Impact of a structured remediation program on academic performance of family medicine residents in difficulty: A training centre experience

Background: Residents in difficulty represent a significant challenge in postgraduate medical education. Early, structured remediation may improve academic and clinical performance, yet regional evidence from family medicine training programs remains limited. Objectives: To evaluate the impact of a structured remediation program on examination performance and clinical assessments of family medicine residents in difficulty, and to explore resident-perceived mechanisms contributing to improvement. Methods: A mixed-methods study was conducted at a single accredited family medicine training center over three academic years (2022–2025). Quantitative analysis included a retrospective review of promotion examination scores and clinical assessment outcomes before and after participation in a standardized remediation program. Qualitative data were obtained through semi-structured interviews with participating residents and analyzed thematically. Wilcoxon signed-rank test, Stuart–Maxwell test, and multivariable linear regression were used to assess performance changes and predictors of post-course outcomes. Results: Thirty-one first-year family medicine residents were included. Mean promotion examination scores improved significantly from 55.1 ± 2.4 pre-course to 79.0 ± 5.1 post-course (p < 0.0001). Clinical assessment outcomes improved from universal borderline or failing status to 100% pass rates (p = 0.0009). Perceived exam difficulty decreased significantly following remediation (p < 0.0001). Multivariable analysis showed that age, gender, and training sector were independently associated with post-course scores. Qualitative analysis identified five key themes underlying improvement: transformation of learning strategies, enhanced clinical exposure, mentorship support, feedback-driven reflection, and professional accountability. Conclusion: A structured remediation program was associated with significant improvements in academic performance, clinical competence, and learner confidence among family medicine residents in difficulty. Early, supportive, and mentorship-driven remediation may represent an important component of postgraduate family medicine training.