The remediation challenge: theoretical and methodological insights from a systematic review

Cleland, Jennifer; Leggett, Heather; Sandars, John; Costa, Manuel João; Patel, Rakesh; Moffat, Mandy

doi:10.1111/medu.12052

Cited by 149 publications

(179 citation statements)

References 64 publications

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“…10 Earlier intervention and remediation targeted to specific areas of deficit may be more successful. 6,11,12 The purpose of our study was to better understand the reasons that students failed the Medicine Clerkship at the University of Minnesota Medical School. We reviewed letters written by the clerkship site director to the Committee on Student Scholastic Standing (COSSS), describing in detail the specific reasons for student failure.…”

Section: Introductionmentioning

confidence: 99%

Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

2016

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BACKGROUND: In addition to training future members of the profession, medical schools perform the critical role of identifying students who are failing to meet minimum standards in core competencies. OBJECTIVE: To better understand reasons for failure in an internal medicine clerkship. DESIGN: A qualitative content analysis of letters describing reasons for students' failure. PARTICIPANTS: Forty-three students (31 men) who failed the internal medicine clerkship at the University of Minnesota Medical School, 2002. APPROACH: We conducted a qualitative content analysis of the 43 letters describing reasons for students' failure. We coded critical deficiencies and mapped them to the Physician Competency Reference Set (PCRS) competency domains and classified them into two categories: conduct (unprofessional behaviors) and knowledge and skills specific to the practice of medicine. We then calculated the frequency of each critical deficiency. We statistically tested for relationships between gender and critical deficiencies in each of the competency domains. KEY RESULTS: We coded 50 critical deficiencies with all codes mapping to a PCRS competency domain. The most frequently cited deficiencies were Binsufficient knowledge( 79 % of students) and Binadequate patient presentation skills^(74 %). Students exhibited critical deficiencies in all eight competency domains, with the highest concentrations in Knowledge for Practice (98 %) and Interpersonal and Communication Skills (91 %). All students demonstrated deficiencies in multiple competencies, with 98 % having deficiencies in three or more. All 43 students demonstrated deficits in the knowledge and skills category, and 81 % had concurrent conduct issues. There were no statistically significant relationships between gender and critical deficiencies in any competency domain. CONCLUSIONS: This study highlights both the diversity and commonality of reasons that students fail a clinical clerkship. Knowing the range of areas where students struggle, as well as the most likely areas of difficulty, may aid faculty in identifying students who are failing and in developing remediation strategies.

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Section: Introductionmentioning

confidence: 99%

Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

2016

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“…17 PAs coach students in reflection, self-assessment, and goal-setting. 2,20,21 They also form long-term relationships with students and frequently serve as student advocates. The MSPRC encourages students to identify measurable outcomes to document competence, while offering positive support in written correspondence to students (See Appendices for series of letters to one student throughout the remediation process).…”

Section: Discussionmentioning

confidence: 99%

“…This emphasis on competence may explain why students' time in remediation was longer (Median=448 days) than normally needed for Bmore of the same,^such as retaking a test or course. 2 Some learners may not know how to navigate performance obstacles, making it important to offer guidance and oversight. 19,20 For this reason, we train a core group of faculty to help students apply the self-regulation cycle.…”

Section: Discussionmentioning

confidence: 99%

“…), across the medical education continuum, increases the likelihood we will identify and diagnose individuals with several performance deficits beyond the familiar and easy to measure. [2][3][4][5][6] By casting a wider net, we will probably encounter more learners who require remediation. Therefore, it is essential we identify mechanisms to maximize remedial processes that benefit a growing number of struggling medical learners without overburdening our faculty.…”

Section: Introductionmentioning

confidence: 99%

“…7,12 We cannot assume all faculty have the time, resources, or expertise to Bfix the problem^or judge when learners have successfully remediated all deficiencies. 1,2,13 In light of these challenges, some institutions have built programs where teams of experts, from multiple professions, manage remediation processes. [5][6][7]12 Working together, such teams develop guidelines and best practices to provide more efficient and successful approaches to assist struggling learners.…”

Section: Introductionmentioning

confidence: 99%

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Time to Loosen the Apron Strings: Cohort-based Evaluation of a Learner-driven Remediation Model at One Medical School

2015

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BACKGROUND: Remediation in the era of competencybased assessment demands a model that empowers students to improve performance. AIM: To examine a remediation model where students, rather than faculty, develop remedial plans to improve performance. SETTING/PARTICIPANTS: Private medical school, 177 medical students. PROGRAM DESCRIPTION: A promotion committee uses student-generated portfolios and faculty referrals to identify struggling students, and has them develop formal remediation plans with personal reflections, improvement strategies, and performance evidence. Students submit reports to document progress until formally released from remediation by the promotion committee. PROGRAM EVALUATION: Participants included 177 students from six classes (2009)(2010)(2011)(2012)(2013)(2014). Twenty-six were placed in remediation, with more referrals occurring during Years 1 or 2 (n=20, 76 %). Unprofessional behavior represented the most common reason for referral in Years 3-5. Remedial students did not differ from classmates (n=151) on baseline characteristics (Age, Gender, US citizenship, MCAT) or willingness to recommend their medical school to future students (p<0.05). Two remedial students did not graduate and three did not pass USLME licensure exams on first attempt. Most remedial students (92 %) generated appropriate plans to address performance deficits. DISCUSSION: Students can successfully design remedial interventions. This learner-driven remediation model promotes greater autonomy and reinforces self-regulated learning.

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What is known already: reviewing evidence in health professions education

Gordon¹

2022

Researching Medical Education

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The remediation challenge: theoretical and methodological insights from a systematic review

Cited by 149 publications

References 64 publications

Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

Time to Loosen the Apron Strings: Cohort-based Evaluation of a Learner-driven Remediation Model at One Medical School

What is known already: reviewing evidence in health professions education

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