Remediation for Residents: The Crucial Role of Self-Reflection
Known to be highly motivated and academically strong, residents don’t typically require remediation but when they do, it is rarely self-identified and can lead to a high level of stress. The prevalence of remedial residents may be low—ranging from 5.8% to 9.1%, depending on country, specialty, and program1— but it is imperative that they get the required support to not only minimize the risk of board failure and the impact that has on the program’s accreditation status, but also to upkeep the quality of their training as it can impact their future practice and standards of patient care.
The fact that residents often struggle to identify their deficiencies indicates a critical gap in self-reflection, a skill that is essential in adult learning to ensure development and success. Theories of andragogy agree that self-reflection helps learners understand their internal motivations and direct their own learning2, is crucial for processing experiences and informing future actions,3 and encourages continuous improvement by reflecting both during and after events.4
For more ways to help your residents develop self-reflection, download our Educator Guide: How Educators Can Foster Self-Reflection in Healthcare Learning—and Empower Learners to Become Successful Practitioners
Self-reflection is a fundamental component of learning, involving the critical analysis of one’s actions, thoughts, and experiences to enhance clinical performance and professional development. There are three types of self-reflection:
| Type of Reflection | Description |
|---|---|
| Reflection for Action | Thinking ahead and planning based on past experiences |
| Reflection in Action | Modifying behavior while performing a task |
| Reflection on Action | Retrospectively analyzing actions to gain new insights |
How can program directors, faculty, and mentors help residents develop this all-important skill?
Self-Reflection for the Remedial Resident: Leverage Environmental Scanning
It can be a daunting task to teach self-reflection to residents; they typically demonstrate a mix of adult and non-adult learner traits such as having both internal (desire to be a doctor) and external (desire to pass exams) motivations. To cater to this highly challenging group, educators must leverage a well-established model of learning—such as environmental scanning, a rigorous and well-developed business approach that’s found to be effective for fostering self-reflection among residents.5
Environmental scanning involves gathering and analyzing information about internal and external environments to better understand one’s strengths and weaknesses.6 In collecting the required information, a number of processes can be employed, depending on how easy it is to analyze the environments:
- For straightforward environments: Systematic methods like surveys and trials
- For more complex environments: Qualitative methods such as focus groups and in-depth interviews are effective
Furthermore, there are two main approaches that can be applied:
- Inside out: Starts with internal assessments and then examines the external environment
- Outside in: Begins with broader external trends and focuses internally afterward
When paired with environmental scanning, self-reflection can significantly enhance the remediation process by providing a structured approach to identifying and addressing areas for improvement. Residents first conduct an environmental scan to gather the required information and then ask themselves relevant questions. Here’s a guide:
Self-Reflection as Part of Successful Remediation
By integrating self-reflection with environmental scanning, residents gain a structured approach to continuous improvement. This method enhances their ability to identify and address areas for growth, leading to sustained improvements in clinical skills and professional behavior. Ultimately, self-reflection equips residents to become lifelong learners, benefiting their long-term development and future success.
Programs can empower faculty and residents to cultivate self-reflection by equipping them with TrueLearn’s tools that are proven to elevate learning, retention, and recall: board-style practice questions, assessments, and performance feedback. Educators can guide residents to pair the tools with self-reflection practices and:
- Get immediate, real-time feedback on performance and comprehension
- Interact meaningfully with the content (active learning), improve long-term retention and ease of recall
- Identify learning strengths and weaknesses, pinpoint areas for improvement
- Track and measure learning progress and exam readiness longitudinally
- Adjust/tailor teaching/study methods for most effective, efficient learning
Help your residents achieve optimal exam performance and outcomes, read and share this blog with them and encourage them to utilize our free Post-Assessment Self-Reflection Questionnaire!
References
1 Ratan RB, Pica AG, Berkowitz RL. A model for instituting a comprehensive program of remediation for at-risk residents. Obstet Gynecol. 2008;112(5):1155-1159. doi:10.1097/aog.0b013e31818a6d61
2 Knowles M. Andragogy in Action: Applying Modern Principles of Adult Learning. 1st ed. Jossey-Bass; 1984.
3 Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. Financial TImes Prentice Hall; 1983.
4 Bennett NL. Donald A. Schön, Educating the reflective practitioner. San Francisco: Jossey-Bass Publishers, 1987. 355 pages. J Contin Educ Health Prof. 1989;9(2):115-116. doi:10.1002/chp.4750090207
5 Leung FH, Ratnapalan S. A framework to teach self-reflection for the remedial resident. Med Teach. 2011;33(3):e154-e157. doi:10.3109/0142159x.2011.543199
6 Hatch TF, Pearson TG. Using environmental scans in educational needs assessment. J Contin Educ Health Prof. 1998;18(3):179-184. doi:10.1002/chp.1340180308
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