Remediation of the Deficiencies of Physicians Across the Continuum From Medical School to Practice: A Thematic Review of the Literature

Despite widespread endorsement of competency-based assessment of medical trainees and practicing physicians, methods for identifying those who are not competent and strategies for remediation of their deficits are not standardized. This literature review describes the published studies of deficit remediation at the undergraduate, graduate, and continuing medical education levels. Thirteen studies primarily describe small, single-institution efforts to remediate deficient knowledge or clinical skills of trainees or belowstandard-practice performance of practicing physicians. Working from these studies and research from the learning sciences, the authors propose a model that includes multiple assessment tools for identifying deficiencies, individualized instruction, deliberate practice followed by feedback and reflection, and reassessment. The findings of the study reveal a paucity of evidence to guide best practices of remediation in medical education at all levels. There is an urgent need for multiinstitutional, outcomes-based research on strategies for remediation of less than fully competent trainees and physicians with the use of long-term follow-up to determine the impact on future performance. Acad Med. 2009; 84:1822–1832. Medical educators and accrediting organizations have shifted their emphasis from what is taught in the curriculum to what a medical student, resident, or practicing physician can perform. Whereas most trainees and practicing physicians can demonstrate competence in clinical and communication skills, a minority fail to meet the expected standard and require remediation. Despite widespread endorsement of the expectation that physicians-in-training and practicing physicians be assessed for their competence, it remains challenging to identify accurately and reliably those trainees and physicians who are incompetent or less than fully competent and to remediate their deficiencies effectively. Less than fully competent physicians or trainees fail to maintain acceptable standards in one or more areas of professional physician practice, whereas incompetent physicians lack the abilities (cognitive, noncognitive, and communicative) and qualities needed to