Graduate Medical Education “Trainee in difficulty” current remediation practices and outcomes

‘The program director's word … it's stronger than the word of God’: Epistemic injustice revealed through narratives of remediated graduate medical education residents

“…The prevalence of struggling trainees ranges from 2% to 30.7%, and most programmes have at least one struggling resident at any given time. 2 While remediation programmes have reported varied success, remediated residents may feel dismay, shame and guilt, particularly due to the high academic undertaking required to reach graduate medical education (GME) training. 3,4 Additionally, the remediated resident may become isolated or experience self-doubt 5 and be at risk for negative outcomes affecting board certification, medical practice and patient safety.…”

“…3,4 Additionally, the remediated resident may become isolated or experience self-doubt 5 and be at risk for negative outcomes affecting board certification, medical practice and patient safety. 2,6 Shared experiences of practising physicians that underwent remediation outside of GME elucidated perceptions of the remediation as a threat to their identity as good doctors, in some cases leading to self-positioning as victims of the system. 7 Researchers have found that higher proportions of residents from historically excluded groups, including international students, underrepresented in medicine learners, and those with prior academic difficulty, undergo academic deceleration and remediation or experience an increased risk for withdrawal from both undergraduate and GME.…”

“…The current literature on remediation focuses on issues of prevalence or identification of trainees at risk, systematic practices or strategies in remediation. 2,6,8,[17][18][19][20] In these studies, educator perspectives are privileged, with several reports describing PD perspectives of remediation. [21][22][23][24][25][26][27][28] Learner underperformance, from the perspective of physician educators, was perceived as an inability or unwillingness to engage in programmatic learning.…”

“…Remediation is additional support to progress a resident's training, including extra time, supervision or resources. The prevalence of struggling trainees ranges from 2% to 30.7%, and most programmes have at least one struggling resident at any given time 2 . While remediation programmes have reported varied success, remediated residents may feel dismay, shame and guilt, particularly due to the high academic undertaking required to reach graduate medical education (GME) training 3,4 .…”

“…While remediation programmes have reported varied success, remediated residents may feel dismay, shame and guilt, particularly due to the high academic undertaking required to reach graduate medical education (GME) training 3,4 . Additionally, the remediated resident may become isolated or experience self‐doubt 5 and be at risk for negative outcomes affecting board certification, medical practice and patient safety 2,6 . Shared experiences of practising physicians that underwent remediation outside of GME elucidated perceptions of the remediation as a threat to their identity as good doctors, in some cases leading to self‐positioning as victims of the system 7 .…”