Multifaceted remediation program: experience of a residency program to rescue residents who failed the American Board of Anesthesiology basic examination

Attitudes of Anesthesiology Postgraduate Residents Toward the Influential Factors in Their Success in the Iranian National Board Exam

Background

One of the prominent indicators of academic success in postgraduate medical education is the "Residents' Pass Rate" in the "National Board Exam."

Objectives

This study was designed and implemented to assess the attitudes of the anesthesiology residents toward factors affecting their success in the National Board Exam.

Methods

After the Institutional Review Board (IRB) approval, in an attitude assessment study, 20 of the 21 recently graduated anesthesiology residents were asked about the factors affecting their success quantitatively and qualitatively. A self-administered questionnaire with 19 closed questions and a personal virtual WhatsApp Messenger® interview were used for the study.

Results

The respondents' viewpoints demonstrated that a step-by-step multifaceted integrative program in combination with psychological support (both from the family and the department) and individual motivation positively affected their success and their endurance to overcome the high load of the mandatory texts. In contrast, unplanned stressors leading to program shifts (mainly due to COVID-19) had adverse effects on their success.

Conclusions

Anesthesiology residents believed that a well-designed and appropriately implemented study plan with psychological support and personal motivating factors could facilitate passing the National Board Exam, and unplanned external stressors could hinder it.

Strangers in a strange land: The experience of physicians undergoing remediation

INTRODUCTION

The experience of remediation in practising physicians has not been widely studied. Remediatees frequently present negative emotions, but observers can only infer the underlying reasons behind these. Understanding remediatees' perspectives may help those mandating and organising remediation to structure the process in ways that improve the experience for all concerned parties and maximise chances of a successful outcome for remediatees.

METHODS

Seventeen physicians who had undergone remediation for clinical competence concerns were interviewed via telephone. Participant data were first iteratively analysed thematically and then reanalysed using a narrative mode of analysis for each participant in order to understand the stories as wholes. Figured worlds (FW) theory was used as a lens for analysing the data for this constructivist research study.

RESULTS

Participants entering the FW of remediation perceived that their position as a 'good doctor' was threatened. Lacking experience with this world and with little available support to help them navigate it, participants used their agency to draw on various discursive threads within the FW to construct a narrative account of their remediation. In their narratives, participants tended to position themselves either as victims of regulatory bodies or as resilient individuals who could make the best of a difficult situation. In both cases, the chosen discursive threads enabled them to maintain their self-identity as 'good doctor'.

CONCLUSION

Remediation poses a threat to a physician's professional and personal identity. Focusing mainly on the educational aspect of remediation-that is, the improvement in knowledge and skills-risks missing its impact on physician identity. We need to ensure not only that we support physicians in dealing with this identity threat but that our assessment and remediation processes do not inadvertently encourage remediatees to draw on discursive threads that lead them to see themselves as victims.

Emotion in remediation: A scoping review of the medical education literature

OBJECTIVES

Remediation can be crucial and high stakes for medical learners, and experts agree it is often not optimally conducted. Research from other fields indicates that explicit incorporation of emotion improves education because of emotion's documented impacts on learning. Because this could present an important opportunity for improving remediation, we aimed to investigate how the literature on remediation interventions in medical education discusses emotion.

METHODS

The authors used Arksey and O'Malley's framework to conduct a scoping literature review of records describing remediation interventions in medical education, using PubMed, CINAHL Complete, ERIC, Web of Science and APA PsycInfo databases, including all English-language publications through 1 May 2020 meeting search criteria. They included publications discussing remediation interventions either empirically or theoretically, pertaining to physicians or physician trainees of any level. Two independent reviewers used a standardised data extraction form to report descriptive information; they reviewed included records for the presence of mentions of emotion, described the mentions and analysed results thematically.

RESULTS

Of 1644 records, 199 met inclusion criteria and were reviewed in full. Of those, 112 (56%) mentioned emotion in some way; others focused solely on cognitive aspects of remediation. The mentions of emotion fell into three themes based on when the emotion was cited as present: during regular coursework or practice, upon referral for remediation and during remediation. One-quarter of records (50) indicated potential intentional incorporation of emotion into remediation programme design, but they were non-specific as to how emotions related to the learning process itself.

CONCLUSION

Even though emotion is omnipresent in remediation, medical educators frequently do not factor emotion into the design of remediation approaches and rarely explicitly utilise emotion to improve the learning process. Applications from other fields may help medical educators leverage emotion to improve learning in remediation, including strategies to frame and design remediation.

Evaluation of One-Day Multiple-Choice Question Workshop for Anesthesiology Faculty Members

BACKGROUND

Multiple-choice questions (MCQs) are used commonly to evaluate medical health students. Most novice educators tend to create poor quality, flawed, and low-cognitive-level questions. Therefore, there is a need for educating the assessors to maximize the quality of MCQs and evaluations.

OBJECTIVES

The current study aimed to evaluate the effect of a one-day MCQ workshop on anesthesiology faculty members.

METHODS

Faculty members were invited to participate in a four-hour, one-day MCQ workshop. At the beginning of the workshop, the participants were questioned about their knowledge about MCQ quality indexes and also were asked about MCQ general principles (pre-test). Participants were again asked about the questions which they had in the pre-test as their post-test and were questioned about their expectations and the influence of this workshop.

RESULTS

The participants declared that their expectations were fulfilled (9.4 ± 0.6 out of 10), and the course was applicable (9.7 ± 0.7 out of 10). Before the workshop, only 12.5% of the participants know MCQ indicators. This rate increased to 41% after the workshop (P < 0.05). Also, they were questioned about Millman's checklist for the MCQ examination. Participants' correct answers were increased from 2.75 to 3.05 out of four (P < 0.05).

CONCLUSIONS

Although previous participation in MCQ training courses did not demonstrate an increase in knowledge and attitude, it could be theorized that short-term repetition would yield better results.