Hiding in Plain Sight: Resident Remediation in Obstetrics and Gynecology

OBJECTIVE

Residents who are in need of remediation are prevalent across residency programs and often tend to be deficient in multiple competencies that the American Council for Graduate Medical Education (ACGME) has established. The purpose of this study was to determine the prevalence of residents requiring remediation, understand the scope of the challenges in resident remediation, and assess what resources were used to aid in remediation in obstetrics and gynecology programs.

DESIGN

An anonymous survey was emailed to obstetrics and gynecology program directors. Survey responses were summarized through descriptive statistics.

SETTING

Obstetrics and gynecology residency program directors were invited to respond to this survey.

PARTICIPANTS

Thirty-nine respondents out of 241 residency training programs responded (16%).

RESULTS

The majority (84.6%) of programs had placed a resident on remediation. The most common area requiring remediation was professionalism (75.8%), followed by medical knowledge (72.7%), interpersonal communication (60.6%), laparoscopic technical skills (54.6%), and inpatient care (42.4%). Residents who required remediation were identified in a number of ways, most commonly through feedback from the Clinical Competency Committee (87.8%) and faculty feedback (84.8%). Program directors utilized a variety of resources, most commonly prior remediation plans from the program, to create remediation plans. Sixty percent of programs had residents who failed remediation.

CONCLUSION

This study highlighted the prevalence of resident remediation in obstetrics and gynecology training programs and the importance of faculty in identifying residents in need of remediation, evaluating residents, and mentoring residents.

Twelve tips for providing academic remediation to widening access learners in medical education

As medical schools expand access and diversity through widening access initiatives, there is an increasing need to provide academic remediation for learners during their first year in medical school. The previous educational experiences of widening access learners are often mismatched for continuing success in medical school. This article offers 12 tips for providing academic remediation to widening access learners and draws on insights from the learning sciences and research in psychosocial education to support academic development within a holistic framework.

Key differences between severity of disciplinary issues and medical student insights

CONTEXT

This study explores the reliability of tools designed to rate the type of remediable medical student offences, their severity, and the quality of student insight in response to the remediation, and tests the relationships between these three constructs.

METHODS

Data were collected via retrospective appraisal of remediation files from the 2009-2016 incoming classes of McMaster University's medical programme. Across two studies, 12 faculty members categorised the offences by type (academic or professionalism), and rated severity and insight by way of single anchored Likert scales. In Study 1, Krippendorff's alpha and independent, two-way, consistency type, average measures (k = 6), random-effects inter-rater reliability analyses were conducted to assess the inter-rater reliability of ratings of the measures. In Study 2, independent samples t-tests were conducted for the severity and insight measures as a function of offence type. Pearson correlations were used to assess the relationship between severity and insight as a function of offence type.

RESULTS

High inter-rater reliability was found with respect to the type of offence (α = 0.86), severity (0.92) and student insight (0.88). Mean (±standard deviation) ratings of severity are significantly higher for professionalism (4.37 ± 1.20) than academic offences (2.89 ± 1.25), t(73) = -5.3, p < 0.001, |d| = 1.21, whereas the opposite is true for ratings of insight, (professionalism, 3.19 ± 1.37; academic, 4.48 ± 1.01), t(73) = 4.6, p < 0.001, |d| = 1.07. Ratings of severity and insight are moderately negatively correlated for both academic (r = -0.64, p < 0.001, n = 38) and professionalism offences (r = -0.57, p < 0.001, n = 37).

CONCLUSIONS

Professionalism offences are perceived as more severe and are associated with lower insight than academic offences, pointing to the difficulty that learners face in assessing the constitution of a professionalism offence. This illustrates a need for deeper consideration about remedial strategies for lapses in professionalism.

Growth under intervention by means of instructional time expended: Empirical illustrations of applicable models

The empirical literature on academic intervention has increasingly promoted comparative research, moving the field forward in addressing the question, "What works best?" Poncy et al. (2015), Skinner (2008, 2010), and Skinner, Fletcher, and Henington (1996) have suggested that researchers enhance traditional evaluations of learning (behavior change) by using learning rates (behavior change over instructional time [IT]). The precise documentation or control of IT allows researchers to address confounds commonly found in comparative intervention research, most notably variability in intervention duration. The current article demonstrates how recent developments within the field of single-case analysis creates an opportunity to address Skinner's (2008, 2010), Skinner et al. (1996), and Poncy et al. (2015) IT within the context of comparative intervention research. Specifically, a rationale and tutorial on several coding schemes for the generalized linear model is presented that can be used to isolate the effect of IT. The use of these analyses is demonstrated across design frameworks and when considering individual participants, studies, and research synthesis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Charting a successful course: The academic and clinical success committee's impact on student success

BACKGROUND

The road from prematriculation to graduation looks different for each student at each institution. To successfully complete the curriculum, students must often overcome difficulties, both academic and nonacademic. Up to 15% of 3^rd-year medical students in the United States are still struggling on the major components of their clerkships and 11% in their 4^th year. While there is an established need for medical school remediation, there is little evidence supporting what specifically works across the board. These deficiencies often do not go away on their own and with the need to educate all students, the guidance provided by multiple stakeholders (i.e., administration, staff, faculty, and clinicians) would be necessary to chart a course of success for these students.

