Remediation in Pediatric Residency Training: A National Survey of Pediatric Program Directors

Background: The goal of graduate medical education is for residents to achieve the skills and knowledge to practice medicine independently. While remediation is not uncommon in residency training, evidence is lacking to guide best practices. Methods: We conducted a national survey of pediatric residency programs regarding their remediation experiences identifying struggling residents, documentating the process, and monitoring progress during remediation. Results: A total of 50.8% (99/195) programs responded. Approximately 4.7% of residents underwent remediation, and 91% (262/288) of residents successfully completed remediation. Programs used data from the Clinical Competency Committee (CCC; 100%), rotation evaluations (98.9%) and direct observation (96.6%) to identify residents who need remediation. Most programs used an improvement plan to document resident progress (88.8%) and assigned a mentor or coach to support the resident (88.8%). Nearly all programs used rotation evaluations (93.3%) to monitor progress towards achieving the goals of remediation. Two-thirds (66.3%) felt their remediation process was either very effective or effective, and about half (56.2%) were very satisfied or satisfied with their remediation process. Programs with more residents who successfully completed remediation were more likely to feel satisfied with their program's remediation processess and effectiveness. Conclusions: Nearly 5% of pediatrics residents undergo remediation, with 91% successfully remediating. Two-thirds of program leaders feel their remediation practices are effective, and only half are satisfied with remediation processes in their program. Opportunities exist to improve remediation processes for pediatric residents and for programs to ensure graduation of competent pediatricians.