Subsequent qualitative data suggested that beyond summative exam results, gains were translated to the clinical context with enhanced confidence and selfвЂ“belief, enabling perceived improved performance in the workplace. Self-efficacy beliefs were markedly increased post-intervention with the total score increasing from 33.52 (SD=4.9) points pre-remediation to 45.71 (SD=5.1) points post-remediation (95% CI = -14.52 to -9.83 p<0.001 r = 0.77). Large effect sizes were obtained, indicating the substantive significance of the results. There was a 44% improvement in number of stations passed by participants post-remediation (95% CI = -52.25 to -35.64 r = 0.82). Students demonstrated significant improvements across 3 of the 5 domains measured in OSCE performance (management, diagnosis and communication). The in-depth interviews were used to explore the short- and long-term causal effects of the remediation program on improved performance.

The efficacy of the intervention was evaluated using mixed-method approach consisting of interviews, questionnaire and quantitative analysis of OSCE outcomes (pre and post intervention).

Interventions were multi-faceted and composed of a wide range of group activities. Eighteen medical (eight 4 th and ten 5 th year) students participated in the remediation program. This study investigated the effectiveness of an innovative remediation program, based on promoting self-efficacy, a construct of self-regulation theory, which was developed to provide sustainable improvements in academic and clinical performance of underperforming medical students.

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