Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review update: BEME Guide No. 85

Abstract

Background

Clinical teachers often struggle to record trainee underperformance due to lacking evidence-based remediation options.

Objectives

To provide updated evidence-based recommendations for addressing academic difficulties among undergraduate and postgraduate medical learners.

Methods

A systematic review searched databases including MEDLINE, CINAHL, EMBASE, ERIC, Education Source, and PsycINFO (2016–2021), replicating the original Best Evidence Medical Education 56 review strategy. Original research/innovation reports describing intervention(s) for medical learners with academic difficulties were included. Data extraction used Michie’s Behaviour Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraised used the Mixed Methods Appraisal Tool (MMAT). Authors synthesized extracted evidence by adapting GRADE approach to formulate recommendations.

Results

Eighteen articles met the inclusion criteria, primarily addressing knowledge (66.7%), skills (66.7%), attitudinal problems (50%) and learner’s personal challenges (27.8%). Feedback and monitoring was the most frequently employed BCT. Study quality varied (MMAT 0–100%). We identified nineteen interventions (UG: n = 9, PG: n = 12), introducing twelve new thematic content. Newly thematic content addressed contemporary learning challenges such as academic procrastination, and use of technology-enhanced learning resources. Combined with previous interventions, the review offers a total dataset of 121 interventions.

Conclusion

This review offers additional evidence-based interventions for learners with academic difficulties, supporting teaching, learning, faculty development, and research efforts.

Keywords:

• Academic performance
• clinical competence
• education
• medical
• graduate
• education
• medical
• undergraduate
• remediation

Acknowledgements

This is an update of the systematic review BEME 56. Contributors to the earlier version include Nathalie Caire Fon, Marie-Hélène Dufour, Ève La Rue, Emmanuelle Paquette Raynard, Caroline Simard and Johanne Théorêt.

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

After the publication of this update, the search strategy will be conducted periodically using a priority-setting approach to assess the necessity and relevance of a future update.

Box 1 Teaching scenario with a postgraduate learner.

Sabrina, a 24-year-old graduate currently in her PY1 in family medicine, demonstrates advanced clinical reasoning, patient management, and collaboration skills. Despite excelling in these areas, she faces challenges in promptly submitting charting to supervisors. Although her documentation is efficient and comprehensive, it takes days to weeks, even after multiple reminders, before “closing” her notes. These persistent delays have raised concerns among clinical teachers, particularly due to its potential impact on patient safety.

The MedEd DxTx application can assist in identifying learners’ symptoms or educational diagnoses and subsequently identify relevant remediation interventions, each associated with its corresponding level of recommendation. In this teaching scenario, the learner’s symptoms, educational diagnoses, and relevant remediation interventions are identified through:

• Learner’s symptoms according to MedEd DxTx application

  • Quality improvement

    • Does not make personal adjustments in spite of repeated messages from others about performance in the workplace

    • Does not actively look at his/her practice with assessment tools, and implement appropriate changes

  • Charting

    • Does not do charting in a timely fashion, therefore leading to increased risk of inaccuracies and lost information, and delaying availability of information for others involved in care

    • Allows chart completion to back up unreasonably

• Learner’s diagnoses according to MedEd DxTx application

  • Knowledge deficits

    • Work setting knowledge

  • Skills deficits

    • Structural skill

  • Attitudinal problems

    • Professional attitude

• Selection of relevant interventions with their level of recommendation according to MedEd DxTx application

  • Learning/remediation plan (Strong)

  • Daily management reviews by quality insurance coordinator (Moderate)

  • Faculty advisor meeting with learning plan (Moderate)

  • Informal discussion with program director (Moderate)

  • Reflection (Moderate)

  • Warning letter (Moderate)

  • Learning contract (Weak)

  • Point system to document unprofessional behavior (Weak)

  • Review of behaviours (Weak)

  • Reflective writing to remediate professionalism (Very weak)

In response to Sabrina’s challenges, clinical teachers planned an informal discussion with the program site director. Through this conversation, Sabrina understood the importance of promptly submitting charting to supervisors for patient safety. Following this meeting, Sabrina gained insight into professionalism competency, prompting her to improve her timeliness in documenting her patient care.

Additional information

Funding

This project was supported by the CMA-MD Chair of Educational Leadership in Health Sciences Education, Université Laval.

Notes on contributors

Julie Montreuil

Julie Montreuil, MD, PharmD (lead reviewer), was a family medicine resident at Université Laval (Quebec, Canada) at the time of the project. She is now a master’s student for the Master of Health Professions Education programme, offered by the School of Health Professions Education (SHE) at Maastricht University (Maastricht, Netherlands). She has a clinical practice in a family medicine teaching unit in the Université Laval network (Quebec, Canada). This is her first BEME review.

Miriam Lacasse

Miriam Lacasse, MD, MSc, CCFP, FCFP, is a family physician and professor at the Department of Family Medicine and Emergency Medicine, Université Laval (Quebec, Canada). She is Clerkship director for the undergraduate medical program at Laval Université. She is involved in the teaching of undergraduate and postgraduate medical learners, mostly in the clinical setting. She teaches graduate degree courses in medical education and health sciences education. She has a clinical practice in a family medicine teaching unit. She was the lead author of the original BEME 56 review.

Marie-Claude Audétat

Marie-Claude Audétat, MPs, MA (Ed), PhD, is an associate professor at the University Institute for primary care (IuMFE) and the Unit of Development and Research (UDREM), both at the University of Geneva, Geneva, Switzerland. She is deputy director of the UDREM and leads or is involved in various innovative projects regarding clinical reasoning and faculty development.

Élisabeth Boileau

Elisabeth Boileau, MD M.Sc. LL.M. CCFP(EM) FCFP, is an associate professor at Université de Sherbrooke (Quebec, Canada), where she is the Family Medicine Program Director.

Marie-Claude Laferrière

Marie-Claude Laferrière, MSI, is a health sciences librarian and liaison to the Faculty of Nursing and the Faculty of Dentistry at Université Laval (Quebec, Canada).

Alexandre Lafleur

Alexandre Lafleur, MD, MHPE, FRCPC, is an associate professor of medicine at Université Laval (Canada) and specialist in internal medicine involved in clinical teaching of postgraduate and undergraduate medical learners. He co-chaired the QMA-CMA-MDM Educational Leadership Chair in Health Sciences Education. One of his research interests is competency-based postgraduate medical education.

Shirley Lee

Shirley Lee, MD, CCFP(EM), MHSc(Ed), FCFP, CPC(HC), ACC, is an associate professor at the University of Toronto and emergency physician. She is a Special Advisor for Curriculum Design and Development at the Canadian Medical Protective Association and is the current Chair for the Coalition for Physician Learning and Practice Improvement, Canada. Her areas of interest are in curriculum development, digital education technology and organizational coaching.

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 and Vice-dean 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.

Yvonne Steinert

Yvonne Steinert, PhD, is a clinical psychologist and Professor of Family Medicine and Health Sciences Education. She is also the Richard and Sylvia Cruess Chair in Medical Education and the former Director of the Institute of Health Sciences 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 five BEME systematic reviews.