OBJECTIVE: The goal of graduate medical education is for trainees to develop the competence needed to practice independently
however, some residents struggle to achieve competency and require remediation. Evidence around how to best facilitate remediation is lacking. The objective of this study was to understand best practices for remediation in pediatrics. METHODS: A national web-based survey of pediatric residency program directors (PDs) on remediation practices was performed. The survey included three open-ended questions about PDs' experiences with remediation. Self-reported barriers to and strategies for remediation were systematically analyzed using inductive thematic analysis to develop a theory of effective remediation in pediatric residency training. RESULTS: A total of 99 out of 195 (50.8%) program directors responded. Two main themes emerged: developing a personalized plan that ensures competency attainment and fostering psychological safety. Twelve categories outline actionable steps that PDs can take to make the remediation process successful. CONCLUSIONS: Built from insight from pediatric PDs, we propose a conceptual model for effective remediation that accounts for competency attainment while safeguarding the emotional health of the resident. The conceptual model breaks the remediation process down into four phases: identification of the learner who struggles, planning the remediation process, implementation of the plan, and assessing the outcome of the process.