medicine residents during their inpatient medicine rotation. Program stakeholders critically appraised a core medicine rotation at a university-affiliated U.S. Veterans Affairs Medical Center utilizing end-of-rotation evaluations by residents. Thematic analysis identified three areas for improvement: culture, communication, and workload. Solutions were developed to address each theme: (1) site-specific orientation was provided to new trainees, (2) real-time notification of admissions occurred via secure messaging platform, and (3) an assistive rounding tool was integrated into the electronic medical record. Outcome measures of education were obtained via end-of-rotation evaluations by residents. This study included 198 pre-intervention and 58 post-intervention evaluations by trainees from October 2022 through December 2023. Using a 5-point Likert scale, the quality of education improved from good to very good (3.26 to 4.02, +15%, p < 0.001) over the course of one year. All four subcategories also improved: diversity/quality of pathology (0.33; +7%), supervision (0.50; +10%), workload (0.42; +8%), and learning value (0.51; +10%). When the five categories are compared immediately pre-intervention (fourth quarter of 2022-2023 academic year) to full post-intervention (second quarter of 2023-2024 academic year) using a paired t-test, the change was statistically significant (p = 0.007). Significant educational enhancements were achieved over time for a core rotation in a residency program using solutions developed from interconnected themes found in learner evaluations.