Table 12.

Enablers to Successful Remediation Programs

Enablers	References
Institutional factors
Remediation coordinator for streamlining of processes and outcomes	[9, 72, 89, 91, 92, 96, 100, 105, 110, 122, 123]
Screening for genuine shortcomings with valid and reliable tools and at appropriate timings	[81, 84, 109, 110, 126, 137, 146]
Understand the basis for the need for remediation	[9, 81, 122]
Use of continuous improvement processes	[85, 126, 127, 146]
Provide resources such as remediation toolkits, guidelines, faculty development sessions and workshops	[9, 106, 108, 125, 148]
Having a framework of remediation that clearly defines each stage of remediation for documentation, transparency and communication	[10, 64, 107, 122, 123]
Setting expectations and goals for physician performance	[4, 66, 75, 108, 114, 122, 137, 145]
Collaborative negotiation of remediation plans and goals, reasons for lapses and consequences of failing remediation	[4, 10, 66, 67, 72, 84, 88, 97, 98, 122, 128, 139, 149, 150]
Training mentors and supervisors how to assess, provide meaningful feedback and remediate	[9, 70, 82, 84, 95, 99, 100, 114, 141, 145, 147, 151]
Provide contact with different interdisciplinary experts to allow for a more holistic remediation process	[10, 110]
Protected time	[84, 138, 152]
Increased emphasis on remediation by institutions	[152]
Continuous/frequent monitoring of trainee competencies	[9, 83, 105, 115, 146]
Reframe remediation (not as a punishment)	[80, 122, 146]
Further evaluation of remediation tools’ effectiveness	[101, 103]
Tutor factors
Tight supervision with follow-up	[94, 96, 108, 113, 145, 148]
Faculty as role models	[108, 111, 114]
Address trainee’s personal problems if possible	[84, 122]
Empower the learner to learn at his own pace, self-directed	[9, 70, 133, 146]
Learner factors
Learner must be receptive	[18, 122]
Continuous reflection of the experience	[4, 69, 100, 104, 109, 133, 150]
Barriers	References
Institutional factors
Lack of standardisation/evidence-based remediation programs/established theory	[9, 10, 62, 64, 73, 76–78, 89, 101, 107, 113, 114, 131, 139, 153]
Time-consuming, resource-expensive	[9, 62, 69, 72, 85, 89, 99, 103, 109, 110, 112, 122, 131, 147, 154]
Suboptimal screening and evaluation methods	[62, 72, 73, 78, 80, 95, 99, 122, 148, 154]
Wrongly identifying residents	[10, 70, 84]
Lack of documentation and clear process to be followed	[63, 73, 77, 95, 123, 136, 139]
Insufficient monitoring of resident performance	[62, 63, 77, 83]
Lack of institutional support	[9, 77, 140, 155]
Tutor factors
Progress and outcomes of trainees can be subjective	[10, 84, 108]
Faculty unwilling to participate in supervising remediation programs	[69, 72, 112, 138]
Reluctance of faculty to fail poorly performing trainees	[62, 95, 107, 115, 122, 136, 154]
Faculty not trained to give feedback	[62, 95, 122, 148, 154]
Emotional drain on faculty given difficulties in remediating trainees	[9, 72, 99, 131]
Learner factors
Learners reluctant to be identified as needing remediation, lack of self-awareness	[65, 66, 69, 73, 88, 91, 92, 98, 100, 114, 122, 127, 137, 150, 155]
High clinical responsibilities of learners	[63, 99, 137]
Some learner deficiencies are not amenable with remediation given incompatible inherent attitudes and learning styles	[61, 90, 122]