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Table 12 Enablers to Successful Remediation Programs

From: Post graduate remediation programs in medicine: a scoping review

Enablers References
Institutional factors
 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]
Tutor factors
 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 factors
 Learner must be receptive [18, 122]
 Continuous reflection of the experience [4, 69, 100, 104, 109, 133, 150]
Barriers References
Institutional factors
 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]
Tutor factors
 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]
Learner factors
 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]