METHODS

The Academic and Clinical Success Committee (ACSC) at the Texas A and M University College of Medicine provides a venue to review individual students and provide input, resources, and support on a timely basis. This is a necessary ingredient in guiding the students facing academic and clinical challenges toward successful completion of graduation requirements.

RESULTS

Since its incorporation, the work of the ACSC has contributed to a decrease in failures on consecutive block examinations, a decreased failure rate on Step 2 clinical skills (CS), and increased capacity to help students at risk of failing Step 1 to not do so.

DISCUSSION

In this brief report, we illustrate how we developed the ACSC, the impact and levels of success it has had on students, and challenges we have faced.

Deliberate Practice as an Effective Remediation Strategy for Underperforming Medical Students Focused on Clinical Skills: a Prospective Longitudinal Study

BACKGROUND

It is critical to develop remedial education for underperforming medical students, but little is known about how to create an effective remediation program. Deliberate practice (DP) is a structured and reflective activity that is designed to optimize performance. Here we applied the concept of DP to create remedial education to improve the clinical practices of medical students. We also analyzed the effectiveness of the remediation program.

METHODS

Based on the expert performance approach of DP, we designed a 4-week remedial program for clinical performance that included feedback and reflection. There were 74 student participants in this program from 2014 to 2017. Their clinical performance was re-evaluated after completion, and changes in their clinical performance scores were analyzed.

RESULTS

Students who completed the remediation program showed significant improvements in clinical performance scores (P < 0.001). Most students found the program to be instructive and helpful for improving their clinical performance. They reported that role play with peers was the most helpful for improving their skills.

CONCLUSION

The DP-based remediation program improved the clinical performance of failing medical students. This remediation program should continue to be offered to underperforming students to ensure that medical school graduates are competent.

Comprehensive Assessment of Struggling Learners Referred to a Graduate Medical Education Remediation Program

BACKGROUND

Implementation of the Next Accreditation System has provided a standardized framework for identifying learners not meeting milestones, but there is as yet no corresponding framework for remediation.

OBJECTIVE

We developed a comprehensive assessment process that allows correct diagnosis of a struggling learner's deficit(s) to promote successful remediation.

METHODS

At the University of Pennsylvania, resident learners within the Department of Medicine who are not meeting milestones are referred to the Early Intervention Remediation Committee (EIRC). The EIRC, composed of 14 faculty members with expertise in remediation, uses a standardized process to assess learners' deficits. These faculty members categorize primary deficits as follows: medical knowledge, clinical reasoning, organization and efficiency, professionalism, and communication skills. The standardized process of assessment includes an analysis of the learner's file, direct communication with evaluators, an interview focused on learner perception of the problem, screening for underlying medical or psychosocial issues, and a review of systems for deficits in the 6 core competencies. Participants were surveyed after participating in this process.

RESULTS

Over a 2-year period, the EIRC assessed and developed remediation plans for 4% of learners (14 of a total 342). Following remediation and reassessment, the identified problems were satisfactorily resolved in all cases with no disciplinary action. While the process was time intensive, an average of 45 hours per learner, the majority of faculty and residents rated it as positive and beneficial.

CONCLUSIONS

This structured assessment process identifies targeted areas for remediation and adds to the tools available to Clinical Competency Committees.

Effects of Prolonged Reading Disability: A Preliminary Study

A comparison of rest data for 16 primary and 16 adolescent or preadolescent cases attending a reading clinic seemed to warrant the following conclusions. (1) Both primary and teenage groups revealed frustration and negative attitudes toward reading more frequently than did children in the middle grades. (2) There was no significant difference among three age groups on four WISC subtests: Similarities, Digit Span, Picture Arrangement, and Block Design. Adolescents with severe reading problems were significantly lower than young children in Information, Arithmetic, and Vocabulary. Older cases showed greater strength in verbal comprehension and less weakness in coding. (3) If remedial readers developed problems in personal and social adjustment, these were not revealed by extreme ranks on the group test. (4) Some factors such as distractability, which were identified in young clinical cases as probable causes for reading disability were observed rarely, or not at all, in teenage cases. Other factors, such as low self-esteem, were not observed in young children and may have developed as a result of the disability.

Critical review: medical students' motivation after failure

About 10 % of students in each years' entrants to medical school will encounter academic failure at some stage in their programme. The usual approach to supporting these students is to offer them short term remedial study programmes that often enhance approaches to study that are orientated towards avoiding failure. In this critical review I will summarise the current theories about student motivation that are most relevant to this group of students and describe how they are enhanced or not by various contextual factors that medical students experience during their programme. I will conclude by suggesting ways in which support programmes for students who have encountered academic failure might be better designed and researched in the future.

The Effects of Self-Management in General Education Classrooms on the Organizational Skills of Adolescents With ADHD

Self-management procedures have been used in school settings to successfully reduce problem behaviors, as well as to reinforce appropriate behavior. A multiple-baseline across participants design was applied in this study to evaluate the effects of using a self-management procedure to enhance the classroom preparation skills of secondary school students with attention-deficit/ hyperactivity disorder (ADHD). Three male students enrolled in a public secondary school were selected for this study because teacher reports suggested that these students were insufficiently prepared for class and inconsistently completed assignments. The intervention involved training in self-management procedures focusing on the improvement of classroom preparation skills. Following the intervention, the training process was systematically faded. Results were consistent across the 3 participants in enhancing classroom preparation behaviors. Implications for practice and future research are discussed.

