JMIR Publications

ABSTRACT

Background:

Recognizing the complexity of these interventions and their dependence on local contexts, this review aims to identify how, why, and under what circumstances these programs work effectively to improve patient safety. This review will employ a realist synthesis approach due to its capacity to address the multifaceted nature of interventions and diverse contexts in LMICs.

Objective:

This realist review protocol aims to explore the mechanisms and contexts influencing the success of clinical skills remediation programs in low- and middle-income countries (LMICs).

Methods:

Following Wong et al.’s guidelines and the Realist and Meta-narrative Evidence Syntheses Evolving Standards (RAMESES) standards, this synthesis explores primary studies and program evaluations to uncover context-mechanism-outcome (CMO) configurations. Comprehensive database searches (e.g., PubMed, MEDLINE, CINAHL, and PsycINFO) will focus on interventions such as simulation-based learning, peer-assisted learning, and formative feedback.

Results:

Key outcomes include competency-based performance, learner confidence, and patient safety improvement. Stakeholder workshops involving policymakers, educators, and healthcare practitioners will refine the program theories to ensure the relevance and applicability of the findings. This review elucidates how specific contextual factors—such as resource limitations, cultural practices, and local healthcare infrastructure—impact the implementation and outcomes of remediation programs. The findings provide actionable recommendations for designing scalable, contextually relevant interventions in LMICs. These insights directly influence policy reform and practical implementation, addressing local challenges, and supporting evidence-informed decision-making.

Conclusions:

Ultimately, this work will contribute to improving clinical education, enhancing student performance, fostering empathy, and ensuring better patient safety outcomes in LMICs. Clinical Trial: The realist review has been registered in PROSPERO 2023 (registration number CRD42023447029) because its objectives are limited to educational outcomes.