Early Detection and Remediation of Problem Learners

There are myriad types of problem learners in surgical residency and most have difficulty in more than 1 competency. Programs that use a standard curriculum of study and assessment are most successful in identifying struggling learners early. Many problem learners lack appropriate systems for study; a multidisciplinary educational team that is separate from the team that evaluates the success of remediation is critical. Struggling residents who require formal remediation benefit from performance improvement plans that clearly outline the issues of concern, describe the steps required for remediation, define success of remediation, and outline consequences for failure to remediate appropriately.

Improving reading skills in children with dyslexia: efficacy studies on a newly proposed remedial intervention-repeated reading with vocal music masking (RVM)

In this work, two different studies are examined to evaluate the effectiveness of a novel intervention program for the improvement of reading ability in children with dyslexia, known as repeated reading with vocal music masking (RVM). The proposed remedial approach is inspired by Breznitz's original work. The studies assess a 5-week program of intensive RVM training in a pre-post-test clinical paradigm, as well as a longitudinal paradigm where it is compared to 8 months of the standard remediation program (SRP). The results of both studies support the efficacy of the newly proposed RVM method. Notably in the longitudinal study, the reading speed of children, as well as related phonological, visuo-attentional, and cognitive skills, and attitudes toward reading, were measured regularly. Significant improvements in reading efficiency and related skills were observed, as well as greater motivation to read after RVM training. A modeling of the data specifically linked executive and processing speed skills to be involved in RVM training, suggesting that RVM may help rebalance the phonological and orthographic coding procedures necessary for efficient reading. The short, intensive, and focused nature of RVM training makes it a viable and attractive intervention for clinical practice. As preliminary results are promising, RVM training may prove to be a valuable tool that clinicians can call upon to effectively treat reading fluency disorders, especially when standard programs do not provide results.

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

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.

The Evolution of Resident Remedial Teaching at One Institution

Residency program directors and teaching faculty invest an enormous amount of time, energy, and resources in providing underperforming at-risk learners with remedial teaching. A remediation program was created and centralized at the University of Colorado School of Medicine in 2006 and 2012, respectively, that consolidated expertise in and resources for learner assessment and individualized teaching for struggling learners, particularly those placed on probation or receiving letters of warning (called focused review letters) from their residency programs. Since the implementation of the program, the authors have observed a decrease in the number of residents being placed on probation, and, of those on probation, more are graduating and obtaining board certification. In this Article, the authors aim to describe the development and outcomes of the program and to explore possible reasons for the improved outcomes.

Longitudinal outcomes of an individualized and intensive reading intervention for third grade students

Early intervention is known to reduce reading disabilities; however, treatment response is variable, and some students have persistent deficits that require intensive supports. This study examined the immediate and 1-year outcomes of an individualized and intensive reading program for third grade students, which was delivered throughout the school day for an average of 189 hr of instruction over 3 months. These students' performances were compared with two comparison groups, including poor readers who received small group supports and good readers who did not have additional reading instruction. The intensive group showed an improvement in word recognition and decoding fluency immediately after the program and 1 year later, and there was a decrease in significant reading impairments from 62% before intervention to 35% at follow-up. Furthermore, baseline reading, spelling, phonological awareness, and rapid naming skills were predictive of persistent reading deficits at a later time point. Although improvements in reading skills were shown, a significant gap between poor and good readers persisted in the third and fourth grades. This study illustrates the importance of a tertiary intensive reading program, but also the need for continuing supports.

Evaluation of the effectiveness of a literacy intervention programme on enhancing learning outcomes for secondary students with dyslexia in Hong Kong

OBJECTIVE

This quasi-experimental study reported the results of a structured literacy intervention programme designed for secondary school students of Year 7 to Year 9 with dyslexia. Students of the intervention group (n = 116) participated in 40-week sessions of small-size, classroom-based, and split-group intervention setting with 45-min daily lesson on both Chinese and English language compared with students in the control group who received normal classroom instructions (n = 98).

RESULTS

Students in the intervention group outperformed the control groups in self-regulated learning scales, which indicated that there was positive change in students' behavioural and cognitive outcomes in learning. Although students demonstrated gains in phonetic skills, posttest results in academic achievement did not exhibit significant improvement when compared with their control group peers.

CONCLUSION

The findings provided some encouraging evidence of the effectiveness of intervention programme. Students that demonstrated gains in phonetic skills and improvement in behavioural and cognitive aspects required continuous intervention lessons to become a self-regulated learner, who would be self-motivated to improve methods of learning and adopt strategies for attaining academic goals. The study contributed to the literature by presenting one of the very first school-based, small-size, classroom-based, and split-group intervention programme for secondary school dyslexic students, which included teachers and students training on English and Chinese intervention content (phonological and literacy content), teaching curriculum integrated with school curriculum, and coteaching with school teachers in the mainstream classrooms, whereas most of the existing intervention programmes used pull-out approach involving the first language only.

Training RAN or reading? A telerehabilitation study on developmental dyslexia

Rehabilitation procedures recommended for developmental dyslexia (DD) are still not fully defined, and only few studies directly compare different types of training. This study compared a training (Reading Trainer) working on the reading impairment with one (Run the RAN) working on the rapid automatized naming (RAN) impairment, one of the main cognitive deficits associated with DD. Two groups of DD children (N = 45) equivalent for age, sex, full IQ, and reading speed were trained either by Reading Trainer (n = 21) or by Run the RAN (n = 24); both trainings required an intensive home exercise, lasting 3 months. Both trainings showed significant improvements in reading speed and accuracy of passages and words. Bypassing the use of alphanumeric stimuli, but empowering the cognitive processes underlying reading, training RAN may be a valid tool in children with reading difficulties opening new perspectives for children with severe impairments or, even, at risk of reading difficulties.

