Managing residents in difficulty within CBME residency educational systems: a scoping review

Abstract

Background: Best practices in managing residents in difficulty (RID) in the era of competency-based medical education (CBME) are not well described. This scoping review aimed to inventory the current literature and identify major themes in the articles that address or employ CBME as part of the identification and remediation of residents in difficulty. Methods: Articles published between 2011 to 2017 were included if they were about postgraduate medical education, RID, and offered information to inform the structure and/or processes of CBME. All three reviewers performed a primary screening, followed by a secondary screening of abstracts of the chosen articles, and then a final comprehensive sub-analysis of the 11 articles identified as using a CBME framework. Results: Of 165 articles initially identified, 92 qualified for secondary screening; the 63 remaining articles underwent full-text abstracting. Ten themes were identified from the content analysis with "identification of RID" (41%) and "defining and classifying deficiencies" (30%) being the most frequent. In the CBME article sub-analysis, the most frequent themes were: need to identify RID (64%), improving assessment tools (45%), and roles and responsibilities of players involved in remediation (27%). Almost half of the CBME articles were published in 2016-2017. Conclusions: Although CBME programs have been implemented for many years, articles have only recently begun specifically addressing RID within a competency framework. Much work is needed to describe the sequenced progression, tailored learning experiences, and competency-focused instruction. Finally, future research should focus on the outcomes of remediation in CBME programs.

Post graduate remediation programs in medicine: a scoping review

“…Personal factors contributing to the need for remediation include: mental health concerns including anxiety, depression and stress [ 6 , 11 , 65 , 66 , 71 , 74 , 85 , 93 – 102 ], poor physical health [ 74 , 97 , 99 ] learning disability or difficulties (e.g. conceptualisation, time management or assessment anxiety) [ 6 , 65 , 85 , 93 , 96 , 98 , 100 , 102 – 104 ] substance abuse [ 65 , 66 , 68 , 85 , 93 , 99 , 105 , 106 ] personality disorders [ 88 , 95 ] personal relationship concerns such as divorce [ 65 , 66 , 74 , 94 , 101 ] lack of resilience, and setbacks that threaten one’s identity [ 92 , 106 ] …”

“…mental health concerns including anxiety, depression and stress [ 6 , 11 , 65 , 66 , 71 , 74 , 85 , 93 – 102 ],…”

“…learning disability or difficulties (e.g. conceptualisation, time management or assessment anxiety) [ 6 , 65 , 85 , 93 , 96 , 98 , 100 , 102 – 104 ]…”

A Survey on Changes to the Canadian Anatomical Pathology Certification Examination Due to Coronavirus Disease 2019 and Implications for Competency-Based Medical Education

“…Our findings raise a potential lack of confidence in residency training programs to tackle the problem of failureto-fail, which is consistent with other studies noting that residency programs struggle with remediating and potentially failing residents. 24,25,32 However, in all, early identification of residents in difficulty is essential for remediation 33 and mitigating the problem of failure-to-fail should be addressed at the program level.…”

Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors

“…This focus on achieving milestones on the path to fulfilling competency-based medical education (CBME) has changed the way FM-RPs evaluate residents. 1,11,12 Neither the ACGME, the Association of Family Medicine Residency Directors (AFMRD), nor the Society of Teachers of Family Medicine (STFM) have established formal remediation standards or guidelines. The remediation process varies greatly across and within specialties, in part due to the inconsistencies in remediation definitions and procedures.…”