HIGHLIGHTS
- •Significant heterogeneity existed for prevalence not explained by specialty.
- •Overall attrition in trainees in difficulty was 18%.
- •Trainees in difficulty had lower odds of board certification.
- •Attrition was not found to be different in trainees in difficulty.
- •Standardized criteria and better reporting of outcome is necessary.
Abstract
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.
Keywords
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Article info
Publication history
Published online: December 29, 2021
Accepted:
December 27,
2021
Received in revised form:
December 23,
2021
Received:
July 18,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
