Remediation in Canadian medical residency programs: Established and emerging best practices

Abstract

Background: Policies to guide remediation in postgraduate medical education exist in all Canadian medical schools. This study examines concordance between these policies and processes, and published “best practices” in remediation.

Method: We conducted a literature review to identify best practices in the area of remediation. We then reviewed remediation policies from all 13 English medical schools in Canada other than our own and conducted interviews with key informants from each institution. Each policy and interview transcript pair was then reviewed for evidence of pre-defined “best practices.” Team members also noted additional potential policy or process enablers of successful remediation.

Results: Most policies and processes aligned with some but not all published best practices. For instance, all participating schools tailored remediation strategies to individual resident needs, and a majority encouraged faculty-student relationships during remediation. Conversely, few required the teaching of goal-setting, strategic planning, self-monitoring, and self-awareness. In addition, we identified avoidance of automatic training extension and the use of an educational review board to support the remediation process as enablers for success.

Discussion: Remediation policies and practices in Canada align well with published best practices in this area. Based on key informant opinions, flexibility to avoid training extension and use of an educational review board may also support optimal remediation outcomes.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Remediation: A targeted educational program intended to assist postgraduate medical learners who require extra or enhanced training in order to achieve competency in their discipline.

Hauer KE, Ciccone A, Henzel TR, Katsufrakis P, Miller SH, Norcross WA, Irb DM. 2009. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Academic Medicine. 84(12):1822-1832.

Key informant interviews: Qualitative in-depth interviews with individuals who have extensive first-hand knowledge of the interview topic.

DiCicco‐Bloom B, & Crabtree BF. 2006. The qualitative research interview. Medical education 40(4):314–321.

Template analysis: An analytic technique applied to qualitative data in which themes may be identified in advance and form a coding template. Qualitative data (e.g. interview transcripts) are analyzed for the presence of themes as defined in the coding template.

King N. 2012. Doing template analysis. In: Symon G, Cassell C, editors. Qualitative Organizational Research: Core Methods and Current Challenges. London: Sage Publications; 426–450.

Additional information

Notes on contributors

Cindy Shearer

Cindy Shearer, PhD, is an Evaluation Specialist and Manager of the Medical Education Teaching and Research Office in Postgraduate Medical Education at Dalhousie. She employs qualitative and quantitative research strategies to inform the development and improvement of educational activities. She coordinated and contributed to all aspects of this project.

Mark Bosma

Mark Bosma, MD, FRCPC, is an Assistant Professor in the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia. He works clinically as a geriatric psychiatrist, and serves as the Postgraduate Program Director for the Psychiatry Residency Program at Dalhousie. He participated in the planning, interviewing, coding, and editing phases of this project.

Fiona Bergin

Fiona Bergin, MD, CCFP, LLM, MEd, is an Assistant Professor in the Department of Family Medicine and practices family medicine. She currently serves as the Halifax Site Director for Dalhousie's Family Medicine Postgraduate Training program. She participated in all aspects of this project.

Joan Sargeant

Joan Sargeant, PhD, is a Professor in the Division of Medical Education and Continuing Professional Development, Dalhousie University. She has a special interest in formative assessment and how best to engage learners in feedback discussions and coaching to enable their longitudinal progression. She provided valuable guidance to the research team and participated in coding, analysis, and editing.

Andrew Warren

Andrew Warren, MD, MEd, FRCPC, is an Associate Professor in the Department of Pediatrics at Dalhousie University in Halifax, Nova Scotia. He works clinically as a pediatric cardiologist and serves as the Associate Dean for Postgraduate Medical Education at Dalhousie. He participated in the planning, interviewing, coding, and editing phases of this project.