Remediation of the Deficiencies of Physicians Across the Continuum From Medical School to Practice: A Thematic Review of the Literature

Abstract

Despite widespread endorsement of competency-based assessment of medical trainees and practicing physicians, methods for identifying those who are not competent and strategies for remediation of their deficits are not standardized. This literature review describes the published studies of deficit remediation at the undergraduate, graduate, and continuing medical education levels. Thirteen studies primarily describe small, single-institution efforts to remediate deficient knowledge or clinical skills of trainees or below-standard-practice performance of practicing physicians. Working from these studies and research from the learning sciences, the authors propose a model that includes multiple assessment tools for identifying deficiencies, individualized instruction, deliberate practice followed by feedback and reflection, and reassessment. The findings of the study reveal a paucity of evidence to guide best practices of remediation in medical education at all levels. There is an urgent need for multiinstitutional, outcomes-based research on strategies for remediation of less than fully competent trainees and physicians with the use of long-term follow-up to determine the impact on future performance.

An exploratory study of the perspectives of clinical preceptors about difficult student situations during clinical teaching of final year undergraduate nursing students

“…[8] The most successful remediation programs for students have been found to be those which have the four critical elements of: initial assessment using multiple assessment strategies to identify deficiencies; diagnosis of problems and development of an individualized learning plan; instruction which include deliberate practice, feedback and reflection; and reassessment and certification of competence. [29] Preceptors can also be supported and facilitated through group supervision by a nurse lecturer from the nursing school. [30] Using a nurse lecturer to supervise and support preceptors has been reported to enhance CPs positive experiences, pedagogical competences, personal competences and role awareness.…”

« Ils sont carrément incurables » : comment les métaphores des cliniciens enseignants révèlent leur malaise dans la gestion des difficultés de raisonnement clinique de leurs internes

“…La littérature s'accorde à reconnaitre l'importance de mettre en oeuvre des processus de remédiations de telles difficultés [6][7][8][9] . On souligne notamment l'importance d'identifier les difficultés rapidement, de poser un diagnostic pédago-gique de ces difficultés, d'en identifier la source ou les causes, enfin de mettre en oeuvre un plan de remé-diation et de suivi, à la fois personnalisé et spécifique, des difficultés identifiées [8][9][10][11][12] .…”

Why Don't We Dismiss Residents?

“…Review of the literature demonstrates a dearth of literature and/or evidence of successful models. 4 The ACGME provides residents with a due process that often, as the authors allude to, brings in the legal system, which makes the dismissal process time and labor intensive. Although a program may be maintaining exact, detailed records of the performance issues, residents challenge or appeal their dismissals, which makes programs reticent to pursue this course of action.…”