Comparing the effects of incremental rehearsal and traditional drill on retention of mathematics facts and predicting the effects with memory

The purpose of this study was to examine the effects of Incremental Rehearsal (IR) and traditional drill (TD) on retention of multiplication facts with 29 students in third and fourth grades with low mathematical skills. Results indicated that IR led to significantly more facts being retained, and was essentially equal to TD for efficiency as measured by number of facts retained per instructional minute. Memory scores accounted for 34% of the variance beyond mathematics calculation scores in retention of multiplication facts for the TD condition, but only 2% of the variance for the IR condition. Thus, retention of multiplication facts seems largely influenced by a student's memory skills when using less effective instructional techniques such as TD, while approaches like IR are likely effective regardless of memory skills. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Successful Remediation of an Advanced Pharmacy Practice Experience for an At-risk Student

Objective. To describe a successful remediation for an Acute Care Medicine advanced pharmacy practice experience (APPE) in a student with multiple learning deficits. Methods. A literature review of pharmacy and medical experiential remediation was conducted to identify best practices to implement prior to designing the remediation for our student case. Based on this search and experience as preceptors, a three-phase remediation was designed: one week for assessment, two weeks for development of learning skills and strategies and six weeks for an on-campus APPE. Success of the remediation was determined by student performance, as defined by the APPE preceptor, in all relevant 2013 Center for the Advancement of Pharmacy Education (CAPE) educational outcomes. Results. Baseline assessment indicated that the student was below minimal competency in six of 13 relevant 2013 CAPE educational outcomes. Upon completion of the three-part remediation, the student repeated the Acute Care Medicine APPE, achieving better than minimal competency in all 13 outcomes. The student demonstrated significant improvement in nine of 13 CAPE educational outcomes. Conclusion. This student case provides a novel and successful blueprint for remediation of APPE. However, more evidence-based literature is needed to guide educators in experiential remediation.

Rethinking Remediation: A Model to Support the Detailed Diagnosis of Clinicians' Performance Problems and the Development of Effective Remediation Plans

The successful remediation of clinicians demonstrating poor performance in the workplace is essential to ensure the provision of safe patient care. Clinicians may develop performance problems for numerous reasons, including health, personal factors, the workplace environment, or outdated knowledge/skills. Performance problems are often complex involving multifactorial issues, encompassing knowledge, skills, and professional behaviors. It is important that (where possible and appropriate) clinicians are supported through effective remediation to return them to safe clinical practice. A review of the literature demonstrated that research into remediation is in its infancy, with little known about the effectiveness of remediation programs currently. Current strategies for the development of remediation programs are mostly "intuitive"; a few draw upon established theories to inform their approach. Similarly, although it has been established that identification of the nature/scope of performance problems through assessment is an essential first step within remediation, the need for a more widespread "diagnosis" of why the problems exist is emerging. These reasons for poor performance, particularly in the context of experienced practicing clinicians, are likely to have an impact on the potential success of remediation and should be considered within the "diagnosis." A new model for diagnosing the performance problems of the clinicians has been developed, using behavioral change theories to explore known barriers to successful remediation, such as insight, motivation, attitude, self-efficacy, and the working environment, in addition to addressing known deficits regarding knowledge and skills. This novel approach is described in this article. An initial feasibility study has demonstrated the acceptability and practical implementation of our model.

Effect of an Individualized Post-Examination Instructor Remediation on Pharmacy Student Performance in a Biochemistry Course

Objective. To assess the effectiveness of a post-examination, one-on-one instructor remediation process on student performance in a pharmacy biochemistry course by measuring the degree of score improvement on a subsequent examination. Methods. Students who scored below 70% on any examination were encouraged to meet with the course coordinator. A typical remediation session lasts about 30 minutes, and covers academic preparation, study habits, concept understanding, application, critical thinking, time management, and stress control. Scores in two consecutive examinations were compared between students who underwent remediation and those who did not. All scores were adjusted for level of difficulty. Results. At-risk students with relatively lower scores are more likely to seek remediation. After receiving a score below 70%, students perform better on the next examination regardless of remediation. However, the remediation process results in a statistically significant 43% increase in the degree of improvement in student performance on the next examination. Conclusion. A post-examination, one-on-one remediation is effective in enhancing student performance in the biochemistry course. As this course is one of the two with the highest failure rates in the PharmD program, current intervention might improve student retention.

Untying the Gordian knot: remediation problems in medical schools that need remediation

This position paper discusses on-going academic remediation challenges within the field of medical education. More specifically, we identify three common contemporary problems and propose four recommendations to strengthen remediation efforts. Selecting or determining what type of remediation is needed for a particular student is akin to analyzing a Gordian knot with individual, institutional and systemic contributors. More emphasis, including multi-institutional projects and research funding is needed. Recommendations regarding language use and marketing of such programs are given.

Efficacy of a Word- and Text-Based Intervention for Students With Significant Reading Difficulties

We examine the efficacy of an intervention to improve word reading and reading comprehension in fourth- and fifth-grade students with significant reading problems. Using a randomized control trial design, we compare the fourth- and fifth-grade reading outcomes of students with severe reading difficulties who were provided a researcher-developed treatment with reading outcomes of students in a business-as-usual (BAU) comparison condition. A total of 280 fourth- and fifth-grade students were randomly assigned within school in a 1:1 ratio to either the BAU comparison condition ( n = 139) or the treatment condition ( n = 141). Treatment students were provided small-group tutoring for 30 to 45 minutes for an average of 68 lessons (mean hours of instruction = 44.4, SD = 11.2). Treatment students performed statistically significantly higher than BAU students on a word reading measure (effect size [ES] = 0. 58) and a measure of reading fluency (ES = 0.46). Though not statistically significant, effect sizes for students in the treatment condition were consistently higher than BAU students for decoding measures (ES = 0.06, 0.08), and mixed for comprehension (ES = -0.02, 0.14).

