Post graduate remediation programs in medicine: a scoping review

Abstract

Background Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the ‘deliberate practice of improving performance through practising beyond one’s comfort level under guidance’. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. Methods Krishna’s Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA’s Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. Results The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. Conclusion Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy’s Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation’s role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.

Systematic scoping review on moral distress among physicians

“…We believe that the findings of the RToP-MD tool 203 will help direct a holistic, appropriate, accessible, personalised, longitudinal and timely support to physicians from members of a multidisciplinary mentoring, 204 supervision 205 and or coaching team which would also include a psychologist and or counsellor. 206 …”

“…We believe that the findings of the RToP-MD tool 203 will help direct a holistic, appropriate, accessible, personalised, longitudinal and timely support to physicians from members of a multidisciplinary mentoring, 204 supervision 205 and or coaching team which would also include a psychologist and or counsellor. 206 The proposed framework for a RToP-MD tool also serves to highlight the shortfalls of the current management of MD (online supplemental materials D and E) that tends to be singular, short term and impersonal when what is required is a holistic, appropriate, accessible, personalised, longitudinal and timely approach to overcome MD.…”

Physician-patient boundaries in palliative care

“…This portfolio-based program echoes Fronek et al [ 48 ]’s calls for “a model of training that can meet multi-level learning needs of practitioners” that “is delivered along the professional life span[ing] and incorporate[ing] external reinforcement, inclusive of peer support and supervision opportunities”. This portfolio-based approach must be supplemented by safe communication channels and a structured mentorship program within a psychologically ‘safe’ practice environment [ 49 , 50 ].…”

Understanding mentoring relationships between mentees, peer and senior mentors

“…The Tool design SEBA methodology designed around Krishna’s Systematic Evidence Based Approach (SEBA) was adopted to guide this two-staged study (Fig. 2 ) [ 1 , 4 , 8 , 19 , 21 , 29 – 32 , 36 , 38 – 42 ]. The Tool design SEBA methodology is detailed in Appendix 1 .…”