The elephant in the room: a mixed-methods study of remediation perceptions across resident physicians, teaching faculty, and program directors

Background: Remediation in postgraduate medical education (PGME) is a complex, high-stakes endeavor. Studies have examined learner perspectives, but few have explored those of program directors and teaching faculty. We explored the perceptions and experiences of remediation from the perspectives of program directors (PDs), teaching faculty (TF), and resident physicians (RPs). Methods: We used an explanatory sequential-mixed methods design underpinned by pragmatism, combining survey data with semi-structured, one-on-one interviews conducted with 17 participants purposively recruited from survey respondents. Data were collected between 2021-2023 and analyzed in 2024. Interviews were transcribed verbatim and coded in duplicate by at least two team members. Discrepancies were discussed in regular meetings until consensus was reached. Results: A total of 252 participants completed the survey, with response rates ranging from 3% to 37% across participant groups. We identified five themes: stigma, compassion, complexity, perfectionism culture, and peer support. Limited confidence by PDs and TF perpetuated the stigma of remediation and RPs reported remediation rarely being discussed. Participants also highlighted that substantial time and effort required for remediation goes unacknowledged, with limited resources and support for faculty involved in these processes. Conclusions: Remediation in postgraduate medical education is shaped by shared experiences of stigma, complexity, and resource constraints, but also by a strong commitment to learner growth. Addressing these challenges will require action at individual, program, and system levels.