"When You're in It, It Feels Like It's Everything": Medical Students' Experience of Failure and Remediation in the United States and the Netherlands.

Purpose: Medical training institutions worldwide must be prepared to remediate struggling learners, but there is little empirical evidence around learners' perspectives on remediation efforts. Research shows that emotion has a significant effect on learning, but it has not been well studied in remediation in medical education. Given the high stakes of remediation, understanding more about learners' emotional experience could lead to improvements in remediation programs. This study aimed to explore medical students' emotional experience of failure and remediation to offer opportunities to improve remediation.

Method: This study is a thematic analysis of data collected from July to September 2022 from one-to-one interviews with students from 4 institutions (2 in the United States and 2 in the Netherlands) who had not met expectations on 1 or more medical school assessment(s). Interview questions explored students' experiences with learning of and responding to a performance that was below expected standards, with probes around any mentions of emotions.

Results: Fourteen students participated: 9 from schools in the United States and 5 from schools in the Netherlands. The students perceived the failure and remediation event to be highly significant, reflecting negatively on their suitability for a career as a physician. We identified 5 themes: (1) shame was pervasive and only retrospectively perceived as unwarranted; (2) self-doubt was common and weighty; (3) resentment, blame, and other external-facing emotions were present but softened over time; (4) worry and stress related to perceived career effect differed across countries; and (5) students had mixed emotional reactions to the remediation process.

Conclusions: Medical students have strong emotional responses to failure and remediation. Expecting and considering emotions such as shame, self-doubt, and anger could help educators design better remediation programs. Differences across countries may be at least partially explained by different degrees of time variability and flexibility within the curricula.