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25-10-2017 | Eye-opener | Uitgave 6/2017 Open Access

Perspectives on Medical Education 6/2017

To fail is human: remediating remediation in medical education

Perspectives on Medical Education > Uitgave 6/2017
Adina Kalet, Calvin L. Chou, Rachel H. Ellaway
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This paper is an outcome of an Emerging Issues session that we conducted at the AAMC Medical Education Meeting in 2014 and therefore our thinking was influenced by the nearly 50 participants at that session. It is with deep gratitude that we thank Dr. Muriel Bebeau for partnering with us on that session and inspiring generations of health professions educators with her work on professional identity development.


The cases of Sally Smith and Vin Bas are fictional and are based on an amalgamation of many different remediation cases across three different institutions. Any similarity, real or imagined, to an actual learner, case, or program is purely coincidental.



Remediating failing medical learners has traditionally been a craft activity responding to individual learner and remediator circumstances. Although there have been moves towards more systematic approaches to remediation (at least at the institutional level), these changes have tended to focus on due process and defensibility rather than on educational principles. As remediation practice evolves, there is a growing need for common theoretical and systems-based perspectives to guide this work.


This paper steps back from the practicalities of remediation practice to take a critical systems perspective on remediation in contemporary medical education. In doing so, the authors acknowledge the complex interactions between institutional, professional, and societal forces that are both facilitators of and barriers to effective remediation practices.


The authors propose a model that situates remediation within the contexts of society as a whole, the medical profession, and medical education institutions. They also outline a number of recommendations to constructively align remediation principles and practices, support a continuum of remediation practices, destigmatize remediation, and develop institutional communities of practice in remediation.


Medical educators must embrace a responsible and accountable systems-level approach to remediation if they are to meet their obligations to provide a safe and effective physician workforce.
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