Making sense of it: a brief programme to improve reading comprehension in adolescents with language impairments in main stream school

BACKGROUND

Children with language impairment show academic outcomes that are consistently poorer than those of their typically developing peers. A contributor to this is difficulty with reading comprehension. Although these difficulties are reported to continue well into adolescence, this population is generally underserved with regard to therapy. The efficacy of interventions for reading comprehension is well established in the research literature, but whether the same effects are achievable within a reasonable time reflecting available resources in real-life circumstances is less clear.

AIMS

Efficacy trials may significantly overestimate how strong an effect will be when the treatment is used under more natural conditions and within local constraints. The aim was to discover whether a short classroom intervention would be effective in improving reading comprehension in adolescents with the heterogeneous profiles of general or specific learning disabilities, additional diagnoses and behavioural and socio-emotional problems found in mainstream schools today.

METHOD & PROCEDURES

Twenty-eight adolescents with heterogeneous language and reading profiles were recruited from a mainstream school. The intervention programme comprised eight sessions of instruction in multiple reading comprehension strategies, held over 4 weeks. Experiment 1 had 10 participants. Experiment 2 had 18 participants who underwent the same programme, plus the addition of a session dedicated to decoding skills. Efficacy was evaluated within a pre- and post-study design, with baseline and post-therapy measures taken using the York Assessment of Reading for Comprehension (YARC).

OUTCOMES & RESULTS

Both experiments showed a significant group difference pre/post-intervention, with similar large effect sizes. Experiment 2 also showed a significant group difference in decoding ability pre and post the single intervention session.

CONCLUSIONS & IMPLICATIONS

This short intervention programme proved effective in a population with heterogeneous profiles, and fitted well with delivery in a mainstream school setting. It showed significant gains can be attained for this client group with relatively few resources.

Improving communication outcomes for young offenders: a proposed response to intervention framework

BACKGROUND

Speech, language and communication needs (SLCN) are strongly overrepresented in young offender populations, and there is growing commitment internationally to ensuring access to speech-language therapy services for such young people. However there is currently no framework in which such interventions might be conceptualized, delivered and evaluated. This is significant given the role of language competence in the development of prosocial skills and also in the transition to literacy.

AIMS

To present Response to Intervention (RTI) as a framework in which SLCN of young offenders might be systematically addressed and evaluated within youth justice settings, led by speech-language therapists, in conjunction with other education and welfare team members.

METHODS & PROCEDURES

Literature regarding prevalence rates of SLCN in young offenders is reviewed, together with the limited extant evidence on interventions for this group. The importance of applying evidence-based interventions is argued, and a framework for adapting RTI for SLCN in custodial settings is outlined.

MAIN CONTRIBUTION

A framework for adapting RTI to design, deliver and evaluate speech-language therapy interventions in youth custodial settings is presented.

CONCLUSIONS

Speech-language therapy interventions for young offenders will be better addressed at policy, practice and research levels if a framework such as an RTI adaptation is employed. It is expected, however, that this model will evolve over time, as intervention evidence pertaining to the youth offender population emerges.

The role of phonological awareness in treatments of dyslexic primary school children

The present study investigated whether phonological awareness training is an effective intervention to significantly improve reading in German dyslexic third and fourth graders with a phonological awareness deficit, and whether these children can equally benefit from a phonology-based reading training or a visually-based reading training. German speaking dyslexic elementary school children (n=30; M=9.8 years) were matched by forming triplets based on IQ, reading quotient and phonological awareness and then randomly assigned to one out of three interventions (n=10): a phonological awareness training, a phonology-based reading training (phonics instruction), and a visually-based reading training (repeated reading of sight words). A total of 20 training sessions (30 minutes each) were distributed over four weeks. Typical readers (n=10; M=9.5 years) were assigned to the control group. Phonological awareness training directly improves reading comprehension in German dyslexic children with a phonological awareness deficit. However, these children can equally benefit from a visually-based reading training. In contrast, the phonology-based reading training has a direct selective effect on decoding but not on reading comprehension. Despite divergent short-term patterns, long-term improvement of reading comprehension and decoding is similar across all training groups, irrespective of the training method. Phonological awareness may but does not need to be part of reading remediation in dyslexic children with a phonological deficit when learning to read a consistent orthography. Rather, a visually-based reading strategy might compensate for the phonological deficit in dyslexic children after the initial stage of reading acquisition.

