Background: Clinical teachers often struggle to report unsatisfactory trainee performance, partly because of a lack of evidence-based remediation options.Objective: To identify interventions for undergraduate (UG)/postgraduate (PG) medical learners experiencing academic difficulties, link them to a theory-based framework and provide literature-based recommendations around their use.Methods: This systematic review searched MEDLINE, CINAHL, EMBASE, ERIC, Education Source and PsycINFO (1990PsycINFO ( -2016 combining these concepts: medical education, professional competence/difficulty and educational support. Original research/innovation reports describing intervention(s) for UG/PG medical learners with academic difficulties were included. Data extraction employed Michie's Behaviour Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraisal used the Mixed Methods Appraisal Tool (MMAT). The authors synthesized extracted evidence by adapting the GRADE approach to formulate recommendations.Results: 68 articles met the inclusion criteria, most commonly addressing knowledge (66.2%), skills (53.9%) and attitudinal problems (26.2%), or learner personal issues (41.5%). The most common BCTs were Shaping knowledge, Feedback/monitoring, and Repetition/substitution. Quality appraisal was inconstant (MMAT 0-100%). A thematic content analysis identified 109 interventions (UG: n=84, PG: n=58), providing 24 strong, 48 moderate, 26 weak and 11 very weak recommendations. Conclusion:This review provides a repertoire of literature-based interventions for teaching/learning, faculty development, and research purposes.

Struggling medical trainees pose a challenge to clinical teachers, since these learners warrant closer supervision that is time-consuming and competes with time spent on patient care. Clinical teachers’ perception that they are ill equipped to address learners’ difficulties efficiently may lead to delays or even lack of remediation for these learners. Because of the paucity of evidence to guide best practices in remediation, the best approach to guide clinical teachers in the field remains to be established. We aimed to present a synthetic review of the empirical evidence and theory that may guide clinical teachers in their daily task of supervising struggling learners, reviewing current knowledge on the challenges and solutions that have been identified and explored. A computerized literature search was performed using Medline, Embase, Education Resources Information Center, and Education Source, after which final articles were selected based on relevance. The literature reviewed provided best evidence for clinical teachers to address learners’ difficulties, which is presented in the order of the four steps inherent to the clinical approach: 1) detecting a problem based on a subjective impression, 2) gathering and documenting objective data, 3) assessing data to make a diagnosis, and 4) planning remediation. A synthesized classification of pedagogical diagnoses is also presented. This review provides an outline of practical recommendations regarding the supervision and management of struggling learners up to the remediation phase. Our findings suggest that future research and faculty development endeavors should aim to operationalize remediation strategies further in response to specific diagnoses, and to make these processes more accessible to clinical teachers in the field.

Objectives Educators and researchers recently implemented developmental progress assessment (DPA) in the context of competency‐based education. To reap its anticipated benefits, much still remains to be understood about its implementation. In this study, we aimed to determine the nature and extent of the current evidence on DPA, in an effort to broaden our understanding of the major goals and intended outcomes of DPA as well as the lessons learned from how it has been executed in, or applied across, educational contexts. Methods We conducted a scoping study based on the methodology of Arksey and O’Malley. Our search strategy yielded 2494 articles. These articles were screened for inclusion and exclusion (90% agreement), and numerical and qualitative data were extracted from 56 articles based on a pre‐defined set of charting categories. The thematic analysis of the qualitative data was completed with iterative consultations and discussions until consensus was achieved for the interpretation of the results. Results Tools used to document DPA include scales, milestones and portfolios. Performances were observed in clinical or standardised contexts. We identified seven major themes in our qualitative thematic analysis: (a) underlying aims of DPA; (b) sources of information; (c) barriers; (d) contextual factors that can act as barriers or facilitators to the implementation of DPA; (e) facilitators; (f) observed outcomes, and (g) documented validity evidences. Conclusions Developmental progress assessment seems to fill a need in the training of future competent health professionals. However, moving forward with a widespread implementation of DPA, factors such as lack of access to user‐friendly technology and time to observe performance may render its operationalisation burdensome in the context of competency‐based medical education.

Medical education research has unique characteristics that raise their own set of ethical issues, which differ significantly from those commonly found in clinical research. In contexts where researchers have a dual role as teachers, free consent to participate in research may be undermined and students' data must be kept confidential from faculty who play any role in their academic or professional path. Faculty members who recruit students as research subjects within their institution for education research should pay particular attention to ensure students' consent to participate is indeed free and continuous and that their privacy is adequately protected. A good understanding of ethical standards and of the appropriate strategies to fulfill them is essential to conduct ethical medical education research and to ensure ethics approval is obtained. These twelve tips draw from the Declaration of Helsinki, from the ICMJE recommendations and from the example of their application to medical education research in a Canadian and North American context. They aim to act as a reminder and as a guide to address the main ethical issues which should be given proper consideration when designing a study involving students as subjects for medical education research.

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Background Although clinical teachers can often identify struggling learners readily and reliably, they can be reluctant to act upon their impressions, resulting in failure to fail. In the absence of a clear process for identifying and remediating struggling learners, clinical teachers can be put off by the prospect of navigating the politically and personally charged waters of remediation and potential failing of students. Methods To address this gap, we developed a problem-solving algorithm to support clinical teachers from the identification through the remediation of learners with clinical reasoning difficulties, which have significant implications for patient care. Based on this algorithm, a mobile application (Pdx) was developed and assessed in two emergency departments at a Canadian university, from 2015 to 2016, using interpretive description as our research design. Semi-structured interviews were conducted before and after a three-month trial with the application. Interviews were analysed both deductively, using pre-determined categories, and inductively, using emerging categories. Results Twelve clinical teachers were interviewed. Their experience with the application revealed their need to first validate their impressions of difficulties in learners and to find the right words to describe them before difficulties could be addressed. The application was unanimously considered helpful regarding both these aspects, while the mobile format appeared instrumental in allowing clinical teachers to quickly access targeted information during clinical supervision. Conclusions The value placed on verifying impressions and finding the right words to pinpoint difficulties should be further explored in endeavours that aim to address the failure to fail phenomenon. Moreover, just-in-time mobile solutions, which mirror habitual clinical practices, may be used profitably for knowledge transfer in medical education, as an alternative form of faculty development. Electronic supplementary material The online version of this article (10.1186/s12909-019-1558-2) contains supplementary material, which is available to authorized users.