# Beyond Workarounds: Enhancing Education, Care, and Wellness on Inpatient Medicine Rotations —A Multicenter Qualitative Study

## TL;DR

This study explores how inpatient medicine rotations can better balance education and patient care while improving clinician wellness.

## Contribution

The study introduces a conceptual model to help physician-leaders improve inpatient medicine rotations.

## Key findings

- Increasing workloads and resource challenges undermine the quality of care and education on inpatient rotations.
- Six key categories were identified to support or hinder the success of inpatient medicine rotations.
- Workarounds often create unintended problems, highlighting the need for structured solutions.

## Abstract

Inpatient medicine rotations (IMRs) aim to deliver exceptional clinical education and high-quality patient care. However, increasing workloads and the fast pace of inpatient wards are undermining this dual objective.

To explore tensions and challenges between balancing education and clinical practice on IMRs and how physician-leaders are addressing them.

Constructivist grounded theory.

Inpatient medicine rotation physician-leaders from academic medical centers in the United States and Canada.

Data collection involved semi-structured individual and group interviews, collected and analyzed iteratively to develop an explanatory conceptual model. Rigor was enhanced through constant comparison, investigator triangulation, and return-of-findings sessions.

Twenty interviews involving 27 participants from 20 distinct training programs were conducted. Participants endorsed IMRs unique clinical and educational value. However, they flagged how increasing workloads and resource challenges produce tensions that can undermine the quality of both which, as a consequence, negatively impact attending and trainee wellness. While reactionary “workarounds” were the norm, they often created unanticipated problems. Key IMR features and strategies for success were identified and organized into six categories: (1) patient mix/census; (2) leadership collaboration; (3) collaborative care models; (4) rotation scheduling; (5) clinical workflow; (6) educational workflow. How physician-leaders configured their IMR structures and processes within these categories had the potential to support or undermine the delivery of high-quality care, education, and wellness.

Inpatient medicine rotations, which is essential for clinical care and education, are currently facing serious challenges from a changing clinical and educational landscape. Our findings present a conceptual model highlighting key modifiable variables, giving physician-leaders a framework to assess and enhance their IMR’s clinical learning environment, thus fostering quality care, education, and clinician wellness.

The online version contains supplementary material available at 10.1007/s11606-025-09392-y.