The Struggling Trainee: Principles of Effective Remediation

Abstract

Struggling trainees exist in all residency programs across all fields. Remediation, the act of improving deficiencies in struggling trainees, is necessary to promote the graduation of competent physicians. Deficiencies may be primarily cognitive or behavioral, and occasionally physical limitations do arise during residency. Remediation is challenging for all parties involved, and there is a paucity of literature to help guide the most effective process. In this review, we outline key principles of effective remediation of a struggling trainee in the modern era of medical education. A systematic approach that begins early, is consistent, and remains sensitive to a trainee's need for self-reflection in a nonjudgmental culture is essential for successfully remediating a trainee.

Keywords

remediation - feedback - milestones - mentorship - competency

• References

• 1 Steinert Y. The “problem” junior: whose problem is it?. BMJ 2008; 336 (7636): 150-153
• 2 Yao DC, Wright SM. The challenge of problem residents. J Gen Intern Med 2001; 16 (07) 486-492
• 3 Jardine D, Deslauriers J, Kamran S, Khan N, Hamstra S, Edgar L. Milestones Guidebook for Residents and Fellows; 2017. Available at: https://www.acgme.org/Portals/0/PDFs/Milestones/MilestonesGuidebookforResidentsFellows.pdf . Accessed June 25, 2018
• 4 Dupras DM, Edson RS, Halvorsen AJ, Hopkins Jr RH, McDonald FS. “Problem residents”: prevalence, problems and remediation in the era of core competencies. Am J Med 2012; 125 (04) 421-425
• 5 Tabby DS, Majeed MH, Schwartzman RJ. Problem neurology residents: a national survey. Neurology 2011; 76 (24) 2119-2123
• 6 Kalet A, Chou CL. Remediation in Medical Education. New York: Springer; 2014: 17-37
• 7 Kalet A, Chou CL, Ellaway RH. To fail is human: remediating remediation in medical education. Perspect Med Educ 2017; 6 (06) 418-424
• 8 Guerrasio J, Garrity MJ, Aagaard EM. Learner deficits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006-2012. Acad Med 2014; 89 (02) 352-358
• 9 Hauer KE, Ciccone A, Henzel TR. , et al. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med 2009; 84 (12) 1822-1832
• 10 Cleland J, Leggett H, Sandars J, Costa MJ, Patel R, Moffat M. The remediation challenge: theoretical and methodological insights from a systematic review. Med Educ 2013; 47 (03) 242-251
• 11 Dudek NL, Marks MB, Regehr G. Failure to fail: the perspectives of clinical supervisors. Acad Med 2005; 80 (10, Suppl): S84-S87
• 12 Boileau E, St-Onge C, Audétat MC. Is there a way for clinical teachers to assist struggling learners? A synthetic review of the literature. Adv Med Educ Pract 2017; 8: 89-97
• 13 Amory C, Dhand A, Edgar L. , et al. The Neurology Milestone Project; 2015. Available at: http://www.acgme.org/portals/0/pdfs/milestones/neurologymilestones.pdf . Accessed June 25, 2018
• 14 Wu JS, Siewert B, Boiselle PM. Resident evaluation and remediation: a comprehensive approach. J Grad Med Educ 2010; 2 (02) 242-245
• 15 Meier AH, Gruessner A, Cooney RN. Using the ACGME milestones for resident self-evaluation and faculty engagement. J Surg Educ 2016; 73 (06) e150-e157
• 16 American Board of Psychiatry and Neurology, Inc. Requirements for clinical skills evaluation in neurology and child psychiatry; November 2017. Available at: https://www.abpn.com/wp-content/uploads/2015/01/CSE-Neurology-2017.pdf . Accessed June 25, 2018
