Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review: BEME Guide No. 56

Abstract

Background: Clinical teachers often struggle to report unsatisfactory trainee performance, partly because of a lack of evidence-based remediation options.

Objectives: To identify interventions for undergraduate (UG) and postgraduate (PG) medical learners experiencing academic difficulties, link them to a theory-based framework and provide literature-based recommendations around their use.

Methods: This systematic review searched MEDLINE, CINAHL, EMBASE, ERIC, Education Source and PsycINFO (1990–2016) combining these concepts: medical education, professional competence/difficulty and educational support. Original research/innovation reports describing intervention(s) for UG/PG medical learners with academic difficulties were included. Data extraction employed Michie’s Behavior Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraisal used the Mixed Methods Appraisal Tool (MMAT). The authors synthesized extracted evidence by adapting the GRADE approach to formulate recommendations.

Results: Sixty-eight articles met the inclusion criteria, most commonly addressing knowledge (66.2%), skills (53.9%) and attitudinal problems (26.2%), or learner personal issues (41.5%). The most common BCTs were Shaping knowledge, Feedback/monitoring, and Repetition/substitution. Quality appraisal was variable (MMAT 0–100%). A thematic content analysis identified 109 interventions (UG: n = 84, PG: n = 58), providing 24 strong, 48 moderate, 26 weak and 11 very weak recommendations.

Conclusion: This review provides a repertoire of literature-based interventions for teaching/learning, faculty development, and research purposes.

Disclosure statement

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

Plans for updating the review

Five years after publication of this review, the search strategy will be conducted for 2016–2021 to assess the necessity and relevance of an update.

Note

Notes

1 Cognitive skills include clinical reasoning skills, study skills and test-taking skills.

Additional information

Funding

This project was supported by the QMA-CMA-MDM Chair of Educational Leadership in Health Sciences Education, Université Laval, and partly funded by the Fonds Gilles-Cormier, Faculté de médecine, Université Laval.

Notes on contributors

Miriam Lacasse

Miriam Lacasse, MD, MSc, CCFP, FCFP (lead reviewer), is a family physician and associate professor at the Department of Family Medicine and Emergency Medicine, Université Laval (Quebec City, Canada). She co-chairs the QMA-CMA-MDM Educational Leadership Chair in Health Sciences Education and is the evaluation director for the family medicine residency program. She is involved in the teaching of undergraduate and postgraduate medical learners, mostly in the clinical setting. She teaches graduate degree courses about medical education principles and practices as well as scholarship in health sciences education. She is involved in faculty development and counseling regarding learners in difficulty. She has a clinical practice in a family medicine teaching unit. This is her first BEME review.

Marie-Claude Audétat

Marie-Claude Audétat, MPs, MA (Ed), PhD, is an associate professor at the Family medicine Unit (UIGP) and the Unit of Development and Research (UDREM), both at the University of Geneva, Geneva, Switzerland. She is involved in innovative projects regarding clinical reasoning and faculty development in the Unit of Development and Research (UDREM).

Élisabeth Boileau

Elisabeth Boileau, MD, MSc CCFP(EM) FCFP, is an emergency physician and an associate professor at Université de Sherbrooke (Quebec, Canada), where she is the Program Director for the Family Medicine Enhanced Skills residency program.

Nathalie Caire Fon

Nathalie Caire Fon, MD, CCFP (COE), is a family physician and Chair of the Department of Family Medicine and Emergency Medicine at the Université de Montréal (Québec, Canada). Previously she was the Academic Assistant to the Vice-Dean of Undergraduate Studies. Over the years she has been actively involved in providing support for struggling medical students, implementing remediation programs and organizing faculty development workshops on learners with academic difficulties. Her research has led to publications that include a model of clinical reasoning and a guide to help detect clinical reasoning difficulties and provide remediation for students.

