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

Abstract

Context Practicing physicians who remediate their peers face unique challenges. Recent research suggests that leaders of regulatory and educational institutions (i.e., those who might be seen as responsible for overseeing remediation programs for practicing 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 sensitizing 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 articulated about 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: educator, judge and 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. Conclusion This study suggests that the duality of remediation as both education and regulation may be contributing to the challenges faced by those working one‐on‐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.