关键词: 教育, 医学, 住院医师规范化培训, 内科学, 门诊教学, 动态轮转模式

Abstract: Outpatient clinic rotation is a critical component of internal medicine standardized residency training. To meet the requirements of the training standards, the Second Affiliated Hospital of Zhejiang University School of Medicine reformed the traditional ″preceptor-led″ model into a ″dynamic rotation″ model for internal medicine outpatient rotations. In this model, residents rotated through eight subspecialties on a weekly basis, supported by a three-level collaborative management framework of ″base-department-faculty″, a two-way evaluation system between supervisors and residents, and digital process management tools. The teaching effects of the two models were compared using theoretical examination, objective structured clinical examination, and questionnaire. Third-year residents who completed their internal medicine outpatient rotation at our hospital between June 2024 and May 2025 were enrolled (n=51) and naturally allocated by rotation period into the preceptor-led model (n=26) and the dynamic rotation model (n=25). The χ² test or Fisher′s exact test, independent-samples t test, or Mann-Whitney U test were used for data analysis. Results showed that the dynamic rotation group achieved significantly higher scores compared with the preceptor-led group in OSCE stations of history taking, physical examination, and clinical reasoning and decision-making [94.50(7.80) vs. 91.25(7.60), 93.00(7.80) vs. 90.50(18.30), 88.00(9.00) vs. 84.50(5.00), all P<0.05]. Self-rated scores in five dimensions (disease diversity, learning interest, interdisciplinary thinking, confidence in independent diagnosis, and doctor-patient communication) and overall satisfaction were also significantly higher in the dynamic rotation group [5.00(0) vs. 4.00(1.00), 5.00(1.00) vs. 3.00(2.00), 5.00(1.00) vs. 3.00(2.00), 4.00(2.00) vs. 3.00(1.00), 5.00(1.00) vs. 3.50(1.00), 5.00(0) vs. 3.50(1.00), all P<0.05], with no significant difference in depth of subspecialty learning between the two groups [5.00(1.00) vs. 4.00(1.00), P=0.190]. The most frequently reported problem in both groups was insufficient teaching time during outpatient clinics. However, the proportion of residents whose clinic hours were shortened due to non-teaching tasks was significantly lower in the dynamic rotation group[8.0%(2/25) vs. 38.5%(10/26), P=0.019 ]. This study indicates that the dynamic rotation model effectively covers a broad range of subspecialty diseases while maintaining the depth of subspecialty learning, and it enhances residents′ clinical practice abilities and learning experience. However, constrained by common factors such as insufficient outpatient teaching time, the homogenization of teaching quality and the formative evaluation system still require continuous improvement.

Key words: Education, medical, Standardized residency training, Internal medicine, Outpatient teaching, Dynamic rotation model