Graduate Medical Education “Trainee in difficulty” current remediation practices and outcomes

Qi Yan, Rebecca N. Treffalls, Taoran Li, Sanaa Prasla, Mark G. Davies

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Trainees in difficulty require additional support to complete training program and become successful physicians. This study reviewed the current remediation practices and outcomes of trainees in difficulty. Methods: A PRISMA-based literature review was performed. Meta-analyses were performed using random effects model. Results: 30 studies met inclusion criteria. Sixteen studies surveyed program directors and 14 were observational. Prevalence and attrition of trainees in difficulty ranged widely from 2.0% to 30.7% and 0.0%–50.0%, respectively, with significant heterogeneity. Pooled odds of attrition was higher for trainees in difficulty, however, the confidence interval crossed one and there was statistically significant heterogeneity. Residents in difficulty were significantly less likely to become board certified (OR = 0.08, 95%-CI = 0.04–0.18; I2 = 0%, P = .70). Conclusion: Trainees in difficulty were less likely to be board certified but attrition rate did not differ. Future studies with standardized criteria for trainees in difficulty and better reporting of the outcomes can better guide our remediation practices.

Original languageEnglish
Pages (from-to)796-808
Number of pages13
JournalAmerican Journal of Surgery
Issue number2
StatePublished - Aug 2022


  • Graduate education
  • Intervention
  • Outcomes meta-analysis
  • Problem learner
  • Surgery
  • Systemic review


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