Marie-Hélène Dufour

Marie-Hélène Dufour, MD, CCFP, is a family physician and assistant professor at the Department of Family Medicine and Emergency Medicine, Université Laval (Quebec City, Canada). She is member of the promotion committee for the family medicine residency program and the Faculty development assistant director. She is involved in the teaching of undergraduate and postgraduate medical learners, especially in the clinical setting, and she has a special interest in mentorship and learners in difficulty.

Marie-Claude Laferrière

Marie-Claude Laferrière, MSI, is a health sciences librarian at Université Laval (Quebec City, Canada). She provides reference assistance and curricular information literacy instruction for nursing, dental medicine and physiotherapy students, since 2004.

Alexandre Lafleur

Alexandre Lafleur, MD, MSc(Ed), FRCPC, is a specialist in internal medicine involved in clinical teaching of postgraduate and undergraduate medical learners. He co-chairs the QMA-CMA-MDM Educational Leadership Chair in Health Sciences Education at Université Laval. One of his research interests is competency assessment. Dr. Lafleur has developed a competency-based assessment program and a simulation-based program as the assistant program director of the internal medicine and general internal medicine residency programs at Université Laval (Quebec City, Canada).

Ève La Rue

Ève La Rue, B.Éd., is a psychoeducator, currently pursuing a master's degree in psychoeducation in the department of Education at Université Laval (Quebec, Canada). She is also involved in a pilot project on mainstreaming education in nursing at Université Laval. She is mostly interested in the mental health of young adults.

Shirley Lee

Shirley Lee, MD, CCFP(EM), MHSc(Ed), FCFP, is an emergency physician involved in teaching residents and faculty nationally. Previously she was the Education Director for the Schwartz/Reisman Emergency Center, Mount Sinai Hospital, Sinai Health System in Toronto (Canada). She is an associate professor at the University of Toronto. Her areas of interest are in curriculum development, e-learning, knowledge translation tools, assessment and evaluation. In 2016, she became a physician advisor for safe medical care at the Canadian Medical Protective Association.

Mathieu Nendaz

Mathieu Nendaz, MD, MHPE, is an internist at the Geneva University Hospitals and trained in health professions education at the University of Illinois at Chicago. He is currently Director of the Unit of Development and Research (UDREM) and Professor at the Faculty of Medicine, University of Geneva, Switzerland. His research interests include Internal Medicine and Medical Education. In this field, he is particularly interested in decision-making, clinical reasoning, clinical supervision, and interprofessional issues. He is deeply involved in direct teaching, clinical supervision and training, as well as in the development and organization of teaching concepts and medical curriculum.

Emmanuelle Paquette Raynard

Emmanuelle Paquette Raynard, MSI, is a medical librarian and liaison to the Faculty of medicine at Université Laval (Quebec City, Canada). She received her Master of Science in Library and Information Science from Université de Montréal in 2016.

Caroline Simard

Caroline Simard, PhD, is a measurement and evaluation specialist at Université Laval (Quebec City, Canada). In the context of her thesis, she specialized in the measurement and operationalization of university students’ adaptation. She is the research professional for the QMA-CMA-MDM Educational Leadership Chair in Health Sciences Education. Her research interests include developing and validating measurement tools and scoring systems.

Yvonne Steinert

Yvonne Steinert, PhD, is a clinical psychologist and Professor of Family Medicine and Health Sciences Education. She is also the Director of the Institute of Health Sciences Education and the Richard and Sylvia Cruess Chair in Medical Education in the Faculty of Medicine at McGill University. Her educational interests relate to teaching and learning in medicine, the impact of faculty development on the individual and the organization, and the continuing professional development of faculty members. She has authored/co-authored four BEME systematic reviews.

Johanne Théorêt

Johanne Théorêt, MD, MA, CCFP, FCFP, is a family physician and professor in the Department of Family Medicine and Emergency Medicine, Université Laval (Quebec City, Canada), where she is Director of Faculty Development and Director of the Promotion Committee for the Family Medicine Program. She has completed a Master Degree in Health Sciences Education. She is involved in challenging learners faculty development workshops. She is involved in the teaching of postgraduate medical learners, especially in the clinical setting.