Education or regulation? Exploring our underlying conceptualisations of remediation for practising physicians

Abstract

Context The remediation of practising physicians is coming to the fore in several countries in response to increasing demands for physician accountability and quality improvement initiatives in health care. However, the profession continues to grapple with the concepts and processes of remediation, particularly for physicians in practice who struggle with performance issues related to clinical competence. This suggests that current conceptualisations of remediation might be contributing to this situation. This study therefore, explored how various administration‐level stakeholders conceptualise remediation in order to construct a description of the nature and meaning of remediation. Methods Semi‐structured interviews were conducted using purposive sampling across the range of Canadian stakeholders involved in the remediation of practising physicians, including regulatory authorities, universities, national certifying bodies and medical organisations. With the use of constructivist grounded theory processes, analysis proceeded apace with data collection in an iterative process, with initial insights guiding subsequent interviews. Results Participants often simultaneously held two different conceptualisations of remediation: (i) remediation as part of an educational continuum involving different degrees of support, and (ii) remediation as a regulatory process removing an individual's educational autonomy. Interviewees moved between these two conceptualisations but did not always appear to be aware of doing so. These conceptualisations each had different implications regarding the degree to which remediation can be incorporated into professional processes of maintaining competence. Conclusions Understanding that stakeholders frequently approach the complex issue of remediation with two different perspectives without conscious awareness of doing so may help to explain several challenges in the field, including the issues of what falls under the umbrella of remediation and who should be responsible for offering remediation support. Our findings suggest the need for conceptual clarity around remediation, both to ensure that we illuminate logistical dilemmas in enacting remediation and to address the stigma of ‘de‐professionalisation’ that the provision of even minor educational supports (such as feedback) might invoke by association.

Remediating professionalism lapses in medical students and doctors: A systematic review

“…Remediation has been classified as a ‘wicked’ problem with which the medical profession has struggled for decades . One of the reasons for this refers to the fact that remediation has tended to be conceptualised as an educational issue; however, few studies are underpinned by educational theory . Recent work by Prescott‐Clements et al has shown how conceptualisations have moved towards the use of behavioural change theories to underpin remediation models.…”

“…Recent work by Prescott‐Clements et al has shown how conceptualisations have moved towards the use of behavioural change theories to underpin remediation models. We conceptualised remediation as a behaviour change intervention because a large part of professionalism relates to behaviours …”

“…12 One of the reasons for this refers to the fact that remediation has tended to be conceptualised as an educational issue; however, few studies are underpinned by educational theory. 13,14 Recent work by Prescott-Clements et al 5 has shown how conceptualisations have moved towards the use of behavioural change theories to underpin remediation models. We conceptualised remediation as a behaviour change intervention 5 because a large part of professionalism relates to behaviours.…”

Physician remediation: accepting and working with complementary conceptualisations

“…Opining that challenges with physician remediation are in part due to our limited understanding of how remediation of practising physicians is conceptualised, Bourgeois‐Law et al conducted a qualitative study exploring the conceptualisation of the remediation of practising physicians. In an article featured in this issue, the authors identify two conceptualisations of remediating practising physicians: remediation as an educational process on a continuum of learning and remediation as a regulatory process . They seem to suggest that simultaneously holding these ‘conflicting’ conceptualisations of physician remediation is somehow problematic, and conclude that efforts need to be made to avoid the ‘de‐professionalisation’ that accompanies the regulatory conceptualisation of remediation.…”

“…Stigmatisation, loss of autonomy and the resulting sense of ‘de‐professionalisation’ are well‐founded concerns raised in relation to physician remediation . A systemic approach to remediation has been recommended as one way of addressing the challenges that are part of implementing physician remediation .…”