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DOI: 10.1055/s-0045-1813684
Modern Strategies for Remediation and Faculty Support
Authors
Abstract
Surgeons at all stages of training and practice may be found to be deficient in one or more domains of practice. The formal process for addressing these deficits is known as remediation. Remediation efforts should be individualized to the physician in question based upon the competency(ies) requiring remediation and the underlying reasons for the physician's difficulties. In this article, we outline the six competencies that may require remediation, signs that a physician may be deficient in each, and specific strategies for assessing and remediating them. Additionally, we outline a process for determining the need for intervention, addressing this with the struggling physician, developing a remediation plan, implementing the plan, and evaluating its success. Although this process can be difficult given the stigma surrounding physicians who need remediation, especially in surgery, it is frequently successful. To facilitate successful remediation, institutions can focus on gathering granular and broad feedback, fostering a supportive culture, and educating faculty on its utility and implementation.
Publication History
Article published online:
04 December 2025
© 2025. Thieme. All rights reserved.
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References
- 1 Williams RG, Roberts NK, Schwind CJ, Dunnington GL. The nature of general surgery resident performance problems. Surgery 2009; 145 (06) 651-658
- 2 Sanfey H. Assessment of surgical training. Surgeon 2014; 12 (06) 350-356
- 3 Yan Q, Treffalls RN, Li T, Prasla S, Davies MG. Graduate medical education “trainee in difficulty” current remediation practices and outcomes. Am J Surg 2022; 224 (02) 796-808
- 4 Cheong CWS, Quah ELY, Chua KZY. et al. Post graduate remediation programs in medicine: a scoping review. BMC Med Educ 2022; 22 (01) 294
- 5 Crannell WC, Brasel KJ. Dealing with the struggling learner. Surgery 2020; 167 (03) 523-527
- 6 Williams BW, Williams MV. Understanding and remediating lapses in professionalism: lessons from the Island of Last Resort. Ann Thorac Surg 2020; 109 (02) 317-324
- 7 Price T, Wong G, Withers L. et al. Optimising the delivery of remediation programmes for doctors: a realist review. Med Educ 2021; 55 (09) 995-1010
- 8 Ellaway RH, Chou CL, Kalet AL. Situating remediation: accommodating success and failure in medical education systems. Acad Med 2018; 93 (03) 391-398
- 9 To H, Cargill A, Tobin S, Nestel D. Remediation of underperformance in surgical trainees—a scoping review. J Surg Educ 2021; 78 (04) 1111-1122
- 10 Guerrasio J, Garrity MJ, Aagaard EM. Learner deficits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006-2012. Acad Med 2014; 89 (02) 352-358
- 11 Frazier W, Wilson SA, D'Amico F, Bergus GR. Resident remediation in family medicine residency programs: a CERA survey of program directors. Fam Med 2021; 53 (09) 773-778
- 12 Jensen RL, Kestle JRW, Brockmeyer DL, Couldwell WT. Principles of remediation for the struggling neurosurgery resident. World Neurosurg 2021; 146: e1118-e1125
- 13 Schwed AC, Lee SL, Salcedo ES. et al. Association of general surgery resident remediation and program director attitudes with resident attrition. JAMA Surg 2017; 152 (12) 1134-1140
- 14 Zbieranowski I, Takahashi SG, Verma S, Spadafora SM. Remediation of residents in difficulty: a retrospective 10-year review of the experience of a postgraduate board of examiners. Acad Med 2013; 88 (01) 111-116
- 15 Sparks JW, Landrigan-Ossar M, Vinson A. et al. Individualized remediation during fellowship training. J Clin Anesth 2016; 34: 452-458
