Experiences of remediation in family medicine postgraduate education: An interpretative phenomenological analysis

Remediation programs in postgraduate medical education aim to help struggling residents successfully complete their training and graduate. Research has mostly focused on educators' and program directors' perspectives on the development and quality of remediation programs. However, little is known about the experience of being remediated. This investigation aimed to understand how practicing family physicians who underwent remediation during their residency experienced their remediation program.

In this Interpretative Phenomenological Analysis (IPA) study, we purposively sampled six family medicine practitioners who underwent successful remediation as residents in a Canadian medical school. We individually interviewed them in-depth, one to six years after graduation. For data analysis, we combined IPA thematic and narrative techniques.

While each participant had a unique experience of remediation, we identified a common longitudinal process of four consecutive periods: pre-remediation, remediation, and early and late post-remediation. All participants experienced the remediation announcement as shocking, surprising, and disruptive, as most were unaware that they were not reaching the expected competency standards. This triggered the hot-cognition learning process that characterized the initial phases of their remediation experience. During remediation, they went through a progressive reorganization of a self-coherent professional identity formation process, mediated by the interactions with their educators. In the early post-remediation phase, most participants accepted their teachers' and institution's educational evaluations and expectations. Some, however, started developing a dissonant professional identity vis-à-vis their community of practice. In the late post-remediation phase, most participants viewed their remediation experiences as beneficial to their career development, but others felt lasting harm, evidenced by less career satisfaction and practice advancement.

The experience of being remediated in postgraduate medical education is an emotionally charged one. It is modulated by a variety of personal factors and surrounding features. The quality of interactions between residents who need remediation and their remediators appears to be a critical element in the success of a remediation program. Remediation, even when successful, is a shocking and emotionally challenging educational experience for those who undergo it, with important and lasting implications.