To fail is human: remediating remediation in medical education

Abstract

IntroductionRemediating failing medical learners has traditionally been a craft activity responding to individual learner and remediator circumstances. Although there have been moves towards more systematic approaches to remediation (at least at the institutional level), these changes have tended to focus on due process and defensibility rather than on educational principles. As remediation practice evolves, there is a growing need for common theoretical and systems-based perspectives to guide this work.MethodsThis paper steps back from the practicalities of remediation practice to take a critical systems perspective on remediation in contemporary medical education. In doing so, the authors acknowledge the complex interactions between institutional, professional, and societal forces that are both facilitators of and barriers to effective remediation practices.ResultsThe authors propose a model that situates remediation within the contexts of society as a whole, the medical profession, and medical education institutions. They also outline a number of recommendations to constructively align remediation principles and practices, support a continuum of remediation practices, destigmatize remediation, and develop institutional communities of practice in remediation.DiscussionMedical educators must embrace a responsible and accountable systems-level approach to remediation if they are to meet their obligations to provide a safe and effective physician workforce.

Developing a two-dimensional model of unprofessional behaviour profiles in medical students

“…The two variables discriminating between the profiles appeared to be reflectiveness and adaptability . This confirms earlier findings that reflective ability plays a role as a determinant for describing the thresholds between pass and fail for professional behaviour (Kalet et al 2016 , 2017 ; Hoffman et al 2016 ) We add to these earlier findings that adaptability is also an important guiding factor in the decision-making process on remediation strategies or dismissal. A question that still remains is: “Are these two variables independent, or do they influence each other?”…”

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

“…Lapses are a part of learning, and discussing lapses among teachers and students can effectively enhance students' professional identity formation (Lucey and Souba 2010). Thus, responding to unprofessional behaviour to prevent future lapses should be part of the normal curriculum (Kalet et al 2017). Medical educators need to be taught about how to recognize and respond to unprofessional behaviour, and to be informed about the way the behaviour is dealt with after reporting.…”

Physician remediation: accepting and working with complementary conceptualisations

“…Stigmatisation, loss of autonomy and the resulting sense of ‘de‐professionalisation’ are well‐founded concerns raised in relation to physician remediation . A systemic approach to remediation has been recommended as one way of addressing the challenges that are part of implementing physician remediation . This requires the full involvement of stakeholders at all levels, from the remediating student and his or her teachers to the various levels of the institution and the society within which it is situated, so that the idea of remediation becomes normalised and accepted at all levels.…”

“…2,3 A systemic approach to remediation has been recommended as one way of addressing the challenges that are part of implementing physician 1 remediation. 4,7,8 This requires the full involvement of stakeholders at all levels, from the remediating student and his or her teachers to the various levels of the institution and the society within which it is situated, 4,7 so that the idea of remediation becomes normalised and accepted at all levels. Still, even within a well-designed systemic approach, there will be a need for both supportive and regulatory components of remediation.…”