Early Detection and Remediation of Problem Learners

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

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.

The Lake Wobegon effect is real: All general surgery residents appear to be better than average

Resident evaluations remain controversial. Metric systems are employed to objectify evaluations. Our institution adopted the question "Relative to all other trainees that I have supervised over my career, I place this individual's performance in the following percentile" with the goal of objectifying the evaluations. We report the distribution and the correlation of this value to other evaluation parameters.

Design

Retrospective single-institution review of general surgery resident evaluations (2008-2020). Demographic characteristics, level of training and internal evaluation variables were collected. Percentile distribution and association between subjective and objective measures were analyzed.

Results

3117 evaluations (116 residents) were reviewed. 96% had the percentile question answered. Faculty ranked 68% of residents at or above 80th percentile. Faculty subjective evaluation on residents' overall performance and technical skills correlate with resident objective assessment scores in PGY-1 and -2 but not in PGY-3 to PGY-5.

Conclusion

Rank failed to produce a bell-shaped curve, remaining right-skewed; indicating grade inflation. The lack of association between variables indicates that both assessments remain useful for residency programs. Work is needed to benchmark evaluations, ensuring proper feedback about performance.