- 16 Taggarshe D, Mittal V. The utility of the ABS in-training examination (ABSITE) score forms: percent correct and percentile score in the assessment of surgical residents. J Surg Educ 2012; 69 (04) 554-558
- 17 Mackenzie CF, Elster EA, Bowyer MW, Sevdalis N. Scoping evidence review on training and skills assessment for open emergency surgery. J Surg Educ 2020; 77 (05) 1211-1226
- 18 Hatala R, Cook DA, Brydges R, Hawkins R. Constructing a validity argument for the Objective Structured Assessment of Technical Skills (OSATS): a systematic review of validity evidence. Adv Health Sci Educ Theory Pract 2015; 20 (05) 1149-1175
- 19 Schlick CJR, Bilimoria KY, Stulberg JJ. Video-based feedback for the improvement of surgical technique: a platform for remote review and improvement of surgical technique. JAMA Surg 2020; 155 (11) 1078-1079
- 20 Chatziisaak D, Sparn M, Krstic D. et al. Be prepared! Impact of structured video-assisted coaching on performance in a simulated bleeding exercise during laparoscopic surgery. Surg Endosc 2024; 38 (10) 6120-6127
- 21 Montgomery KB, Mellinger JD, Lindeman B. Entrustable professional activities in surgery: a review. JAMA Surg 2024; 159 (05) 571-577
- 22 Chen XP, Harzman A, Cochran A, Ellison EC. Evaluation of an instrument to assess resident surgical entrustable professional activities (SEPAs). Am J Surg 2020; 220 (01) 4-7
- 23 O'Connor ES, Mahvi DM, Foley EF, Lund D, McDonald R. Developing a practice-based learning and improvement curriculum for an academic general surgery residency. J Am Coll Surg 2010; 210 (04) 411-417
- 24 Johnson JK, Miller SH, Horowitz SD. Systems-based practice: improving the safety and quality of patient care by recognizing and improving the systems in which we work. In: Henriksen K, Battles JB, Keyes MA, Grady ML. eds. Advances in Patient Safety: New Directions and Alternative Approaches (Vol 2: Culture and Redesign). Rockville, MD: Agency for Healthcare Research and Quality; 2008
- 25 Riebschleger MP, Haftel HM. Remediation in the context of the competencies: a survey of pediatrics residency program directors. J Grad Med Educ 2013; 5 (01) 60-63
- 26 Warburton KM, Mahan JD. Coaching nephrology trainees who struggle with clinical performance. Clin J Am Soc Nephrol 2018; 13 (01) 172-174
- 27 Wu JS, Siewert B, Boiselle PM. Resident evaluation and remediation: a comprehensive approach. J Grad Med Educ 2010; 2 (02) 242-245
- 28 Farid H, Toledo RG, Modest A, Young BC, Mendiola M. Hiding in plain sight: resident remediation in obstetrics and gynecology. J Surg Educ 2024; 81 (05) 656-661
- 29 Nelsen E, Mills D, Orlov N, Goodrich N, Li ST. Remediation in pediatric residency training: a national survey of pediatric program directors. Acad Pediatr 2025; 25 (03) 102776
- 30 Arnold L. Responding to the professionalism of learners and faculty in orthopaedic surgery. Clin Orthop Relat Res 2006; 449 (449) 205-213
- 31 Donnon T, Al Ansari A, Al Alawi S, Violato C. The reliability, validity, and feasibility of multisource feedback physician assessment: a systematic review. Acad Med 2014; 89 (03) 511-516
- 32 Nurudeen SM, Kwakye G, Berry WR. et al. Can 360-degree reviews help surgeons? Evaluation of multisource feedback for surgeons in a multi-institutional quality improvement project. J Am Coll Surg 2015; 221 (04) 837-844
- 33 Cosman BC, Alverson AD, Boal PA, Owens EL, Norcross WA. Assessment and remedial clinical education of surgeons in California. Arch Surg 2011; 146 (12) 1411-1415
- 34 Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot 1997; 12 (01) 38-48
- 35 Williams BW, Flanders P, Welindt D, Williams MV. Importance of neuropsychological screening in physicians referred for performance concerns. PLoS One 2018; 13 (11) e0207874
