Components of postgraduate remediation frameworks: a narrative review

Purpose The identification and remediation of underperformance are essential responsibilities of postgraduate medical training programs. Despite calls for a programmatic approach, remediation practices remain inconsistent, with many institutions lacking formal policies. The aim of this study was to identify the core components for developing remediation frameworks for postgraduate trainees. Methods A narrative review format was chosen. Eligible papers for inclusion included studies, opinion pieces, systematic reviews, and meta-analyses. Fifty-four papers were included for analysis. Results We identified seventeen components which were organized into three overarching phases: (1) assess and support, (2) plan and implement, and (3) evaluate and follow-up. ‘Assess and support’ components included: ensure an accurate diagnosis; give feedback; ensure the trainee’s perspective is heard; address external stressors and system causes; provide emotional support; address attitudes and motivation of the trainee; and destigmatize remediation. ‘Plan and implement’ components included: involve remediation and educational experts; create individualized remediation plans; document plans clearly; and teach goal setting and self-regulation. ‘Evaluate and follow-up’ components included: monitor progress and reassess; feed forward carefully; separate those conducting from those judging remediation; ensure transparent policies and due process; and develop compassionate exit pathways. Guiding principles such as transparency, fairness, and alignment with educational theory often supported these components. Conclusions This narrative review has identified the components to be considered when developing remediation frameworks in postgraduate medical education. Understanding core components and their connections helps design literature-informed frameworks that can be tailored to local contexts, optimizing remediation outcomes in postgraduate training programs.