Current Evidence on the Effects of Intensive Early Reading Interventions

Many students at risk for or identified with reading disabilities need intensive reading interventions. This meta-analysis provides an update to the Wanzek and Vaughn synthesis on intensive early reading interventions. Effects from 25 reading intervention studies are analyzed to examine the overall effect of intensive early reading interventions as well as relationships between intervention and student characteristics related to outcomes. The weighted mean effect size (ES) estimate (ES = 0.39), with a mean effect size adjusted for publication bias (ES = 0.28), both significantly different from zero, suggested intensive early reading interventions resulted in positive outcomes for early struggling readers in kindergarten through third grades. There was no statistically significant or meaningful heterogeneity in the study-wise effect sizes. Exploratory examination of time in intervention, instructional group size, initial reading achievement, and date of publication are provided.

Replication of an Experimental Study Investigating the Efficacy of a Multisyllabic Word Reading Intervention With and Without Motivational Beliefs Training for Struggling Readers

This randomized control trial examined the efficacy of an intervention aimed at improving multisyllabic word reading (MWR) skills among fourth- and fifth-grade struggling readers ( n = 109, 48.6% male), as well as the relative effects of an embedded motivational beliefs training component. This study was a closely aligned replication of our earlier work. The intervention was replicated with a three-condition design: MWR only, MWR with a motivational beliefs component, and business-as-usual control. Students were tutored in small groups for 40 lessons (four 40-min lessons each week). When we combined performance of students in both MWR conditions, intervention students significantly outperformed controls on proximal measures of affix reading and MWR, as well as standardized measures of decoding, spelling, and text comprehension. Furthermore, there was a noted interaction between English learner status and treatment on spelling performance. There were no statistically significant main effects between the MWR groups on proximal or standardized measures of interest. Findings are discussed in terms of their relevance to MWR instruction for students with persistent reading difficulties and considerations for future research related to the malleability of motivation.

Remediating lapses in professionalism among undergraduate pre-clinical medical students in an Asian Institution: a multimodal approach

BACKGROUND

Fostering personal identity formation and professional development among undergraduate medical students is challenging. Based on situated learning, experiential learning and role-modelling frameworks, a six-week course was developed to remediate lapses in professionalism among undergraduate medical students. This study aims to explore the students' perceptions of their personal identity formation and professional development following completion of the course.

METHODS

This qualitative study, adopting a phenomenological design, uses the participants' reflective diaries as primary data sources. In the pilot course, field work, role-model shadowing and discussions with resource personnel were conducted. A total of 14 students were asked to provide written self-reflections. Consistent, multi-source feedback was provided throughout the course. A thematic analysis was conducted to identify the key processes of personal and professional development among the students during remediation.

RESULTS

Three main themes were revealed. First, students highlighted the strength of small group activities in helping them 'internalise the essential concepts'. Second, the role-model shadowing supported their understanding of 'what kind of medical doctors they would become'. Third, the field work allowed them to identify 'what the "noble values" are and how to implement them in daily practice'.

CONCLUSION

By implementing multimodal activities, the course has high potential in supporting personal identity formation and professional development among undergraduate pre-clinical medical students, as well as remediating their lapses in professionalism. However, there are challenges in implementing the model among a larger student population and in documenting the long-term impact of the course.

The modality and redundancy effects in multimedia learning in children with dyslexia

The present study aimed to examine the modality and redundancy effects in multimedia learning in children with dyslexia in order to find out whether their learning benefits from written and/or spoken text with pictures. We compared study time and knowledge gain in 26 11-year-old children with dyslexia and 38 typically reading peers in a within-subjects design. All children were presented with a series of user-paced multimedia lessons in 3 conditions: pictorial information presented with (a) written text, (b) audio, or (c) combined text and audio. We also examined whether children's learning outcomes were related to their working memory. With respect to study time, we found modality and reversed redundancy effects. Children with dyslexia spent more time learning in the text condition, compared with the audio condition and the combined text-and-audio condition. Regarding knowledge gain, no modality or redundancy effects were evidenced. Although the groups differed on working memory, it did not influence the modality or redundancy effect on study time or knowledge gain. In multimedia learning, it thus is more efficient to provide children with dyslexia with audio or with auditory support.

Attitudes and intentions of Greek teachers towards teaching pupils with dyslexia: An application of the theory of planned behaviour

The present study aims to examine Greek public primary school teachers' attitudes and intention towards teaching pupils with dyslexia using a model of the theory of planned behaviour (TPB). Toward that aim, 304 teachers aged between 22 and 59 years old, with an average overall work experience of 16.6 years completed a TPB questionnaire which assessed their attitudes, subjective norms and perceived behavioural control, their intention, as well as other exogenous factors. The validity and the reliability of the questionnaire were found to be adequate. Overall, the participating teachers report a wide range of educational interventions for pupils with dyslexia emphasizing the psychological aspects of support. They also face a number of barriers, but in general they express neutral to positive attitudes to dyslexia. Results show that attitudes, subjective norms and perceived behavioural control significantly predicted the teachers' intention towards teaching dyslexic pupils, thus confirming the applicability of the selected TPB model. Recommendations for teachers' training and limitations of the study are discussed.

Learning support interventions for Year 1 medical students: a review of the literature

CONTEXT

The journey through medical school can be challenging, especially for undergraduate medical students who must deal with a demanding curriculum, coupled with the demands of transitioning into adulthood. Despite experiencing learning challenges, most students succeed with appropriate learning support. Many medical schools offer learning support programmes, particularly in the latter years, but it has been suggested that such support could be more beneficial, especially during the initial years.

OBJECTIVES

This review explores learning support intervention programmes used to address learning challenges and deficits in the first year of medical school. Additionally, we propose a potential framework for supporting learning during the first year of medical school.

METHODS

We searched PubMed, Web of Science, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources Information Centre), Academic Search Premier and Google Scholar using the search terms 'learning support', 'learning challenge', 'remediation', 'change', 'medical education' and 'first year'. We developed and used a review matrix to record the main elements of each article. We also coded the matrix to identify emerging themes.

RESULTS

The main themes that emerged from the study were 'intervention approaches', 'area of intervention', 'intervention strategies', 'intervention dose' and 'intervention outcomes'.