- 36 Merlo LJ, Campbell MD, Shea C. et al. Essential components of physician health program monitoring for substance use disorder: a survey of participants 5 years post successful program completion. Am J Addict 2022; 31 (02) 115-122
- 37 Parry AL, Brooks E, Early SR. A retrospective cross-sectional review of resident care-seeking at a physician health program. Acad Psychiatry 2018; 42 (05) 636-641
- 38 Greenberg CC, Ghousseini HN, Pavuluri Quamme SR, Beasley HL, Wiegmann DA. Surgical coaching for individual performance improvement. Ann Surg 2015; 261 (01) 32-34
- 39 Vande Walle KA, Quamme SRP, Beasley HL. et al. Development and assessment of the Wisconsin Surgical Coaching rubric. JAMA Surg 2020; 155 (06) 486-492
- 40 Klig JE, Kettyle WM, Kosowsky JM. et al. A pilot clinical skills coaching program to reimagine remediation: a cohort study. MedEdPublish 2023; 13: 29
- 41 Hu YY, Mazer LM, Yule SJ. et al. Complementing operating room teaching with video-based coaching. JAMA Surg 2017; 152 (04) 318-325
- 42 Greenberg CC, Ghousseini HN, Pavuluri Quamme SR. et al; Wisconsin Surgical Coaching Program. A statewide surgical coaching program provides opportunity for continuous professional development. Ann Surg 2018; 267 (05) 868-873
- 43 Hu YY, Peyre SE, Arriaga AF. et al. Postgame analysis: using video-based coaching for continuous professional development. J Am Coll Surg 2012; 214 (01) 115-124
- 44 Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Intern Med 2019; 179 (10) 1406-1414
- 45 Pradarelli JC, Yule S, Lipsitz SR. et al. Surgical Coaching for Operative Performance Enhancement (SCOPE): skill ratings and impact on surgeons' practice. Surg Endosc 2021; 35 (07) 3829-3839
- 46 Shaker L, Amilcar C, Kothari N, Murano T. Knowledge, attitudes and perceptions of remediation among trainees in graduate medical education programs. J Emerg Med 2023; 65 (01) e41-e49
- 47 Suresh D, Aydin A, James S, Ahmed K, Dasgupta P. The role of augmented reality in surgical training: a systematic review. Surg Innov 2023; 30 (03) 366-382
- 48 Tellez J, Abdelfattah K, Farr D. In-person versus virtual suturing and knot-tying curricula: skills training during the COVID-19 era. Surgery 2021; 170 (06) 1665-1669
- 49 Humm G, Mohan H, Fleming C. et al. The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials. BJS Open 2022; 6 (04) zrac086
- 50 Shahrezaei A, Sohani M, Taherkhani S, Zarghami SY. The impact of surgical simulation and training technologies on general surgery education. BMC Med Educ 2024; 24 (01) 1297
- 51 Badran KW, Kelley K, Conderman C, Mahboubi H, Armstrong WB, Bhandarkar ND. Improving applicant selection: identifying qualities of the unsuccessful otolaryngology resident. Laryngoscope 2015; 125 (04) 842-847
- 52 Bhatti NI, Ahmed A, Stewart MG, Miller RH, Choi SS. Remediation of problematic residents—a national survey. Laryngoscope 2016; 126 (04) 834-838
- 53 Silverberg M, Weizberg M, Murano T, Smith JL, Burkhardt JC, Santen SA. What is the prevalence and success of remediation of emergency medicine residents?. West J Emerg Med 2015; 16 (06) 839-844
- 54 Turner JA, Fitzsimons MG, Pardo Jr MC. et al. Effect of performance deficiencies on graduation and board certification rates: a 10-yr multicenter study of anesthesiology residents. Anesthesiology 2016; 125 (01) 221-229
- 55 Lagoo J, Berry WR, Miller K. et al. Multisource evaluation of surgeon behavior is associated with malpractice claims. Ann Surg 2019; 270 (01) 84-90
- 56 Bourgeois-Law G, Teunissen PW, Varpio L, Regehr G. Attitudes Towards Physicians Requiring Remediation: One-of-Us or Not-Like-Us?. Acad Med Nov 2019; 94 (11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions): S36-S41
- 57 Torbeck L, Canal DF. Remediation practices for surgery residents. Am J Surg 2009; 197 (03) 397-402