• 17 American Academy of Neurology. RITE (Residency In-Service Training Examination). Available at: https://www.aan.com/tools-and-resources/residents-fellows/residency-in-service-training-examination-rite/ . Accessed June 25, 2018
• 18 Juul D, Flynn FG, Gutmann L. , et al. Association between performance on neurology in-training and certification examinations. Neurology 2013; 80 (02) 206-209
• 19 Disch J. Rethinking mentoring. Crit Care Med 2018; 46 (03) 437-441
• 20 McBride AB, Campbell J, Woods NF, Manson SM. Building a mentoring network. Nurs Outlook 2017; 65 (03) 305-314
• 21 Lee PR, Marsh EB. Mentoring in neurology: filling the residency gap in academic mentoring. Neurology 2014; 82 (10) e85-e88
• 22 Issenberg SB, Scalese RJ. Simulation in health care education. Perspect Biol Med 2008; 51 (01) 31-46
• 23 Cook DA, Hatala R, Brydges R. , et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA 2011; 306 (09) 978-988
• 24 Hamstra S, Philibert I. Simulation in graduate medical education: understanding uses and maximizing benefits. J Grad Med Educ 2012; 4 (04) 539-540
• 25 Harnof S, Hadani M, Ziv A, Berkenstadt H. Simulation-based interpersonal communication skills training for neurosurgical residents. Isr Med Assoc J 2013; 15 (09) 489-492
• 26 Zabar S, Adams J, Kurland S. , et al. Charting a key competency domain: understanding resident physician interprofessional collaboration (IPC) skills. J Gen Intern Med 2016; 31 (08) 846-853
• 27 Riley B. Using simulation-based medical education to meet the competency requirements for the Single Accreditation System. J Am Osteopath Assoc 2015; 115 (08) 504-508
• 28 Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ 2008; 337: a1961
• 29 Sargeant J, Mann K, Manos S. , et al. R2C2 in action: testing an evidence-based model to facilitate feedback and coaching in residency. J Grad Med Educ 2017; 9 (02) 165-170
• 30 Dohrenwend A. Serving up the feedback sandwich. Fam Pract Manag 2002; 9 (10) 43-46
• 31 French JC, Colbert CY, Pien LC, Dannefer EF, Taylor CA. Targeted feedback in the milestones era: utilization of the Ask-Tell-Ask feedback model to promote reflection and self-assessment. J Surg Educ 2015; 72 (06) e274-e279
• 32 Roze des Ordons A, Cheng A, Gaudet J, Downar J, Lockyer J. Adapting feedback to individual residents: an examination of preceptor challenges and approaches. J Grad Med Educ 2018; 10 (02) 168-175
• 33 Kraut A, Yarris LM, Sargeant J. Feedback: cultivating a positive culture. J Grad Med Educ 2015; 7 (02) 262-264
• 34 Hewson MG, Little ML. Giving feedback in medical education: verification of recommended techniques. J Gen Intern Med 1998; 13 (02) 111-116
• 35 Lucey CR, Boote R. Working with problem residents: a systematic approach. In: Holmboe ES, Hawkins RE. , eds. Practical Guide to the Evaluation of Clinical Competence. Philadelphia, PA: Mosby Elsevier; 2008: 201-216
• 36 Katz ED, Dahms R, Sadosty AT, Stahmer SA, Goyal D. ; CORD-EM Remediation Task Force. Guiding principles for resident remediation: recommendations of the CORD remediation task force. Acad Emerg Med 2010; 17 (Suppl. 02) S95-S103
• 37 Domen RE. Resident remediation, probation, and dismissal basic considerations for program directors. Am J Clin Pathol 2014; 141 (06) 784-790
• 38 Regan L, Hexom B, Nazario S, Chinai SA, Visconti A, Sullivan C. Remediation methods for milestones related to interpersonal and communication skills and professionalism. J Grad Med Educ 2016; 8 (01) 18-23
• 39 Smith JL, Lypson M, Silverberg M. , et al. Defining uniform processes for remediation, probation, and termination in residency training. West J Emerg Med 2017; 18 (01) 110-113