Predictors of improvement following speed of processing training in middle-aged and older adults with HIV: a pilot study

Speed of processing training has been shown to improve cognitive functioning in normal older adults. A recent study demonstrated that middle-aged and older adults with HIV also improved on a measure of speed of processing and a measure of everyday functioning after such training. The primary objective was to examine what predicts the speed of processing training gains observed in the previous study. Participants were administered an extensive battery of demographic, psychosocial, and neuropsychological measures at baseline. They were randomized either to the speed of processing training group (n = 22) or to a no-contact control group (n = 24). Participants received approximately 10 hours of computerized speed of processing training. Predictors of training gains on the Useful Field of View (UFOV) Test and the Timed Instrumental Activities of Daily Living (TIADL) Test were examined through correlational analyses. In general, those who performed worse on the UFOV and TIADL at baseline demonstrated significantly more training gains. Also, higher HIV viral load, poorer medication adherence, a higher number of years diagnosed with HIV, and lower baseline scores on the Wisconsin Card Sorting Test (an executive functioning measure) were correlated with better TIADL training gains. TIADL performance improved in those with higher HIV viral load, poorer medication adherence, and poor executive functioning. Speed of processing training may be a way to improve everyday functioning and therefore quality of life in more medically and cognitively vulnerable adults with HIV.

[The role of tutor, a new nursing speciality?]

The implementation of the 2009 training reference framework reinforces the place of the tutor and formalises and defines their role. The analysis of the practice of tutor nurses reveals the emergence of a new professional group. However, while tutors are recognised for their expertise, they do not have sufficient time to supervise students and carry out assessments.

Treating impaired cognition in schizophrenia: the case for combining cognitive-enhancing drugs with cognitive remediation

Cognitive impairment is a well-documented feature of schizophrenia and represents a major impediment to the functional recovery of patients. The therapeutic strategies to improve cognition in schizophrenia have either used medications (collectively referred to as 'cognitive-enhancing drugs' in this article) or non-pharmacological training approaches ('cognitive remediation'). Cognitive-enhancing drugs have not as yet been successful and cognitive remediation has shown modest success. Therefore, we may need to explore new therapeutic paradigms to improve cognition in schizophrenia. The optimal approach may require a combination of cognitive-enhancing drugs with cognitive remediation. We review the available data from animal and human studies that provide the conceptual basis, proof-of-concept and illustrations of success of such combination strategies in experimental and clinical paradigms in other conditions. We address the major design issues relevant to the choice of the cognitive-enhancing drugs and cognitive remediation, as well as the timing and the duration of the intervention as will be relevant for schizophrenia. Finally, we address the practical realities of the development and testing of such combined approaches in the real-world clinical situation and conclude that while scientifically attractive, there are several practical difficulties to be overcome for this approach to be clinically feasible.

Transformative learning in a professional development course aimed at addressing disruptive physician behavior: a composite case study

Disruptive physician behavior presents a challenge to the academic medical center. Such behaviors threaten the learning environment through increasing staff conflict, role modeling poor behaviors to trainees, and, ultimately, posing a risk to patient safety. Given that these physicians are often respected and valued for their clinical skills, many institutions struggle with how to best manage their behaviors. The authors present a composite case study of an academic physician referred to a professional development program for his disruptive behavior. They outline how transformative learning was applied to the development of concrete learning objectives, activities, and assessments for a curriculum aimed at promoting behavior change. Important themes include a safe group process in which the physician's assumptions are critically examined so that through experiential exercises and reflection, new roles, skills, and behaviors are learned, explored, and practiced. Timely feedback to the physician from the institution, colleagues, and administrators is critical to the physician's understanding of the impact of his or her behavior. Ultimately, the physician returns to practice demonstrating more professional behavior. Implications for medical education, prevention, and other professional development programs are discussed.

The effect of medical mathematics retention strategies in decreasing attrition rate among African American licensed practical nursing students in a community college

BACKGROUND

This education evidence based study examined African American students entering the Practical Nursing program and the strategies of medical mathematics bridge and tutoring programs to reduce attrition.

PURPOSE

To increase retention in the fundamentals of nursing courses, augmenting the program completion rate. DATA/OBSERVATIONS: Two groups of students (n = 105) participated for this one-year study over three semesters. Data revealed passing rates of 87%-92% for the nursing course and 75%-92% on medical mathematics when consistently attending programs. The attrition rate plummeting to 8% -34% contrasting previous years 43%-65%.

CONCLUSIONS

Retention intervention programs can have a positive impact on minority students' academic performance.

Changing the face of nursing: reducing ethnic and racial disparities in health

This article reports on findings from a Nursing Diversity Workforce grant, BEST (Becoming Excellent Students in Transition to Nursing), designed to assist students from minority and educationally disadvantaged backgrounds to become culturally competent registered nurses. A program of retention strategies that included peer and faculty tutoring, counseling, and financial support helped to remove barriers to success in nursing. All but 3 of the enrolled students either have graduated or are on track to doing so. Most graduates are practicing in the city where they are helping to reduce health disparities through their contributions to improved health care for vulnerable populations.

Effective literacy instruction for adults with specific learning disabilities: implications for adult educators

Adults with learning disabilities (LD) attending adult basic education, GED programs, or community colleges are among the lowest performers on measures of literacy. For example, on multiple measures of reading comprehension, adults with LD had a mean reading score at the third grade level, whereas adults without LD read at the fifth grade level. In addition, large numbers of adults perform at the lowest skill levels on quantitative tasks. Clearly, significant instructional challenges exist for adults who struggle with literacy issues, and those challenges can be greater for adults with LD. In this article, the literature on adults with LD is reviewed, and evidenced-based instructional practices that significantly narrow the literacy achievement gap for this population are identified. Primary attention is given to instructional factors that have been shown to affect literacy outcomes for adults with LD. These factors include the use of explicit instruction, instructional technology, and intensive tutoring in skills and strategies embedded in authentic contexts.

