Investigators discussed the framework application, and there was no desire to expand the framework. The coding process utilized HyperRESEARCH 2.8.3 (Researchware Inc, Randolph, MA) and Microsoft Excel 2013 (Microsoft Corp, Redmond, WA). Each transcript was then independently coded by 2 investigators to assure accuracy of coding until saturation was achieved. The research team was subsequently trained to the framework. Two investigators (S.W., E.B.) iteratively coded 3 transcripts to create a reliable book of 21 codes with definitions for use as an analytic framework. We then held an open discussion with all investigators to advance understanding across institutions. 24 As such, investigators first reviewed their own institutional transcripts to gain substantial familiarity with the data. 23 We used the framework approach to conventional content analysis, which includes a procedural analysis of transcription, familiarization, coding, developing a framework, applying a framework, charting the data, and analyzing. We pooled the data from all 3 institutions and analyzed it using conventional content analysis. We redacted names from the transcripts to ensure anonymity. Verbatim transcriptions of each focus group's audio recording provided data for analysis. Each institution conducted 2 to 3 focus groups led by members of the research team who were explicitly not in an assessment role for the resident participants (2 authors were affiliated with UICOMP at the time of this study). The guide was piloted with 8 GME fellows, and no major changes were made.

The goal was to stimulate discussion around remediation-related topics rather than elicit first-hand experiences from residents who had undergone remediation, thus the questions were intentionally broad with optional prompts provided for the facilitator to encourage deeper discussion. Drawing on the research team's collective experience with resident remediation, we developed a 13-question semi-structured focus group guide (available as online supplementary data) to explore resident perspectives on peers who are struggling and the remediation process.

Unherd voices