G. Bourgeois-Law is clinical associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and PhD candidate, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-4726-3663. P.W. Teunissen is professor of medical education, School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, and gynecologist, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; ORCID: http://orcid.org/0000-0002-0930-0048. G. Regehr is professor, Department of Surgery, and associate director for research, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X.
Acad Med. 2018 Nov;93(11):1638-1644. doi: 10.1097/ACM.0000000000002266.
Suboptimal performance in practicing physicians is a decades-old problem. The lack of a universally accepted definition of remediation, the paucity of research on best remediation practices, and the ongoing controversy regarding the institutional responsibility for enacting and overseeing the remediation of physicians suggest that it is not merely a difficult problem to solve but a problem that the community does not grapple with meaningfully. Undoubtedly, logistical and political considerations contribute to this state of affairs; however, other underlying conceptual issues may also play a role in the medical profession's difficulties in engaging with the challenges around remediation.Through a review of the medical education and other literatures, the authors examined current conceptualizations of both reme-diation itself and the individual being remediated, as well as how the culture of medicine influences these conceptions. The authors explored how conceptualizations of remediation and the surrounding culture might affect not only the medical community's ability to support but also its willingness to engage with physicians in need of remediation.Viewing remediation as a means of supporting practice change-rather than as a means of redressing gaps in knowledge and skill-might be a useful alternative conceptualization, providing a good place to start exploring new avenues of research. However, moving forward will require more than simply a reconceptualization of remediation; it will also necessitate a change in how the community views its struggling members and a change in the medical culture that currently positions professional autonomy as the foundational premise for individual practice improvement.
临床医生表现欠佳是一个存在了几十年的问题。缺乏普遍接受的补救定义、补救实践最佳方法的研究匮乏，以及关于机构在实施和监督医生补救方面的责任的持续争议表明，这不仅仅是一个难以解决的问题，而是一个社区没有真正解决的问题。毫无疑问，后勤和政治因素对此状况有所影响；然而，其他潜在的概念问题也可能在医学专业处理补救相关挑战时遇到困难中发挥作用。
通过对医学教育和其他文献的回顾，作者检查了补救本身和被补救者的当前概念化，以及医学文化如何影响这些概念。作者探讨了补救的概念化以及周围文化如何不仅影响医疗社区支持的能力，而且影响其与需要补救的医生合作的意愿。将补救视为支持实践变革的手段，而不是弥补知识和技能差距的手段，可能是一种有用的替代概念化，为探索新的研究途径提供了一个良好的起点。然而，向前推进不仅需要对补救进行重新概念化；还需要改变社区对其挣扎成员的看法，以及改变目前将专业自主权作为个体实践改进的基础前提的医学文化。
