Learner Deficits and Academic Outcomes of Medical Students, Residents, Fellows, and Attending Physicians Referred to a Remediation Program, 2006–2012

Guerrasio, Jeannette; Garrity, Maureen J.; Aagaard, Eva

doi:10.1097/acm.0000000000000122

Cited by 141 publications

(167 citation statements)

References 18 publications

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“…12 For the purposes of this program, the competency of patient care is subdivided into clinical skills, clinical reasoning, and time management and organization. Mental well-being includes psychiatric diagnoses, as well as substance abuse, learning disabilities and psychosocial stressors.…”

Section: Contextmentioning

confidence: 99%

“…11 If both deficits exist, knowledge must be remediated first, to provide the foundation to develop clinical reasoning skills. 12,13 In the clinical reasoning process, clinicians routinely adopt three methods to assist with diagnosis: hypothetico-deductive reasoning, which involves formulating and testing hypotheses; pattern recognition, which involves comparing cases to prior or textbook cases; and schema group diagnostics, which is algorithmic, dividing possible diagnoses up into clinical and pathophysiologic categories. [14][15][16] Approaches to remediating clinical reasoning would have to take into account these methods as well as the following relevant information: the mental processing that begins through observation early in the patient encounter; the initial list of possible diagnoses including the most common and the most lethal, and the gathered historical and physical exam information.…”

Section: Introductionmentioning

confidence: 99%

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Methods and Outcomes for the Remediation of Clinical Reasoning

Guerrasio

Aagaard

2014

J GEN INTERN MED

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INTRODUCTION:There is no widely accepted structured, evidence based strategy for the remediation of clinical reasoning skills. AIM: To assess the effectiveness of a standardized clinical reasoning remediation plan for medical learners at various stages of training. SETTING: Learners enrolled in the University of Colorado School of Medicine Remediation Program. PROGRAM DESCRIPTION: From 2006 to 2012, the learner remediation program received 151 referrals. Referrals were made by medical student clerkship directors, residency and fellowship program directors, and through self-referrals. Each learner's deficiencies were identified using a standardized assessment process; 53 were noted to have clinical reasoning deficits. The authors developed and implemented a ten-step clinical reasoning remediation plan for each of these individuals, whose subsequent performance was independently assessed by unbiased faculty and senior trainees. Participant demographics, faculty time invested, and learner outcomes were tracked. PROGRAM EVALUATION: Prevalence of clinical reasoning deficits did not differ by level of training of the remediating individual (p=0.49). Overall, the mean amount of faculty time required for remediation was 29.6 h (SD=29.3), with a median of 18 h (IQR 5-39) and a range of 2-100 h. Fiftyone of the 53 (96 %) passed the post remediation reassessment. Thirty-eight (72 %) learners either graduated from their original program or continue to practice in good standing. Four (8 %) additional residents who were placed on probation and five (9 %) who transferred to another program have since graduated. DISCUSSION: The ten-step remediation plan proved to be successful for the majority of learners struggling with clinical reasoning based on reassessment and limited subsequent educational outcomes. Next steps include implementing the program at other institutions to assess generalizability and tracking long-term outcomes on clinical care.

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Section: Contextmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Methods and Outcomes for the Remediation of Clinical Reasoning

Guerrasio

Aagaard

2014

J GEN INTERN MED

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“…Several students in our study group were dismissed in part or in whole because of unprofessional behavior, so the ramifications of allowing problematic behaviors to go unrecognized or uncorrected can be substantial. Since this population may also be at higher risk for problems after graduation, interventions tailored to a student’s individual needs, including more intense observation, feedback, counseling, or leaves of absence, appear justified [30,31]. …”

Section: Discussionmentioning

confidence: 99%

Student response to reports of unprofessional behavior: assessing risk of subsequent professional problems in medical school

Ainsworth

Szauter

2018

Medical Education Online

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Background: An early concern note (ECN) program is used by some medical schools to identify, counsel, and intervene when students exhibit unprofessional behavior. Student maturity, insight, propensity for reflection, and receptiveness to feedback have been suggested as predictors of future behavior. Objective: We hypothesized that (a) classifying students with a first ECN based on their response to the report would identify students at risk of repeat ECNs better than the action that prompted it and (b) receipt of multiple ECNs would identify students at risk of adverse academic events.Design: For this study, 459 ECNs were classified based on students’ (1) recognition that their behavior was inappropriate and (2) acceptance of responsibility for the behavior. Student academic progress and receipt of subsequent ECNs were tracked.Results: Students who recognized their behavior was inappropriate and accepted responsibility after an initial ECN received subsequent ECNs at lower rates (14–19%) than students who disagreed with the significance of their behavior or were resistant to accepting responsibility (36–59%). Students with limited insight and adaptability appeared to be at highest risk. Seventy-one percent of students with three or more ECNs encountered adverse academic events during enrollment.Conclusion: Student reactions to reports of unprofessional behavior may be useful as a tool to help assess risk of recurrent lapses. Students with diminished capacity to recognize behaviors as unprofessional or accept responsibility for them appear to be at highest risk for additional adverse academic and professionalism events while in medical school.

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“…In a recent survey of nephrology program leaders conducted by the American Society of Nephrology Workforce and Training Committee, 88% of respondents report remediating at least one fellow over the last 5 years (1). There is growing evidence that a structured approach to evaluating and remediating the underperforming trainee can be effective (2).…”

Section: Introductionmentioning

confidence: 99%

“…A deficiency in organization and efficiency can represent many things: true organizational challenges, weakness in clinical reasoning, underlying issues with mental wellbeing, and underpreparedness for a large and complex fellowship. Professionalism is a common area of struggle among nephrology trainees where remediation is complicated and is not always successful (2,3). Additional issues with stress, depression, anxiety, and impairment occur in up to one third of cases and can negatively affect performance (3,4).…”

Section: Introductionmentioning

confidence: 99%