INTERVENTIONS

(i) used proactive-deficit, reactive-deficit and proactive-developmental approaches; (ii) addressed content knowledge, academic success skills, personal and professional skills and programme-related elements; (iii) utilised faculty staff-facilitated, peer-facilitated, support staff-facilitated, experiential placement, self-study and reduced-load strategies; (iv) varied in length from 5 weeks to 2 years, and (v) generally showed positive results.

CONCLUSIONS

This review has identified the main components of learning support interventions used for Year 1 medical students. Interventions, however, are generally not grounded on empirical assessment that elucidates the nature of the challenges faced by students. Future research should provide empirical understanding of the learning challenges to be addressed.

Situating Remediation: Accommodating Success and Failure in Medical Education Systems

There has been a widespread shift to competency-based medical education (CBME) in the United States and Canada. Much of the CBME discourse has focused on the successful learner, with relatively little attention paid to what happens in CBME systems when learners stumble or fail. Emerging issues, such as the well-documented problem of "failure to fail" and concerns about litigious learners, have highlighted a need for well-defined and integrated frameworks to support and guide strategic approaches to the remediation of struggling medical learners.This Perspective sets out a conceptual review of current practices and an argument for a holistic approach to remediation in the context of their parent medical education systems. The authors propose parameters for integrating remediation into CBME and describe a model based on five zones of practice along with the rules of engagement associated with each zone. The zones are "normal" curriculum, corrective action, remediation, probation, and exclusion.The authors argue that, by linking and integrating theory and practice in remediation with CBME, a more integrated systems-level response to differing degrees of learner difficulty and failure can be developed. The proposed model demonstrates how educational practice in different zones is based on different rules, roles, responsibilities, and thresholds for moving between zones. A model such as this can help medical educators and medical education leaders take a more integrated approach to learners' failures as well as their successes by being more explicit about the rules of engagement that apply in different circumstances across the competency continuum.

Are WISC IQ scores in children with mathematical learning disabilities underestimated? The influence of a specialized intervention on test performance

BACKGROUND

Intelligence measures play a pivotal role in the diagnosis of mathematical learning disabilities (MLD). Probably as a result of math-related material in IQ tests, children with MLD often display reduced IQ scores. However, it remains unclear whether the effects of math remediation extend to IQ scores.

AIMS

The present study investigated the impact of a special remediation program compared to a control group receiving private tutoring (PT) on the WISC IQ scores of children with MLD.

METHODS

We included N=45 MLD children (7-12 years) in a study with a pre- and post-test control group design. Children received remediation for two years on average.

RESULTS

The analyses revealed significantly greater improvements in the experimental group on the Full-Scale IQ, and the Verbal Comprehension, Perceptual Reasoning, and Working Memory indices, but not Processing Speed, compared to the PT group. Children in the experimental group showed an average WISC IQ gain of more than ten points.

CONCLUSION

Results indicate that the WISC IQ scores of MLD children might be underestimated and that an effective math intervention can improve WISC IQ test performance. Taking limitations into account, we discuss the use of IQ measures more generally for defining MLD in research and practice.

Examining Predictive Validity of Oral Reading Fluency Slope in Upper Elementary Grades Using Quantile Regression

Within multitiered instructional delivery models, progress monitoring is a key mechanism for determining whether a child demonstrates an adequate response to instruction. One measure commonly used to monitor the reading progress of students is oral reading fluency (ORF). This study examined the extent to which ORF slope predicts reading comprehension outcomes for fifth-grade struggling readers ( n = 102) participating in an intensive reading intervention. Quantile regression models showed that ORF slope significantly predicted performance on a sentence-level fluency and comprehension assessment, regardless of the students' reading skills, controlling for initial ORF performance. However, ORF slope was differentially predictive of a passage-level comprehension assessment based on students' reading skills when controlling for initial ORF status. Results showed that ORF explained unique variance for struggling readers whose posttest performance was at the upper quantiles at the end of the reading intervention, but slope was not a significant predictor of passage-level comprehension for students whose reading problems were the most difficult to remediate.

Enhancing Accessibility for Students With Decoding Difficulties on Large-Scale Reading Assessments

This study reports findings from studies examining potential read-aloud accommodations on standardized reading comprehension assessments for students with decoding difficulties. Three types of accommodations were evaluated: question stems and answer options read aloud; question stems, answer options, and proper nouns read aloud; and full read-aloud. Drawing from a sample of 207 fourth-grade students with and without decoding difficulties, we used 3-level hierarchical linear modeling to assess whether there were significant differences between students with and without decoding difficulties in the effect of each accommodation relative to no accommodation. Analyses showed that, for the students with decoding difficulties, all 3 read-aloud accommodations had significant effects when compared with no accommodation at all, and these effects were significantly larger than for average readers (effect sizes: 0.49, 0.55, and 0.50, respectively). When non-individualized education program students were excluded from the group of students with decoding difficulties, the effect sizes became notably larger.

Early Writing Intervention: A Best Evidence Synthesis

The purpose of this best evidence synthesis was to identify promising interventions that align with a theoretical model of early writing development, targeting three components of early writing: transcription, text generation, and self-regulation. We determined the extent to which these interventions are effective for children who struggle with early writing skills, by calculating effect sizes for group and single-subject designs, and we examined the overall quality of the research. Twenty-five studies met inclusion criteria. Among group design studies, mean effects (Hedge's g) ranged from 0.19 to 1.17 for measures of writing quantity and from 0.17 to 0.85 for measures of writing quality. Percentage of all nonoverlapping data for single-subject designs ranged from 83% to 100% for measures of writing quantity. Interventions with the strongest evidence of effects and highest methodological quality are described in detail. Recommendations for research and practice are provided.