Conduct Problems Prevention Research Group. The effects of the fast track preventive intervention on the development of conduct disorder across childhood

The impact of the Fast Track intervention on externalizing disorders across childhood was examined. Eight hundred-ninety-one early-starting children (69% male; 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention addressed parent behavior-management, child social cognitive skills, reading, home visiting, mentoring, and classroom curricula. Outcomes included psychiatric diagnoses after grades 3, 6, 9, and 12 for conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder, and any externalizing disorder. Significant interaction effects between intervention and initial risk level indicated that intervention prevented the lifetime prevalence of all diagnoses, but only among those at highest initial risk, suggesting that targeted intervention can prevent externalizing disorders to promote the raising of healthy children.

On the importance of a cognitive processing perspective: an introduction

Children with learning problems require early intervention. If it is evidence based and implemented with integrity and intensity, it will accelerate the academic progress of many students. This is the hope and expectation of the many supporters of responsiveness-to-intervention (RTI). A minority of children, however, will not respond sufficiently to such intervention because of learning disorders like specific learning disabilities (SLD). Some RTI models do not include research-backed methods to identify these children, nor do RTI practitioners often produce the data necessary to develop individualized instruction for them. The authors suggest practitioners go beyond typical RTI assessment data documenting responsiveness/ unresponsiveness to conduct comprehensive evaluations of these most difficult-to-teach students and to include in their evaluations carefully chosen cognitive measures. This special issue presents the work of teams of researchers, which suggests that cognitive and neuropsychological assessments can provide information to further understand SLD, which in turn can guide development of promising interventions.

Effects of bottom-up and top-down intervention principles in emergent literacy in children at risk of developmental dyslexia: a longitudinal study

This longitudinal study focused on the effects of two different principles of intervention in children at risk of developing dyslexia from 5 to 8 years old. The children were selected on the basis of a background questionnaire given to parents and preschool teachers, with cognitive and functional magnetic resonance imaging results substantiating group differences in neuropsychological processes associated with phonology, orthography, and phoneme-grapheme correspondence (i.e., alphabetic principle). The two principles of intervention were bottom-up (BU), "from sound to meaning", and top-down (TD), "from meaning to sound." Thus, four subgroups were established: risk/BU, risk/TD, control/BU, and control/TD. Computer-based training took place for 2 months every spring, and cognitive assessments were performed each fall of the project period. Measures of preliteracy skills for reading and spelling were phonological awareness, working memory, verbal learning, and letter knowledge. Literacy skills were assessed by word reading and spelling. At project end the control group scored significantly above age norm, whereas the risk group scored within the norm. In the at-risk group, training based on the BU principle had the strongest effects on phonological awareness and working memory scores, whereas training based on the TD principle had the strongest effects on verbal learning, letter knowledge, and literacy scores. It was concluded that appropriate, specific, data-based intervention starting in preschool can mitigate literacy impairment and that interventions should contain BU training for preliteracy skills and TD training for literacy training.

A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia

OBJECTIVE

There is considerable interest in cognitive remediation for schizophrenia. Our study aimed to evaluate, in a large sample of patients with schizophrenia, the interest of a computer-assisted cognitive remediation program on cognitive performances of patients as well as in clinical and functional outcome.

METHOD

Seventy-seven patients with remitted schizophrenia were randomly assigned to 14 2-hours individual sessions of computer-assisted cognitive remediation (n=39) or a control condition (n=38). Remediation was performed using RehaCom ® software. Four procedures were chosen to train four cognitive functions involved in different stages of the information processing: attention/concentration, working memory, logic, and executive functions. Primary outcomes were remediation exercise metrics, neuropsychological composites (episodic memory, working memory, attention, executive functioning, and processing speed), clinical and community functioning measures.

RESULTS

Cognitive performances concerning Attention/vigilance, verbal working memory and verbal learning memory and reasoning/problem solving improved significantly in the remediation condition when no difference was reported in the control condition between the 2 assessments. However, there were no significant benefits of cognitive remediation on non-verbal working memory and learning and speed of processing or functional outcome measures.

CONCLUSIONS

Cognitive remediation for people with schizophrenia was effective in improving performance, but the benefits of training did not generalize to functional outcome measures. Long term follow-up studies are needed to confirm the maintenance of such improvements.

A framework to teach self-reflection for the remedial resident

BACKGROUND

Regardless of the area of deficiency, be it in knowledge, skills or attitudes, residents requiring remediation are rarely self-identified. This illustrates a diminished ability for self-reflection. Self-reflection is a cornerstone of adult education. During the remediation process, the remediation curriculum needs to emphasize self-reflection.

AIMS

How can one structure self-reflection in a remediation curriculum?

METHODS

This article describes how to adapt and apply environmental scanning for remedial residents.

