Table 12 Enablers to Successful Remediation Programs

 Remediation coordinator for streamlining of processes and outcomes

[9, 72, 89, 91, 92, 96, 100, 105, 110, 122, 123]

 Screening for genuine shortcomings with valid and reliable tools and at appropriate timings

[81, 84, 109, 110, 126, 137, 146]

 Understand the basis for the need for remediation

[9, 81, 122]

 Use of continuous improvement processes

[85, 126, 127, 146]

 Provide resources such as remediation toolkits, guidelines, faculty development sessions and workshops

[9, 106, 108, 125, 148]

 Having a framework of remediation that clearly defines each stage of remediation for documentation, transparency and communication

[10, 64, 107, 122, 123]

 Setting expectations and goals for physician performance

[4, 66, 75, 108, 114, 122, 137, 145]

 Collaborative negotiation of remediation plans and goals, reasons for lapses and consequences of failing remediation

[4, 10, 66, 67, 72, 84, 88, 97, 98, 122, 128, 139, 149, 150]

 Training mentors and supervisors how to assess, provide meaningful feedback and remediate

[9, 70, 82, 84, 95, 99, 100, 114, 141, 145, 147, 151]

 Provide contact with different interdisciplinary experts to allow for a more holistic remediation process

[10, 110]

 Protected time

[84, 138, 152]

 Increased emphasis on remediation by institutions

[152]

 Continuous/frequent monitoring of trainee competencies

[9, 83, 105, 115, 146]

 Reframe remediation (not as a punishment)

[80, 122, 146]

 Further evaluation of remediation tools’ effectiveness

[101, 103]

 Tight supervision with follow-up

[94, 96, 108, 113, 145, 148]

 Faculty as role models

[108, 111, 114]

 Address trainee’s personal problems if possible

[84, 122]

 Empower the learner to learn at his own pace, self-directed

[9, 70, 133, 146]

 Learner must be receptive

[18, 122]

 Continuous reflection of the experience

[4, 69, 100, 104, 109, 133, 150]

Barriers

References

 Lack of standardisation/evidence-based remediation programs/established theory

[9, 10, 62, 64, 73, 76,77,78, 89, 101, 107, 113, 114, 131, 139, 153]

 Time-consuming, resource-expensive

[9, 62, 69, 72, 85, 89, 99, 103, 109, 110, 112, 122, 131, 147, 154]

 Suboptimal screening and evaluation methods

[62, 72, 73, 78, 80, 95, 99, 122, 148, 154]

 Wrongly identifying residents

[10, 70, 84]

 Lack of documentation and clear process to be followed

[63, 73, 77, 95, 123, 136, 139]

 Insufficient monitoring of resident performance

[62, 63, 77, 83]

 Lack of institutional support

[9, 77, 140, 155]

 Progress and outcomes of trainees can be subjective

[10, 84, 108]

 Faculty unwilling to participate in supervising remediation programs

[69, 72, 112, 138]

 Reluctance of faculty to fail poorly performing trainees

[62, 95, 107, 115, 122, 136, 154]

 Faculty not trained to give feedback

[62, 95, 122, 148, 154]

 Emotional drain on faculty given difficulties in remediating trainees

[9, 72, 99, 131]

 Learners reluctant to be identified as needing remediation, lack of self-awareness

[65, 66, 69, 73, 88, 91, 92, 98, 100, 114, 122, 127, 137, 150, 155]

 High clinical responsibilities of learners

[63, 99, 137]

 Some learner deficiencies are not amenable with remediation given incompatible inherent attitudes and learning styles

[61, 90, 122]