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

Abstract

Background and Objectives: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges. Methods: This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation. Results: Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. A majority (242/265, 91%) of residents undergoing remediation were successful within 12 months. The three most important tools to improve remediation were an accessible remediation toolkit (50%), formal remediation recommendations from national family medicine organizations (20%), and on-site faculty development and training (19%). The top-two challenges to the remediation process were a lack of documented evaluations to trigger remediation and a lack of faculty knowledge and skills with effective remediation strategies. Conclusions: Residents needing remediation are common, but most were successfully remediated within 12 months. Program directors wanted access to a standardized toolkit to help guide the remediation process.

Identification and Accommodation of ADHD in Family Medicine Residencies: A CERA Study

“…5 ADHD was the most prevalent disability in their sample. Nouri and colleagues surveyed a national sample of practicing physicians and found that of those with a documented disability (3% of the total sample), 10.4% endorsed having an ADHD diagnosis. Physicians with disabilities are more likely than their peers without disabilities to face discrimination and harassment.…”

“…8 Because stakeholders in medical education perceive "accountability and conscientiousness" as a subcompetency of professionalism, 9 concerns in these areas may be observed as professionalism lapses. Given that professionalism is the most common reason for remediation in family medicine residency programs, 10 residents with ADHD who do not request accommodation may face remediation for concerns about professionalism.…”

Benefits and Challenges of a Global Health Scholars Track for Family Medicine Residents

“…A survey of US family medicine residency directors found that 74.3% (191 of 257) reported that their program offers international and/or domestic global health experiences (Hernandez et al, 2016). In almost half of these programs (47.5%), residents paid for their own international global health-related expenses; 8.8% and 6.6% of these residency programs paid for the international trips outright or via special grants, respectively (Hernandez et al, 2016).…”

“…A survey of US family medicine residency directors found that 74.3% (191 of 257) reported that their program offers international and/or domestic global health experiences (Hernandez et al, 2016). In almost half of these programs (47.5%), residents paid for their own international global health-related expenses; 8.8% and 6.6% of these residency programs paid for the international trips outright or via special grants, respectively (Hernandez et al, 2016). According to a survey of fellowship directors and designees, the most common single-specialty global health fellowship programs in North America were in emergency medicine (23/50) and family medicine (22/50) (Evensen et al, 2019).…”

‘The program director's word … it's stronger than the word of God’: Epistemic injustice revealed through narratives of remediated graduate medical education residents

“…2,6,8,[17][18][19][20] In these studies, educator perspectives are privileged, with several reports describing PD perspectives of remediation. [21][22][23][24][25][26][27][28] Learner underperformance, from the perspective of physician educators, was perceived as an inability or unwillingness to engage in programmatic learning. 27 Despite resident physicians being key stakeholders in their learning and performance, there is little published from the remediated learner's perspective.…”