{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:51:38Z","timestamp":1791352298406,"version":"4.3.1"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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\u2010generated evaluations across inpatient and acute\u2010care specialties in a residency program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Residents in a large pediatric residency program complete anonymous end\u2010of\u2010rotation evaluations, rating rotations on a 5\u2010point scale with optional free\u2010text commentary. This study analyzed inpatient and acute\u2010care rotation evaluations submitted July 2019\u2013June 2024 with a \u201cvery highly\u201d or \u201cvery poorly\u201d rating and an associated free\u2010text 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\u2010determination theory (SDT). SDT was used as a guiding framework, and thematic saturation was confirmed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 712 \u201cvery highly\u201d rated and 106 \u201cvery poorly\u201d 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\u2010quality teaching, educational context, and patient\u2010based learning. Relatedness was enhanced by communication, team culture, and role clarity. Psychological safety and trainee team inclusion impacted all SDT domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70503","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:45:58Z","timestamp":1791351958000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["What makes or breaks a rotation? An analysis of rotation evaluations from pediatric residents"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3742-2079","authenticated-orcid":false,"given":"Mollie G.","family":"Wasserman","sequence":"first","affiliation":[{"name":"Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7852-8329","authenticated-orcid":false,"given":"Laura E.","family":"Chiel","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA"},{"name":"School of Health Professions Education (SHE) Maastricht University Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3860-7110","authenticated-orcid":false,"given":"Carolyn H.","family":"Marcus","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"5","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/ACM.0b013e318212c2c9","article-title":"Lost in transition: the experience and impact of frequent changes in the inpatient learning environment","volume":"86","author":"Bernabeo EC","year":"2011","journal-title":"Acad Med"},{"issue":"1","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1097\/SLA.0000000000004796","article-title":"Comprehensive characterization of the general surgery residency learning environment and the association with resident burnout","volume":"274","author":"Ellis RJ","year":"2021","journal-title":"Ann 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