Tailoring Multicomponent Writing Interventions: Effects of Coupling Self-Regulation and Transcription Training

Writing proficiency is heavily based on acquisition and development of self-regulation and transcription skills. The present study examined the effects of combining transcription training with a self-regulation intervention (self-regulated strategy development [SRSD]) in Grade 2 (ages 7-8). Forty-three students receiving self-regulation plus transcription (SRSD+TR) intervention were compared with 37 students receiving a self-regulation only (SRSD only) intervention and 39 students receiving the standard language arts curriculum. Compared with control instruction, SRSD instruction-with or without transcription training-resulted in more complex plans; longer, better, and more complete stories; and the effects transferred to story written recall. Transcription training produced an incremental effect on students' composing skills. In particular, the SRSD+TR intervention increased handwriting fluency, spelling accuracy for inconsistent words, planning and story completeness, writing fluency, clause length, and burst length. Compared with the SRSD-only intervention, the SRSD+TR intervention was particularly effective in raising the writing quality of poorer writers. This pattern of findings suggests that students benefit from writing instruction coupling self-regulation and transcription training from very early on. This seems to be a promising instructional approach not only to ameliorate all students' writing ability and prevent future writing problems but also to minimize struggling writers' difficulties and support them in mastering writing.

Evaluating the Impact of a Multistrategy Inference Intervention for Middle-Grade Struggling Readers

PURPOSE

We examined the effectiveness of a multistrategy inference intervention designed to increase inference making and reading comprehension for middle-grade struggling readers.

METHOD

A total of 66 middle-grade struggling readers were randomized to treatment (n = 33) and comparison (n = 33) conditions. Students in the treatment group received explicit instruction in 4 inference strategies (i.e., clarification using text clues; activating and using prior knowledge; understanding character perspectives and author's purpose; answering inferential questions). In addition, narrative and informational texts were carefully chosen and sequenced to build requisite background knowledge to form inferences. Intervention was delivered in small groups of 3 students for 10 days of instruction.

RESULTS

One-way analysis of covariance models on outcome measures with the respective pretest scores as a covariate revealed significant gains on a proximal measure of Egyptian-content knowledge (g = 1.37) and on a standardized measure of reading comprehension-i.e., Wechsler Individual Achievement Test-Third Edition Reading Comprehension (g = 0.46).

CONCLUSION

The moderate effect on a standardized measure of reading comprehension provides preliminary evidence for the effectiveness of this multistrategy inference intervention in improving reading comprehension of middle-grade struggling readers.

Combined Modality Intervention for ADHD With Comorbid Reading Disorders: A Proof of Concept Study

To evaluate the relative efficacy of two reading programs with and without adjunctive stimulant medication for children with attention-deficit/hyperactivity disorder and comorbid reading disorder (ADHD+RD). Sixty-five children (7-11 years in age) were assigned randomly to one of three intensive remedial academic programs (phonologically or strategy-based reading instruction, or general academic strategy and social skills training) in combination with either immediate-release methylphenidate or placebo. Multiple-blind procedures were used for medication/placebo, given twice daily. Children received 35 hours of instruction in 10 weeks, taught by a trained teacher in a separate school classroom, in small matched groups of 2 to 3. Children's behavior and reading abilities were assessed before and after intervention. Stimulant medication produced expected beneficial effects on hyperactive/impulsive behavioral symptoms (reported by classroom teachers) but none on reading. Children receiving a reading program showed greater gains than controls on multiple standardized measures of reading and related skills (regardless of medication status). Small sample sizes precluded interpretation of possible potentiating effects of stimulant medication on reading skills taught in particular reading programs. Intensive reading instruction, regardless of treatment with stimulant medication, may be efficacious in improving reading problems in children with ADHD+RD and warrants further investigation in a large-scale study.

Objective Assessment of General Surgery Residents Followed by Remediation

OBJECTIVE

Surgical training programs often lack objective assessment strategies. Complicated scheduling characteristics frequently make it difficult for surgical residents to undergo formal assessment; actually having the time and opportunity to remediate poor performance is an even greater problem. We developed a novel methodology of assessment for residents and created an efficient remediation system using a combination of simulation, online learning, and self-assessment options.

DESIGN

Postgraduate year (PGY) 2 to 5 general surgery (GS) residents were tested in a 5 station, objective structured clinical examination style event called the Surgical X-Games. Stations were 15 minutes in length and tested both surgical knowledge and technical skills. Stations were scored on a scale of 1 to 5 (1 = Fail, 2 = Mediocre, 3 = Pass, 4 = Good, and 5 = Stellar). Station scores ≤ 2 were considered subpar and required remediation to a score ≥ 4. Five remediation sessions allowed residents the opportunity to practice the stations with staff surgeons. Videos of each skill or test of knowledge with clear instructions on how to perform at a stellar level were offered. Trainees also had the opportunity to checkout take-home task trainers to practice specific skills. Residents requiring remediation were then tested again in-person or sent in self-made videos of their performance.

SETTING

Academic medical center.

PARTICIPANTS

PGY2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN.

RESULTS

A total of, 35 residents participated in the Surgical X-Games in the spring of 2015. Among all, 31 (89%) had scores that were deemed subpar on at least 1 station. Overall, 18 (58%) residents attempted remediation. All 18 (100%) achieved a score ≥ 4 on the respective stations during a makeup attempt. Overall X-Games scores and those of PGY2s, 3s, and 4s were higher after remediation (p < 0.05). No PGY5s attempted remediation.

CONCLUSIONS

Despite difficulties with training logistics and busy resident schedules, it is feasible to objectively assess most GS trainees and offer opportunities to remediate if performance is poor. Our multifaceted remediation methodology allowed 18 residents to achieve good or stellar performance on each station after deliberate practice. Enticing chief residents to participate in remediation efforts in the spring of their final year of training remains a work in progress.

Theories of Intelligence in Children with Reading Disabilities: A Training Proposal

A recent trend in the study of reading difficulties promotes multidimensional intervention, focusing on the reciprocal influences exerted by cognitive and emotional-motivational variables. This study evaluated improvements in reading performance as a function of metacognitive training in 36 children ( M age = 8.7 yr.) with different representations of intelligence. Posttest evaluations show significantly more improvement in reading comprehension in children with an incremental theory of intelligence. These results indicate the importance of treatment programmes that take into account both the specificity of deficits and factors relating to the domain of motivation.

