The inhibiting and enabling factors to failing an underperforming trainee were common across the professions included in this study, across the 10 years of data, and across the educational continuum. We suggest that these results can inform efforts aimed at addressing the failure to fail problem.

Many areas of health IT application remain understudied and the majority of studies have non-significant or mixed findings. Our study suggests that larger, higher quality studies need to be conducted, particularly in the long-term care and ambulatory care settings.

BackgroundPhysicians and physicians‐in‐training have repeatedly demonstrated poor accuracy of global self‐assessments, which are assessments removed from the context of a specific task, regardless of any intervention. Self‐monitoring, an in‐the‐moment self‐awareness of one's performance, offers a promising alternative to global self‐assessment. The purpose of this scoping review is to better understand the state of self‐monitoring in graduate medical education.MethodsWe performed a scoping review following Arksey and O'Malley's six steps: identifying a research question, identifying relevant studies, selecting included studies, charting the data, collating and summarising the results and consulting experts. Our search queried Ovid Medline, Web of Science, PsychINFO, Eric and EMBASE databases from 1 January 1999 to 12 October 2022.ResultsThe literature search yielded 5363 unique articles. The authors identified 77 articles for inclusion. The search process helped create a framework to identify self‐monitoring based on time and context dependence. More than 20 different terms were used to describe self‐monitoring, and only 13 studies (17%) provided a definition for the equivalent term. Most research focused on post‐performance self‐judgements of a procedural skill (n = 31, 42%). Regardless of task, studies focused on self‐judgement (n = 66, 86%) and measured the accuracy or impact on performance of self‐monitoring (n = 41, 71%). Most self‐monitoring was conducted post‐task (n = 65, 84%).ConclusionSelf‐monitoring is a time‐ and context‐dependent phenomenon that seems promising as a research focus to improve clinical performance of trainees in graduate medical education and beyond. The landscape of current literature on self‐monitoring is sparse and heterogeneous, suffering from a lack of theoretical underpinning, inconsistent terminology and insufficiently clear definitions.

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Many athletes use anabolic-androgenic steroids (AAS) for physical enhancement but the magnitude of these gains and associated adverse effects has not been rigorously quantified. MEDLINE, EMBASE, Cochrane, SPORTDiscus, and PsycINFO were searched to identify randomized placebo-controlled trials of AAS in healthy exercising adults that reported one of the following outcomes: muscular strength, body composition, cardiovascular endurance, or power. Two authors appraised abstracts to identify studies for full-text retrieval; these were reviewed in duplicate to identify included studies. Study quality was assessed using the Cochrane method. Data were extracted in duplicate and pooled using the DerSimonian and Laird random effects model and to calculate the ratio of mean outcome improvement where possible. Pooled standardized mean difference (SMD) in muscle strength between AAS and placebo was 0.27 (95% confidence interval, 0.07-0.47; I = 12.7%; 21 studies). Change in strength was 52% greater in the AAS group compared to placebo. The SMD for change in lean mass between AAS and placebo was 0.62 (95% confidence interval, 0.35-0.89; I = 26%; 14 studies). Due to missing data, fat mass, cardiovascular endurance, power, and adverse effects were summarized qualitatively. Only 13 of 25 studies reported adverse effects including increased low density lipoprotein (LDL), decreased high density lipoprotein (HDL), irritability, and acne. In healthy exercising adults, AAS use is associated with a small absolute increase in muscle strength and moderate increase in lean mass. However, the transparency and completeness of adverse effect reporting varied, most studies were of short duration, and doses studied may not reflect actual use by athletes.