Remediation in medical education poses significant challenges that require careful coordination and well-defined processes to protect both trainees and program integrity. When trainees struggle to meet expectations, the stakes are high, not just for the individuals involved but for the integrity and reputation of the program itself. Addressing these situations effectively means moving beyond isolated efforts and embracing a collaborative approach.
As part of the 2025 MedHub Virtual Medical Education Summit, Samantha Cascone, MPA, Vice President of Medical Education at UPMC in Pittsburgh, delivered a presentation discussing partnerships to mitigate unsuccessful remediations in medical education programs.
Cascone has spent the last 15 years supporting her trainees, coordinators, program directors, and UPMC Medical Education team to help bridge gaps in communication and create a community of support across more than 150 ACGME-accredited programs.
The Everyday Challenge of Remediation
Cascone began by highlighting that in large programs, remediation is a daily reality rather than a rare occurance. “For me, that half a percent to one percent at any given time is still, you know, 20-ish trainees. It happens every day,” she explained. Because remediation is a frequent issue, directors and faculty need to be ready to tackle it proactively instead of reactively.
She emphasized the emotional and administrative burdens that remediation work places on faculty. “At minimum, we really are talking about five hours per elevated struggling trainee. For us, with the numbers we had so far this year, that’s over 160 program director hours spent towards formal remediations,” she said. The increasing number of struggling learners means programs must be equipped to support remediation as a routine part of their work.
Safety in Numbers and Building Strategic Partnerships
A central theme of the session was the “safety in numbers.” approach, which underscores the power of collaboration in achieving successful remediation. Cascone drew from her experiences at UPMC Medical Education and emphasized that successful remediation is never the work of a single individual. Instead, it requires coordinated partnerships between the Clinical Competency Committee (CCC), HR, legal colleagues, and faculty. “We built the A-Team using human resources and our legal colleagues. Identifying those individuals so you at least know where to start and your programs know where to start is laying the foundation,” Samantha shared.
She encouraged directors to leverage institutional resources to alleviate the administrative load, noting, “Anything that we can do to help alleviate the clinical provider from having to do the administrative need is going to be big.” By involving HR and legal colleagues early, programs can ensure consistency, mitigate risk, and protect both learners and faculty from the pitfalls of isolated decision-making.
Why Transparency and Consistency are Important
Transparency and consistency are vital in remediation, as they build trust and ensure fairness throughout the process. Samantha argued that sharing information, widening the circle of support, and documenting every step of the process not only builds trust but also ensures fairness. “Knowledge is trust. Sharing that knowledge, opening that circle, widening that team, sharing where you are in your process, your data, and your needs will only help to build that team stronger,” she explained.
When everyone involved understands the process and the potential outcomes, remediation becomes less stressful and more effective. This clarity helps prevent misunderstandings and protects both learners and programs from the risks associated with inconsistent or undocumented decisions.
Strategies for Effective Remediation
Throughout her session, Cascone offered practical strategies for directors. She encouraged programs to define clear processes and outcomes at the institutional level, engage key stakeholders in HR and legal early, and use short, realistic timelines for remediation plans. She stressed the importance of regular communication and thorough documentation, noting that these practices not only support the remediation process by helping to track progress, but also protect programs in the event of legal challenges.
Cascone also reminded directors that they are not alone in facing the challenges of remediation. “You are invested. You are an educator, a leader, an advocate for your learner. You don’t need to be a human resource representative, an attorney, or your learner’s care medical care team. Those are the individuals you want to bring to the table,” she advised.
Remediation is a Shared Responsibility
By fostering strong partnerships and open communication, program directors can create safer, more supportive environments, , leading to improved outcomes for both learners and faculty. When approached as a shared responsibility, remediation becomes less daunting and more successful, leading to better outcomes for everyone involved. As Samantha concluded, “At the heart of this, you are all engaged because you care about your trainees and you want them to do great work. If you are keeping that as the foundation, then none of this should feel too scary to take on.”