The Role of Phonological versus Morphological Skills in the Development of Arabic Spelling: An Intervention Study

The current study investigated the contribution of two linguistic intervention programs, phonological and morphological to the development of word spelling among skilled and poor native Arabic readers, in three grades: second, fourth and sixth. The participants were assigned to three experimental groups: morphological intervention, phonological intervention and a non-intervention control group. Phonological awareness, morphological awareness, and spelling abilities were tested before and after the intervention. Participants from both linguistic intervention programs and in all grades made significant progress in linguistic awareness and spelling after the intervention. The results showed that both intervention programs were successful in promoting children's spelling skills in both groups. Also, older poor readers showed a stronger response to the morphological intervention than the older skilled readers. A transfer effect was found with the phonological training contributing to the morphological skills and vice versa. The results of the current study were discussed in the light of developmental and psycholinguistic views of spelling acquisition as well as the characteristics of Arabic language and orthography.

Remedial early numeracy education: can children identified as having a language deficiency benefit?

BACKGROUND

Growing attention has been paid to the possibility of supporting early numeracy in at-risk kindergartners. Furthermore, it is assumed that language proficiency is an important prerequisite in early maths skills.

AIMS

To examine whether remedial early numeracy education in kindergarten, which has been proven to be effective in general, is also beneficial for children with a language deficiency.

METHODS & PROCEDURES

Based on intensive selection, four different conditions were included: two groups received remedial education, one consisting of children being language proficient (N = 86) and one of children with a language deficiency (N = 26), and two groups followed the regular curriculum, one consisting of children being language proficient (N = 51) and one of children with a language deficiency (N = 24). Remedial education was for 1.5 school years (90 sessions, 30 min per session, twice per week), following the programme 'The Road to Mathematics'. During this period, the children receiving remedial education did not attend the regular maths lessons in the classroom, which were offered for at least 1 h per week. Effects were assessed for early numeracy and mathematical skills (operationalized as basic calculation fluency) in kindergarten and first grade.

OUTCOMES & RESULTS

Three analyses of covariance (ANCOVAs) revealed that, when accounting for achievement at pre-test, children with a language deficiency who received remedial numeracy education performed better on early numeracy skills in kindergarten and first grade than kindergartners with a language deficiency that followed the regular curriculum. Furthermore, they were able to catch up with their language proficient peers in early numeracy. However, children with a language deficiency who received remedial numeracy education did not differ from children who followed the regular curriculum on mathematical skills, suggesting that benefits for numeracy did not generalize to more advanced skills of addition and subtraction.

CONCLUSIONS & IMPLICATIONS

Since, in general, it can be concluded that early numeracy education is indeed effective for kindergartners with a language deficiency, this study finds evidence that intensive support is desirable for children with delayed or impaired language development.

[The cognitive paradigm in the rehabilitation of schizophrenia - focusing on cognitive remediation]

Neurocognitive deficits are core features of schizophrenia and well known to the specialists, concerning researches in Hungary as well. Significance of the topic derives from the fact that according to our present knowledge this is the prime symptom principally affecting everyday functioning and limits benefit of rehabilitation opportunities. The classic psychiatric rehabilitation toolset, either pharmacological or psychosocial, does not provide effective and specific assistance to alleviate the symptoms of the neurocognitive deficits. Despite the increasing presence of the neurocognitive-oriented rehabilitation in international publications and professional forums, cognitive development is rather neglected topic in the Hungarian literature; while the therapeutic practice - with the exception of one institution - is absent from the repertoire of the Hungarian rehabilitation. The purpose of this study is the multi-faceted presentation of recent results in the field of the cognitive remediation, describing the position of cognitive training and its place in the rehabilitation of schizophrenia, with the aim to gain reputation and promote clinical practice among the Hungarian experts. Cognitive remediation is a behavioral training, based on learning theory, with the aim of extensive and long-lasting improvement of cognitive functions of patients suffering from schizophrenia or other mental disorders. Despite the deceptively similar acronym it is important to distinguish this method from the cognitive behavioral therapy which shows similarity in its learning theory basis, but remediation involves much more educational features. Cognitive remediation is not a unified technique, different settings are known, but regardless of form factors it clearly has a specific and positive effect on the neurocognitive functions. It fits well into the rehabilitation methodology, in fact this embeddedness significantly increases its effectiveness and supports emergence of skills in everyday functioning, helping improving disorder outcomes. The generalizing process is partly related to the fact that with the improvement of patients' neurocognitive functions, they become "more accessible" in other therapeutic modalities, increasing their efficiency. Functional and structural changes in relevant cerebral fields correlating with improving neurocognitive performance is proven by growing number of imaging techniques. In addition cost efficiency considerations also support the applicability of the method, which adaptations - in terms of cognitive paradigm - were used in other psychiatric disorders with promising results.

How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools

PURPOSE

Teaching and assessing professionalism is an essential element of medical education, mandated by accrediting bodies. Responding to a call for comprehensive research on remediation of student professionalism lapses, the authors explored current medical school policies and practices.

METHOD

In 2012-2013, key administrators at U.S. and Canadian medical schools accredited by the Liaison Committee on Medical Education were interviewed via telephone or e-mail. The structured interview questionnaire contained open-ended and closed questions about practices for monitoring student professionalism, strategies for remediating lapses, and strengths and limitations of current systems. The authors employed a mixed-methods approach, using descriptive statistics and qualitative analysis based on grounded theory.

RESULTS

Ninety-three (60.8%) of 153 eligible schools participated. Most (74/93; 79.6%) had specific policies and processes regarding professionalism lapses. Student affairs deans and course/clerkship directors were typically responsible for remediation oversight. Approaches for identifying lapses included incident-based reporting and routine student evaluations. The most common remediation strategies reported by schools that had remediated lapses were mandated mental health evaluation (74/90; 82.2%), remediation assignments (66/90; 73.3%), and professionalism mentoring (66/90; 73.3%). System strengths included catching minor offenses early, emphasizing professionalism schoolwide, focusing on helping rather than punishing students, and assuring transparency and good communication. System weaknesses included reluctance to report (by students and faculty), lack of faculty training, unclear policies, and ineffective remediation. In addition, considerable variability in feedforward processes existed between schools.

