Realist synthesis of doctor remediation

A review of the evidence for the remediation of practising doctors to restore patient safety
Doctor

What is RESTORE? 

REalist SynThesis of dOctor REmediation (RESTORE) is an evidence review that aims to identify why, how, in what contexts, for whom and to what extent remediation works for practising doctors, to support patient safety.

This research question is operationalised into two main objectives:

  • To conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent do remediation programmes for practising doctors work to restore patient safety
  • To provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.

Read our full review protocol.

Our Protocol is registered with PROSPERO.

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About RESTORE

The human cost of a failing doctor is difficult to measure, but it is estimated that nearly 12,000 patients die in England each year as a result of preventable medical errors. All of us, as patients, expect our doctors to be competent. If they are not, we expect the doctors to be stopped from practising.

The General Medical Council has powers to do this. However, there is a wider problem that is more difficult to address: doctors who underperform. For this group of doctors, they do not need to stop practising but, to keep patients safe, they need help. This could be through retraining in a certain area, or perhaps addressing underlying physical or mental health problems. Bringing a doctor’s performance back up to an acceptable standard is called remediation.

What is a realist review?

A realist review works by building a model, known as a ‘programme theory’, that will show how remediation should work and why in some situations it does not. 

This model is then tested and retested using data from the literature so that the final product is a best-fit theory that can be used to guide policy and practice.

Throughout the process of the review, we shall involve a stakeholder group made up of those professionals involved in delivering remediation for doctors, as well as representatives from patient groups. 

This will provide expert input to help develop the findings and make sure that they are relevant to developing policy and practice in the NHS.

For more information on realist reviews visit the RAMASES (Realist And Meta-narrative Evidence Syntheses - Evolving Standards) project website.

Who we are

Nicola Brennan (University of Plymouth): Senior Research Fellow and Principal Investigator for RESTORE

Tristan Price (University of Plymouth): Research Fellow

Julian Archer (University of Plymouth): Professor of Medical Education Research, Consultant Pediatrician

Geoff Wong (University of Oxford): GP, Clinical Research Fellow

Amanda Wanner (University of Plymouth): Research Fellow (Information Specialist)

Jen Cleland (University of Aberdeen): Professor of Medical Education Research

Linda Prescott-Clements (NCAS): Lead Assessment & Intervention Adviser

Thomas Gale (University of Plymouth): Clinical Associate Professor in Clinical Skills

Lyndsey Withers (University of Plymouth): PPI Collaborator

Funding acknowledgement and collaborative partners

This research was funded by the NIHR HS&DR (17/06/04). Our collaborative partners can be seen below.

Department of Health and Social Care disclaimer

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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