RESULTS

Environmental scanning is a rigorous and well-developed business approach that can be adapted for personal continuous quality improvement to foster self-reflection in medical trainees. There are often already existing tools which can form the foundation for regular reflection in medical education using an environmental scanning structure.

CONCLUSIONS

Environmental scanning can be thought of as a structured approach to internal and external reflections.

The state of educational intervention research as viewed through the lens of literacy intervention

The characteristics of educational intervention research are reviewed: Educational intervention research is inspired by diverse theories, targeted at a variety of simple to very complex interventions, and includes a variety of methods and measurements. Some interventions have been studied much more than others, with the more studied ones often summarized in meta-analyses and other integrative reviews. The study of some of the more complex interventions pose new ethical challenges. Although some intervention research impacts educational practice and policy, much more could and probably should.

Fostering reading comprehension in fifth grade by explicit instruction in reading strategies and peer tutoring

BACKGROUND

Research reveals that explicit reading strategies instruction and engaging students in interaction about texts promote students' reading comprehension ability. The present intervention study combines both aspects.

AIMS

The study examines the educational benefits of explicit reading strategies instruction, followed by practice in (a) teacher-led whole-class activities (STRAT), (b) reciprocal same-age (STRAT + SA), or (c) cross-age peer tutoring activities (STRAT + CA) on fifth graders' reading comprehension achievement.

SAMPLE

Twenty-two fifth-grade teachers and their 454 students from 19 different schools throughout Flanders (Belgium) participated.

METHOD

A quasi-experimental pretest post-test retention test design was used with three experimental (STRAT, STRAT + SA, and STRAT + CA) and a matched control group. The experimental interventions were implemented during an entire school year.

RESULTS

Multilevel analysis revealed that the STRAT and STRAT + CA condition made a significantly larger pretest to retention test progress than the control group. The significant major progress was especially situated from pretest to post-test, during which the intervention took place. Concerning the STRAT + SA condition no significant differences with regard to the control group were detected. Pairwise comparisons of the experimental conditions indicated that the STRAT + CA condition's progress from pretest to retention test also exceeded the STRAT + SA condition's advancement significantly.

CONCLUSION

The study corroborated the efficacy of the STRAT and STRAT + CA conditions' interventions as feasible tools to enhance fifth graders' reading comprehension achievement.

Reflect for success: recommendations for mentors managing failing students

Failing a student nurse for not meeting clinical competency on a practice placement can be a distressing and traumatic event for both student and community nurse mentor. This paper describes how a reflective model can be used to support practitioners' to come to terms with the decision and action of failing a student and dealing with the aftermath of the final interview.

A meta-analysis of morphological interventions: effects on literacy achievement of children with literacy difficulties

This study synthesizes 79 standardized mean-change differences between control and treatment groups from 17 independent studies, investigating the effect of morphological interventions on literacy outcomes for students with literacy difficulties. Average total sample size ranged from 15 to 261 from a wide range of grade levels. Overall, morphological instruction showed a significant improvement on literacy achievement (d = 0.33). Specifically, its effect was significant on several literacy outcomes such as phonological awareness (d = 0.49), morphological awareness (d = 0.40), vocabulary (d = 0.40), reading comprehension (d = 0.24), and spelling (d = 0.20). Morphological instruction was particularly effective for children with reading, learning, or speech and language disabilities, English language learners, and struggling readers, suggesting the possibility that morphological instruction can remediate phonological processing challenges. Other moderators were also explored to explain differences in morphological intervention effects. These findings suggest students with literacy difficulties would benefit from morphological instruction.

Understanding attention-deficit/hyperactivity disorder from childhood to adulthood

Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders requiring treatment in children and adolescents. The disorder is often chronic, with prominent symptoms and impairment spanning into adulthood. It is often associated with co-occurring disorders, including disruptive, mood, anxiety, and substance abuse disorders. The diagnosis of ADHD is clinically established by review of symptoms and impairment. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry, and neuropsychological data. All aspects of an individual's life need to be considered in the diagnosis and treatment of ADHD. Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for treating patients with ADHD and comorbid disorders. Pharmacotherapy, including stimulants, noradrenergic agents, α-agonists, and antidepressants, plays a fundamental role in the long-term management of ADHD.

A scholastic appeals process for dental hygiene student remediation and retention

A scholastic appeals process tailoring individualized remediation for dental hygiene students not meeting academic standards was assessed retrospectively (1999-2008) to evaluate retention and academic failure rates, nature of academic problems, type of remediation, and success of recommendations. Academic records of students (n=55) not meeting academic standards and/or withdrawing were reviewed. Overall retention (92.7 percent) ranged from 86.7 percent to 96.6 percent. Of the fifty-five students whose records were reviewed, six students (10.91 percent) withdrew for medical/personal reasons, and forty-nine (89.1 percent) petitioned for individualized remediation. The number and percentage of students in each category of reasons are as follows: four (7.5 percent) preclinical; thirty-seven (69.8 percent) clinical; eight (15.1 percent) academic/clinical/personal reasons; and four (7.5 percent) academic dishonesty. The options approved were the following: continue in the program with grade below C- (n=3), summer clinical course with individualized contract (n=11), or independent study course during the academic year plus the summer course (n=13), all without delaying graduation; repeating a course with a one-semester delay in graduation (n=7); and auditing/repeating multiple courses with a one-year delay in graduation (n=3). Twelve students were dismissed after denial of a petition requesting remediation or second failure. The scholastic appeals process was successful for 75.5 percent (n=37) of the students who petitioned after failing to meet academic standards, thereby contributing to the 92.7 percent overall retention rate. Student-specific remediation plans based on individual academic appeals are viable options for ensuring success.