CONCLUSIONS

The identified strengths can be used in developing best practices until studies of the strategies' effectiveness are conducted.

An "XL" endodontics intervention for dental students required to repeat the course: changing frustration to improved grades and attitudes

Given the psychological and financial costs involved with failing a clinical course, especially in developing countries, an alternative educational method was tested with students who had to repeat the year-long endodontic course at the University of Chile Faculty of Dentistry. The objectives of the intervention were to deepen theoretical knowledge and practical experiences, as well as to reinforce personal confidence in an endodontic clinical setting for students who failed the regular endodontic course. The aim of this study was to evaluate the success of this new model of educational intervention. In the study, 28 students who had failed the endodontic course repeated it with an alternative teaching method. The students attended patients immediately following practical competence exams, and they had access to simulated models that used rotary instruments and access cavities and had emergency care practice. Feedback sessions were held after each clinical session. Final grades were compared with those of other students who repeated the course without the intervention from 2007 to 2009. A survey was administered to understand the causes of initial failure and their opinions of the intervention. Students who participated in the alternative course did significantly better than their counterparts from previous years who did not receive the intervention (5.7±0.3 vs. 5.4±0.2; p<0.05). Their overall perception of the intervention was positive, and the main cause for previous course failure was personal insecurity and slow clinical care performance (54.2% of the students). The intervention course not only improved grades but also generated interest in endodontics, a contrasting perspective to the frustration students usually express after repeating the course. The results of this study support the introduction of similar interventions in endodontics and perhaps other courses.

Cognitive remediation in anorexia nervosa and related conditions: a systematic review

Research evidence for cognitive remediation therapy's (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.

Examining the predictive validity of a dynamic assessment of decoding to forecast response to tier 2 intervention

The purpose of this study was to examine the role of a dynamic assessment (DA) of decoding in predicting responsiveness to Tier 2 small-group tutoring in a response-to-intervention model. First grade students (n = 134) who did not show adequate progress in Tier 1 based on 6 weeks of progress monitoring received Tier 2 small-group tutoring in reading for 14 weeks. Student responsiveness to Tier 2 was assessed weekly with word identification fluency (WIF). A series of conditional individual growth curve analyses were completed that modeled the correlates of WIF growth (final level of performance and growth). Its purpose was to examine the predictive validity of DA in the presence of three sets of variables: static decoding measures, Tier 1 responsiveness indicators, and prereading variables (phonemic awareness, rapid letter naming, oral vocabulary, and IQ). DA was a significant predictor of final level and growth, uniquely explaining 3% to 13% of the variance in Tier 2 responsiveness depending on the competing predictors in the model and WIF outcome (final level of performance or growth). Although the additional variances explained uniquely by DA were relatively small, results indicate the potential of DA in identifying Tier 2 nonresponders.

The effect of computer-assisted therapeutic practice for children with handwriting deficit: a comparison with the effect of the traditional sensorimotor approach

The objective of this study was to compare the effect of computer-assisted practice with the sensorimotor approach on the remediation of handwriting problems in children with dysgraphia. In a randomized controlled trial, experiments were conducted to verify the intervention effect. Forty two children with handwriting deficit were assigned to computer-assisted instruction, sensorimotor training, or a control group. Handwriting performance was measured using the elementary reading/writing test and computerized handwriting evaluation before and after 6 weeks of intervention. Repeated-measures ANOVA of changed scores were conducted to show whether statistically significant differences across the three groups were present. Significant differences in the elementary reading/writing test were found among the three groups. The computer group showed more significant improvements than the other two groups did. In the kinematic and kinetic analyses, the computer group showed promising results in the remediation of handwriting speed and fluency. This study provided clinical evidence for applying a computer-assisted handwriting program for children with dysgraphia. Clinicians and school teachers are provided with a systematic intervention for the improvement of handwriting difficulties.

Remediation practices in Canadian psychiatry clerkships

OBJECTIVES

There is a lack of information regarding interventions for undergraduate students at Canadian medical schools who require remediation during their psychiatric training. The need for a theoretical framework to guide remediation has been identified. In this study, we sought to characterize remediation taking place in undergraduate psychiatry education, particularly during clerkship. A secondary goal was to ascertain whether those responsible for remediation were aware of the stages of change (transtheoretical) model, and whether they formally incorporated this framework (or another) into their remediation processes.

METHODS

A short six-question survey on remediation practices was e-mailed to educators responsible for undergraduate psychiatry education at all 17 Canadian medical schools as identified through the Canadian Organization of Undergraduate Psychiatry Educators (COUPE).

RESULTS

The response rate was 67 %. Respondents' overall impressions of their school's remediation process were that it was "highly effective" (25 %), or "somewhat effective" (67 %); 8 % reported being unsure of its effectiveness. While 75 % of survey respondents were aware of the stages of change model, only 17 % reported using this framework: no alternate theoretical frameworks were reported.

CONCLUSIONS

The most common form of evaluation was multiple-choice question (MCQ) exams, and the most common form of remediation was exam rewrites. There is little information regarding the long-term outcomes of remediation, and further research would be useful in formulating recommendations regarding best practices.

Effectiveness of treatment approaches for children and adolescents with reading disabilities: a meta-analysis of randomized controlled trials

Children and adolescents with reading disabilities experience a significant impairment in the acquisition of reading and spelling skills. Given the emotional and academic consequences for children with persistent reading disorders, evidence-based interventions are critically needed. The present meta-analysis extracts the results of all available randomized controlled trials. The aims were to determine the effectiveness of different treatment approaches and the impact of various factors on the efficacy of interventions. The literature search for published randomized-controlled trials comprised an electronic search in the databases ERIC, PsycINFO, PubMed, and Cochrane, and an examination of bibliographical references. To check for unpublished trials, we searched the websites clinicaltrials.com and ProQuest, and contacted experts in the field. Twenty-two randomized controlled trials with a total of 49 comparisons of experimental and control groups could be included. The comparisons evaluated five reading fluency trainings, three phonemic awareness instructions, three reading comprehension trainings, 29 phonics instructions, three auditory trainings, two medical treatments, and four interventions with coloured overlays or lenses. One trial evaluated the effectiveness of sunflower therapy and another investigated the effectiveness of motor exercises. The results revealed that phonics instruction is not only the most frequently investigated treatment approach, but also the only approach whose efficacy on reading and spelling performance in children and adolescents with reading disabilities is statistically confirmed. The mean effect sizes of the remaining treatment approaches did not reach statistical significance. The present meta-analysis demonstrates that severe reading and spelling difficulties can be ameliorated with appropriate treatment. In order to be better able to provide evidence-based interventions to children and adolescent with reading disabilities, research should intensify the application of blinded randomized controlled trials.

