A qualitative study of medical educators’ perspectives on remediation: Adopting a holistic approach to struggling residents

Krzyzaniak, Sara; Wolf, Stephen J.; Byyny, Richard L.; Barker, Lisa; Kaplan, Bonnie; Wall, Stephen P.; Guerrasio, Jeannette

doi:10.1080/0142159x.2017.1332362

Cited by 18 publications

(35 citation statements)

References 19 publications

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“…Research-generated profiles of student behaviours are based on two factors: the student's reflectiveness and their adaptability (see Figure 2). Reflective behaviour (listening to feedback and willingness and ability to incorporate it in future behaviour) is the basis of these profiles, as it predicts the future professionalism of a student better than the common engagement behaviours educators tend to denominate Hoffman et al 2016;Krzyzaniak et al 2017;Ainsworth and Szauter 2018). A student's behavioural profile can become apparent over time in different ways: by one teacher observing the student over a period of time; by forward feeding of performance from present teachers to new teachers, or by combining evaluations from different teachers by someone who has an oversight of the assessments.…”

Section: Profiles Of Unprofessional Behaviourmentioning

confidence: 99%

How to identify, address and report students’ unprofessional behaviour in medical school

et al. 2019

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This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students' unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the 'failure to fail' phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions. . She received her MD in 1986, and completed residency training in general practice at the University of Amsterdam in 1990. Marianne worked in general practice for 15 years, combining this work with teaching clerks in the workplace, and from 2001 with other educational activities at the Faculty of Medicine at the VU University. From 2010 onwards, she has been coordinating the educational theme 'Professional behaviour' at the school. Recently, Marianne received her PhD with distinction. Her research explores how educators and peer students perceive and respond to unprofessional behaviours of medical students.Arianne Teherani PhD, is a Professor of role in which she leads design, development, and policy for evaluation of the school's curriculum and programs. Arianne's main research interests are in the areas of professionalism, professional identity formation, and equity in medical education. She has led studies aimed at identification and remediation of unprofessional behaviours, the role of clinical education in shaping the professional identity of learners and teachers, and the role of assessment and learning environment practices in perpetuating educational disparities and interventions aimed at creating equity during medical school. . His current medical education research focuses on generic aspects of (post)graduate training, and on intensive care medicine specifically, including the supervision of national and international PhD students. In addition he performs research in the fields of organ donatio...

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Section: Profiles Of Unprofessional Behaviourmentioning

confidence: 99%

How to identify, address and report students’ unprofessional behaviour in medical school

et al. 2019

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“…We thus present these guidelines with the aim of aiding the development of remediation practice. The guidelines are divided into two highly interrelated groupings: system and individual level guidelines [18, 20, 33].…”

Section: Introductionmentioning

confidence: 99%

Guidelines: The dos, don’ts and don’t knows of remediation in medical education

et al. 2019

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Introduction Two developing forces have achieved prominence in medical education: the advent of competency-based assessments and a growing commitment to expand access to medicine for a broader range of learners with a wider array of preparation. Remediation is intended to support all learners to achieve sufficient competence. Therefore, it is timely to provide practical guidelines for remediation in medical education that clarify best practices, practices to avoid, and areas requiring further research, in order to guide work with both individual struggling learners and development of training program policies. Methods Collectively, we generated an initial list of Do’s, Don’ts, and Don’t Knows for remediation in medical education, which was then iteratively refined through discussions and additional evidence-gathering. The final guidelines were then graded for the strength of the evidence by consensus. Results We present 26 guidelines: two groupings of Do’s (systems-level interventions and recommendations for individual learners), along with short lists of Don’ts and Don’t Knows, and our interpretation of the strength of current evidence for each guideline. Conclusions Remediation is a high-stakes, highly complex process involving learners, faculty, systems, and societal factors. Our synthesis resulted in a list of guidelines that summarize the current state of educational theory and empirical evidence that can improve remediation processes at individual and institutional levels. Important unanswered questions remain; ongoing research can further improve remediation practices to ensure the appropriate support for learners, institutions, and society.

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“…Given the paucity of literature at the practice level, we looked at how remediators at the residency and undergraduate level conceptualise what they do. The only study that engaged with remediators of residents 2 explored how remediation should be conducted, not how they conceptualise their role. Kalet and Zabar 3 imply a particular role for residency remediators by suggesting specific competencies for clinical educators conducting remediation, but this was based on expert opinion on different facets of remediation, and not on discussions with remediators.…”

Section: Introductionmentioning

confidence: 99%

Educator, judge, public defender: Conflicting roles for remediators of practising physicians

et al. 2020

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Context: Practising physicians who remediate their peers face unique challenges. Recent research suggests that leaders of regulatory and educational institutions (ie, those who might be seen as responsible for overseeing remediation programmes for practising physicians) view remediation as a duality: education and regulation. Research has yet to study the perspectives of remediators; therefore, to address that gap we asked: What is the nature of remediation as experienced by remediators? Methods: We used a theory-informing inductive data analysis study design with positioning theory as a sensitising concept. We interviewed nine remediators from five Canadian provinces, asking them to narrate particularly memorable remediation experiences, then exploring the stories in more depth by asking probing questions around topics related to the research question. We used a hermeneutic analytic approach to explore the meanings that participants gave to their remediation work by iteratively reading their stories, examining the sense making that participants achieved through these narratives, and identifying the positions and responsibilities they described. Results: In their remediation narratives, participants variably position themselves in three different ways: (a) educator; (b) judge, and (c) public defender. For each position, remediators in turn framed the remediatee in a particular way. Participants shifted between educator, judge and public defender in response to evolving experiences with the remediatee, but they expressed preference for the educator position. However, they sometimes encountered serious obstacles to enacting that educator position. Those obstacles were imposed both by regulators and by remediatees. Conclusions: This study suggests that the duality of remediation as both education and regulation may be contributing to the challenges faced by those working one to one with remediatees. Understanding the dual nature of remediation and equipping remediators with the tools to manage this duality might contribute to improving the experience for both remediators and remediatees, and ultimately to a greater number of successful remediation outcomes.

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A qualitative study of medical educators’ perspectives on remediation: Adopting a holistic approach to struggling residents

Cited by 18 publications

References 19 publications

How to identify, address and report students’ unprofessional behaviour in medical school

How to identify, address and report students’ unprofessional behaviour in medical school

Guidelines: The dos, don’ts and don’t knows of remediation in medical education

Educator, judge, public defender: Conflicting roles for remediators of practising physicians

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