Educator, judge, public defender: Conflicting roles for remediators of practising physicians

Abstract

Context: Practising physicians who remediate their peers face unique challenges. Recent research suggests that leaders of regulatory and educational institutions (ie, those who might be seen as responsible for overseeing remediation programmes for practising physicians) view remediation as a duality: education and regulation. Research has yet to study the perspectives of remediators; therefore, to address that gap we asked: What is the nature of remediation as experienced by remediators? Methods: We used a theory-informing inductive data analysis study design with positioning theory as a sensitising concept. We interviewed nine remediators from five Canadian provinces, asking them to narrate particularly memorable remediation experiences, then exploring the stories in more depth by asking probing questions around topics related to the research question. We used a hermeneutic analytic approach to explore the meanings that participants gave to their remediation work by iteratively reading their stories, examining the sense making that participants achieved through these narratives, and identifying the positions and responsibilities they described. Results: In their remediation narratives, participants variably position themselves in three different ways: (a) educator; (b) judge, and (c) public defender. For each position, remediators in turn framed the remediatee in a particular way. Participants shifted between educator, judge and public defender in response to evolving experiences with the remediatee, but they expressed preference for the educator position. However, they sometimes encountered serious obstacles to enacting that educator position. Those obstacles were imposed both by regulators and by remediatees. Conclusions: This study suggests that the duality of remediation as both education and regulation may be contributing to the challenges faced by those working one to one with remediatees. Understanding the dual nature of remediation and equipping remediators with the tools to manage this duality might contribute to improving the experience for both remediators and remediatees, and ultimately to a greater number of successful remediation outcomes.

Professional expectations of perfection stymy remediation and growth

“…They explain that remediators struggle to maintain these roles, particularly when the remediatee is uncooperative, and that these struggles may be accentuated by intersecting power differentials derived from the relative gender, age and clinical experience statuses of the remediatee and remediator. 1 As the authors point out, remediation at the practice level is different than at the undergraduate or postgraduate training levels. 1 The main distinction is that practicing physicians lose their professional autonomy during remediation and must relinquish aspects of their independent practice until a decision is made about the success of the remediation process.…”

“…1 As the authors point out, remediation at the practice level is different than at the undergraduate or postgraduate training levels. 1 The main distinction is that practicing physicians lose their professional autonomy during remediation and must relinquish aspects of their independent practice until a decision is made about the success of the remediation process. Although this is undoubtedly an important influence on the differing experiences of in-practice remediators compared to undergraduate remediators, the similarities between remediation in these two distinct contexts are more salient than the differences.…”

“…In their article titled ‘Educator, Judge, Public Defender: Conflicting roles for remediators of practicing physicians’, Bourgeois‐Law, Regehr, Teunissen and Varpio 1 describe the experiences of remediators who work with practicing physicians. Their primary finding is that remediators of practicing physicians are required to continuously shift between the role of an educator (responsible for fostering an ‘educational alliance’ with the remediatee), judge (responsible for determining whether the remediatee can return to independent practice) and public defender (responsible for ensuring the public is safe from incompetent physicians).…”

“…Through their analysis, Bourgeois‐Law et al 1 describe how remediators identify most strongly with the educator role and speak specifically to the tension they face when needing to shift their position to that of judge or public defender. They explain that remediators struggle to maintain these roles, particularly when the remediatee is uncooperative, and that these struggles may be accentuated by intersecting power differentials derived from the relative gender, age and clinical experience statuses of the remediatee and remediator 1 …”

“…As the authors point out, remediation at the practice level is different than at the undergraduate or postgraduate training levels 1 . The main distinction is that practicing physicians lose their professional autonomy during remediation and must relinquish aspects of their independent practice until a decision is made about the success of the remediation process.…”