Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors.

BACKGROUND AND OBJECTIVES: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges. METHODS: This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation. RESULTS: Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. A majority (242/265, 91%) of residents undergoing remediation were successful within 12 months. The three most important tools to improve remediation were an accessible remediation toolkit (50%), formal remediation recommendations from national family medicine organizations (20%), and on-site faculty development and training (19%). The top-two challenges to the remediation process were a lack of documented evaluations to trigger remediation and a lack of faculty knowledge and skills with effective remediation strategies. CONCLUSIONS: Residents needing remediation are common, but most were successfully remediated within 12 months. Program directors wanted access to a standardized toolkit to help guide the remediation process.

Training family medicine residents in HIV primary care: a national survey of program directors.

BACKGROUND AND OBJECTIVES: As the number of people living with HIV steadily increases, severe shortages in the HIV provider workforce in the United States are projected. With an increased emphasis on HIV education during residency, family physicians could play a major role in meeting this need. METHODS: A nationwide survey of family medicine residency program directors (PDs) was conducted to determine their attitudes toward training residents in HIV care. RESULTS: Of 440, 224 (51%) PDs responded to the electronic survey. Teaching HIV care was a high priority for 20% of PDs. Twenty percent of PDs reported residents in their program were providing care to at least five HIV-infected patients. Twenty-five percent of PDs felt that their graduates had the skills to be HIV care providers. Fewer than 25% of PDs reported having a formal HIV curriculum or faculty with adequate HIV expertise. The most favored approaches to strengthen the HIV curriculum by PDs were: (1) a half-day mini-course (30%) and (2) developing a faculty member's expertise in HIV care (17%). A total of 79% of directors saw a need to modify their existing curriculum. CONCLUSIONS: Despite growing numbers of HIV-infected patients, only 25% of family medicine PDs felt that their graduates were adequately trained in HIV primary care, and most saw a need to modify their HIV curricula. Family medicine residency training programs have an important opportunity to develop residency curricula and increase faculty competence to train the next generation of clinicians in HIV care.

The effect of medical student feedback about resident teaching on resident teaching identity: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Residents often teach medical students, other residents, and patients. However, few residents get feedback about their teaching. This study's objective was to determine if feedback from medical students increases resident teaching identity. METHODS: This was a stratified, single blinded, randomized controlled trial of an educational intervention. Residents were stratified based on year of residency and then randomized to receive feedback by medical students or not. Medical students evaluated resident teaching effectiveness by ranking resident ability to apply the five microskills for clinical teaching and to role model being an effective clinician. Residents were surveyed to determine their level of teacher identity before and after the intervention. Allocation concealment and intention to treat principles were used. RESULTS: All residents (n=32) that met inclusion criteria participated with complete response rate to both pre-intervention and post-intervention surveys. There was no difference in teaching identity between residents who received feedback and those who did not, except in one subscale of the Teacher Identity Scale-global teaching identity, where residents who received medical student feedback scored lower. CONCLUSIONS: There was no difference between intervention and control group in resident teaching identity over time. The residents found feedback important. This was a randomized controlled trial with strong methodology that helps advance understanding of the importance of medical student feedback on resident teaching.