Assessment and remediation for physicians with suspected performance problems: an international survey

INTRODUCTION

Little is known about the overall appropriateness and value of the various programs available internationally for assessment and remediation for individual physicians whose performance in their clinical practice has been identified as giving cause for concern.

METHOD

A questionnaire was e-mailed to members of the International Physicians Assessment Coalition and/or the Coalition for Physician Enhancement--organizations that were thought to provide this type of assessment (n = 20). Questions covered the aims, organization, methods, and outcomes of assessment programs and associated remediation.

RESULTS

Responses came from 15 regulatory bodies, universities, not-for-profits, and health service organizations in 5 countries. The assessment programs and remediation activities identified were small in scale. Their focus ranged from a narrow concern with identifying and repairing specific knowledge and skills deficits to a wider interest in the biopsychosocial functioning of the physician as a whole. Both "diagnosis" and "treatment" of problems focused on the individual physician. Less attention was given to broader systems or contextual factors that might impact performance. Although progress through remediation was carefully monitored, none of the programs undertook regular systematic follow-up to ascertain the success of their interventions in the longer term.

DISCUSSION

This field of activity is characterized by the use of sophisticated methods for measuring performance/competence, but provision of remediation is more patchy and variable. The small scale of these programs raises questions about the relationship between scale of provision and potential need for remediation. Gaps in information about impact and outcomes mean that the overall impact and value of this type of assessment and remediation is hard to determine.

The role of working memory and fluency practice on the reading comprehension of students who are dysfluent readers

The authors investigated whether practice in reading fluency had a causal influence on the relationship between working memory (WM) and text comprehension for 155 students in Grades 2 and 4 who were poor or average readers. Dysfluent readers were randomly assigned to repeated reading or continuous reading practice conditions and compared with untreated dysfluent and fluent readers on posttest measures of fluency, word identification, vocabulary, and reading comprehension. Three main findings emerged: (a) The influence of WM on text comprehension was not related to fluency training, (b) dysfluent readers in the continuous-reading condition had higher posttest scores than dysfluent readers in the other conditions on measures of text comprehension but not on vocabulary, and (c) individual differences in WM better predicted posttest comprehension performance than word-attack skills. In general, the results suggested that although continuous reading increased comprehension, fluency practice did not compensate for WM demands. The results were interpreted within a model that viewed reading comprehension processes as competing for a limited supply of WM resources that operate independent of fluency.

Developmental disabilities and behavioral problems among school children in the Western Cape of South Africa

AIM

This descriptive cross-sectional study estimates the frequencies and kinds of potential developmental disabilities (DD) and behavior problems (BP) among children in grades R and 1 who attend a primary public school in rural Western Cape Province, South Africa.

METHODS

Data were collected on 174 children aged 5.1-8.8 years using the Ten Question Screener (10QS) and the Developmental Behaviors Checklist-Short form.

RESULTS

For the entire sample, 42% (n=73) screened positive for 1 or more possible DD on the 10SQ. Twenty-one percent (n=36) screened positive for one or more possible DDs. Thirty-six percent (n=63) of the sample scored above the cutoff for a behavioral problem that may be clinically significant. For this group the proportion of females (n=36, 39%) was slightly higher than males (n=28, 35%).

CONCLUSION

The percent of possible DDs and BP among children in grades R and 1 is higher than the number of learners with special needs reported by the Principal for the entire school (18.7%). The findings from this study suggest that there may be more learners than formally designated who have special educational needs that may benefit from special educational programs (e.g. speech, occupational, language, etc.). There may be a need for expanded remedial educational and behavioral services in this school and elsewhere in the district.

What clinical learning contracts reveal about nursing education and patient safety

While it is widely accepted that adopting a systems perspective is important for understanding and addressing patient safety issues, nurse educators typically address these issues from the perspective of individual student performance. In this study, the authors explored unsafe patient care events recorded in 60 randomly selected clinical learning contracts initiated for students in years 2, 3, and 4 of the undergraduate nursing program at the University of Manitoba. The contracts had been drawn up for students whose nursing care did not meet clinical learning objectives and standards or whose performance was deemed unsafe. Using qualitative content analysis, the authors categorized data pertaining to 154 unsafe patient care events recorded in these contracts.Thirty-seven students precipitated these events. Most events were related to medication administration (56%) and skill application (20%). A breakdown of medication administration events showed that the highest number were errors related to time (33%) and dosage (24%). International students and male students were responsible for a higher number of events than their numbers in the sample would lead one to expect. The findings support further study related to patient safety and nursing education.

