ABSTRACT
Background: Remediation of struggling learners in pulmonary and critical care fellowship programs is a challenge, even for experienced medical educators. Objective: This evidence-based narrative review provides a framework program leaders may use to address fellows having difficulty achieving competency during fellowship training. Methods: The relevant evidence for approaches on the basis of each learner's needs is reviewed and interpreted in the context of fellowship training in pulmonary medicine and critical care. Issues addressed include bias in fellow assessments and remediation, the impacts of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the specific challenges of pulmonary and critical care fellowship programs, a brief review of relevant legal issues, guidance on building and leveraging program resources, and a discussion of learner outcomes. Results: This results in a concise, evidence-based toolkit for program leaders based around four pillars: early identification, fellow assessment, collaborative intervention, and reassessment. Important concepts also include the need for documentation, clear and written communication, and fellow-directed approaches to the creation of achievable goals. Conclusion: Evidence-based remediation helps struggling learners in pulmonary and critical care fellowship to improve their ability to meet Accreditation Council for Graduate Medical Education (ACGME) milestones.