Resident Remediation: Processes and Outcomes over a 16-year period at McMaster University

Abstract

Resident remediation is often guided at the residency program level, however some institutions also have designated bodies within their departments of postgraduate medicine for this purpose, such as the Educational Advisory Board (EAB) at McMaster University. Research from the postgraduate department level has been limited, and this study aims to better understand remediation in postgraduate training with two primary objectives: 1) to review remediation processes and practices at McMaster University, from the standpoint of the postgraduate medical Education Advisory Board (EAB), and 2) to describe the characteristics and relevant outcomes for residents who underwent remediation at McMaster. A total of 85 residents were suitable for analysis and the majority of these residents were international medical graduates (62%). Most had knowledge or medical expert weaknesses (92%) while 51% of residents had behavioural (e.g. professionalism, communication) weaknesses, and a total of 42% of residents had both. A number of residents (25%) had a serious coexistent medical or psychosocial factor that contributed to the need for remediation. Remediation strategies were better described for knowledge weaknesses than for behavioural weaknesses, and there was more consistency in the remediation strategies used for knowledge weaknesses. The most commonly implemented strategies for remediation of behavioural weaknesses involved using resources that were external to the department of postgraduate medicine. The majority of residents completed their training programs at 71%. None of the analyzed predictors were found to be statistically significant for program completion, however this study was underpowered to find such predictors given the convenience sample size. This study represents the most comprehensive review of resident remediation at a single institution and it underscores the need for improved documentation and review of remediation practices at institutions. It also raises important questions regarding the effectiveness of remediation and it highlights the critical nature of accurately diagnosing a learner’s deficiencies and providing targeted remediation strategies.