Proofreading using an assistive software homophone tool: compensatory and remedial effects on the literacy skills of students with reading difficulties

The present study investigated the effects of using an assistive software homophone tool on the assisted proofreading performance and unassisted basic skills of secondary-level students with reading difficulties. Students aged 13 to 15 years proofread passages for homophonic errors under three conditions: with the homophone tool, with homophones highlighted only, or with no help. The group using the homophone tool significantly outperformed the other two groups on assisted proofreading and outperformed the others on unassisted spelling, although not significantly. Remedial (unassisted) improvements in automaticity of word recognition, homophone proofreading, and basic reading were found over all groups. Results elucidate the differential contributions of each function of the homophone tool and suggest that with the proper training, assistive software can help not only students with diagnosed disabilities but also those with generally weak reading skills.

Enhancing the reading fluency and comprehension of children with reading disabilities in an orthographically transparent language

Breznitz (2006) demonstrated that Hebrew-speaking adults with reading disabilities benefited from a training in which reading rate was experimentally manipulated. In the present study, the authors examine whether silent reading training enhances the sentence reading rate and comprehension of children with reading disabilities and whether results found in Hebrew equally apply to an orthographically transparent language. Training results of 59 Dutch children with reading disabilities and normally achieving children show that children with reading disabilities are able to increase their sentence reading rate with high comprehension levels when pushed to do so with accelerated reading training. Posttest results show that transfer to routine reading is less strong for both accelerated and unaccelerated reading. Only accelerated training allows children with reading disabilities to read at high speed while maintaining high comprehension levels.

Clerkship directors' practices with respect to preparing students for and using the National Board of Medical Examiners Subject Exam in medicine: results of a United States and Canadian Survey

PURPOSE

Clerkship directors' practices regarding the National Board of Medical Examiners (NBME) subject exam in medicine are important in enhancing educational evaluation policy. The study's purpose was to determine clerkship directors' use of the subject exam in medicine and related learning activities in the context of curricula and outcomes of the directors' internal medicine clerkships.

METHOD

The authors conducted a survey of directors of internal medicine clerkships in 2007. They performed descriptive statistical and multivariate analyses on all responses.

RESULTS

Of 110 clerkship directors, 82 responded to the survey, for an overall response rate of 75%. Eighty-eight percent of the clerkship directors required the NBME subject examination in medicine. The mean minimum passing score was 62 (SD = 4.2); this score was not adjusted throughout the academic year, and it contributed 20% to 25% of the final grade. Most (89%) clerkships allowed students a retake after a failed first attempt. Most clerkship directors prepared students for the NBME subject exam in their programs through some combination of lectures, independent self-study, and review sessions with exam-preparation review books. However, 42% of clerkship directors lacked a specific strategy for a retake after a failure.

CONCLUSION

Clerkship directors' use of the NBME subject exam in medicine is high. Most allow a retake after a first failure, and a combination of strategies is currently provided to help students prepare. A need exists to develop remediation plans for students who fail the exam. This report may serve as a reference for curricular and programmatic clerkship decisions.

Consequences within medical schools for students with poor performance on a medical school standardized patient comprehensive assessment

PURPOSE

Medical schools increasingly employ comprehensive standardized patient assessments to ensure medical students' clinical competence. The consequences of poor performance on the assessment and the institutional factors associated with imposing consequences are unknown.

METHOD

In 2006, the investigators surveyed 122 U.S. medical school curriculum deans about comprehensive assessments using standardized patients after core clerkships, with questions about exam characteristics, institutional commitment to the examination (years of experience, exam infrastructure, clerkship director involvement), academic consequences of failing the assessment, and satisfaction with remediation.

RESULTS

Ninety-three of 122 (76%) deans responded. Eighty-two (88%) conducted a comprehensive assessment in years three or four of medical school. Of those, required remediation was the only consequence of failing employed by 61 schools (74%), and only 39 (47%) required retesting for graduation. Participants were somewhat satisfied with (mean 3.45 out of maximum 5, SD 1.08) and confident in (3.37, SD 1.17) their remediation process. Satisfaction and confidence were associated with requiring remediation (P = .003) and retesting (P < .001), but experience with the exam, exam infrastructure, and clerkship director involvement were not. No school demographic characteristics or measures of institutional commitment were related to external reporting of students' comprehensive assessment scores.

CONCLUSIONS

Despite the prevalence of comprehensive assessments, schools attach few academic consequences to poor performance. Educators are only moderately satisfied with their efforts to remediate poor performers. However, schools with greater trust in their remediation process than other schools are more likely to enforce consequences of poor performance.

Commentary: Assessment is an educational tool

Three articles in this issue, by Bloodgood and colleagues, Hauer and colleagues, and White and colleagues, address important issues in student assessment. They use different approaches to data collection and focus on issues as broad as pass-fail grading in the preclinical years to standardized patient testing and remediation in the clinical years. However, they all remind us that assessment should not be seen as an end in itself, and they underscore the many functions that assessment can play in medical education. Drawing from these three, the authors of this commentary suggest that assessment should be designed to provide useful information for both faculty and students, at the same time minimizing stress and competition and maximizing cooperative learning. The authors assert that assessment data need to be used and that consequences should be attached to performance. In the case of poor performance, the information gained should not be used punitively. Instead, it can be used for support and remediation, giving students tools for self-improvement, assisting them to be self-reflective and gain insight into their strengths and weaknesses, and making them aware of available resources when necessary.