Purpose <p>The identification and remediation of underperformance are essential responsibilities of postgraduate medical training programs. Despite calls for a programmatic approach, remediation practices remain inconsistent, with many institutions lacking formal policies. The aim of this study was to identify the core components for developing remediation frameworks for postgraduate trainees.</p> Methods <p>A narrative review format was chosen. Eligible papers for inclusion included studies, opinion pieces, systematic reviews, and meta-analyses. Fifty-four papers were included for analysis.</p> Results <p>We identified seventeen components which were organized into three overarching phases: (1) assess and support, (2) plan and implement, and (3) evaluate and follow-up. ‘Assess and support’ components included: ensure an accurate diagnosis; give feedback; ensure the trainee’s perspective is heard; address external stressors and system causes; provide emotional support; address attitudes and motivation of the trainee; and destigmatize remediation. ‘Plan and implement’ components included: involve remediation and educational experts; create individualized remediation plans; document plans clearly; and teach goal setting and self-regulation. ‘Evaluate and follow-up’ components included: monitor progress and reassess; feed forward carefully; separate those conducting from those judging remediation; ensure transparent policies and due process; and develop compassionate exit pathways. Guiding principles such as transparency, fairness, and alignment with educational theory often supported these components.</p> Conclusions <p>This narrative review has identified the components to be considered when developing remediation frameworks in postgraduate medical education. Understanding core components and their connections helps design literature-informed frameworks that can be tailored to local contexts, optimizing remediation outcomes in postgraduate training programs.</p>