Preserving the Educational Value of Off-Service and Cross-Disciplinary Experiences in Competency-Based Residency Training.

Abstract

As residency programs continue to adapt educational structures to support specialty-specific outcomes and workplace-based assessments, some learning experiences that were traditionally mandatory, including off-service and cross-disciplinary rotations, have been modified to improve efficiency and alignment with specialty outcomes and competencies. However, changing such experiences without appropriately replacing the learning they afforded disconnects clinical learners from the broader educational value historically served by these experiences. In this paper, we describe the educational value of off-service and cross-disciplinary learning opportunities in postgraduate medical education. We argue that these experiences have historically contributed not only to discipline-specific competence, but also to broader forms of learning, including understanding how adjacent specialties organize care, developing familiarity across services, appreciating patient transitions across settings, and building collaborative approaches to clinical work. Using the Systems Engineering Initiative for Patient Safety framework as a conceptual lens, we propose that these educational experiences support physician development through interconnected learning processes that are not always easily represented within specialty-specific assessment structures. Rather than focusing on preserving prior rotation models, we invite clinicians and educators to consider how to preserve elements of off-service and cross-disciplinary rotations, which remain important for preparing clinical learners for practice.