Factors associated with clinical skill remediation in dental hygiene education programs

PURPOSE

The purpose of this study was to examine the challenges related to formal clinical remediation in dental hygiene programs, which include timing of student identification, policy development, and the issues of methodology and scheduling.

METHODS

A 23 item investigator-designed survey was electronically distributed to all 303 U.S. entry-level dental hygiene program directors. This questionnaire included 23 forced-choice questions with the options to add comments to 8 of the questions. A total of 111 surveys were returned yielding a response rate of 36%. Descriptive statistics and Chi-square analyses were utilized to analyze relationships between responses and the degree earned from the dental hygiene program.

RESULTS

All schools reported having a remediation policy; however, 13.6% of the respondents revealed this information was not readily available to students. The majority of respondents (67.8%) reported identifying students with clinical deficiencies in the preclinical semester, and 15.5% identified students in the second year, second clinical semester. Instrumentation technique was identified as the area in greatest need of remediation (81%), followed by critical thinking and problem solving skills (12%). Coordination of faculty and student schedules to conduct remediation was identified as one of the greatest challenges by respondents (25.2%). Results of this study suggest that challenges exist with the process of remediation. Some of these challenges include involving the student in remedial plan development, the academic consequences associated with remediation and scheduling time and space for remedial activities.

CONCLUSION

These findings indicate that respondents are well aware of the need for remediation policies in dental hygiene programs. The point in time varies when students in need of remediation are identified. Therefore, further research needs to be conducted to determine the reasons for this difference. Some reasons may include inability to grasp the foundational skills and/or the complexity of advanced instrumentation in the second year. Also, it is suggested that investigation regarding methods used to address the challenge of faculty and student scheduling for remediation sessions would be useful.

Learner deficits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006-2012

PURPOSE

To identify deficit types and predictors of poor academic outcomes among students, residents, fellows, and physicians referred to the University of Colorado School of Medicine's remediation program.

METHOD

During 2006-2012, 151 learners were referred. After a standardized assessment process, program faculty developed individualized learning plans that incorporated deliberate practice, feedback, and reflection, followed by independent reassessment. The authors collected data on training levels, identified deficits, remediation plan details, outcomes, and faculty time invested. They examined relationships between gender, training level, and specific deficits. They analyzed faculty time by deficit and explored predictors of negative outcomes.

RESULTS

Most learners had more than one deficit; medical knowledge, clinical reasoning, and professionalism were most common. Medical students were more likely than others to have mental well-being issues (P = .03), whereas the prevalence of professionalism deficits increased steadily as training level increased. Men struggled more than women with communication (P = .01) and mental well-being. Poor professionalism was the only predictor of probationary status (P < .001), and probation was a predictor of other negative outcomes (P < .0001). Remediation of clinical reasoning and mental well-being deficits required significantly more faculty time (P < .001 and P = .03, respectively). Per hour, faculty face time reduced the odds of probation by 3.1% (95% CI, 0.09-0.63) and all negative outcomes by 2.6% (95% CI, 0.96-0.99).

CONCLUSIONS

Remediation required substantial resources but was successful for 90% of learners. Future studies should compare remediation strategies and assess how to optimize faculty time.

Putting words to work: effects of morphological instruction on children's writing

This quasi-experimental study examined effects of a 12-week, teacher-delivered, morphologically focused intervention on writing outcomes for fifth-grade U.S. students. In order to help students gain control over the morphologically complex words that typify academic writing, the intervention called students' attention to the morphological structure of words drawn from the district's science curriculum, taught morphologically related forms of those words, and provided opportunities for students to use morphologically related forms in reading and writing. Multilevel model results of posttests showed that, compared to control students (n = 75), intervention students (n = 95) included more morphologically complex words in a sentence-combining task, whether this was scored by a strict (correct spellings only) or lenient (plausible incorrect spellings accepted) criterion, and used more morphologically complex words that had been targeted in the intervention in their extended written responses. In addition, students with lower pretest scores on the sentence-combining measure showed greater intervention effects on the sentence-combining measure than did higher performing peers. Taken together, these results support the use of morphological instruction in the classroom, especially for students who struggle with writing.

Morphological awareness intervention with kindergartners and first and second grade students from low SES homes: a small efficacy study

We investigated the efficacy of a morphological awareness intervention on the morphological awareness and reading skills of students from low-socioeconomic-status homes; we also examined whether the intervention was similarly effective for intervention students who differed in their initial morphological awareness abilities. The 8-week intervention was designed to increase awareness of affixes and the relations between base words and their inflected and derived forms for kindergarteners (n = 27) and first- (n = 22) and second-grade (n = 26) students. Students randomly assigned to the small group intervention were provided instruction four times a week, 25 min a day, whereas students assigned to the control group received "business as usual." Kindergarten and first- and second-grade students receiving the intervention showed statistically significant gains in morphological awareness with large effect sizes on most measures. Students in all three grades who received the intervention demonstrated nonsignificant gains in literacy abilities with null to small effect sizes. Further, students with low morphological awareness abilities at the onset of the study demonstrated similar gains from the intervention as their peers with typical morphological awareness abilities. Our results suggest that explicit morphological awareness instruction may produce gains of practical importance to young elementary students at risk for future literacy difficulties.

Morphological awareness and vocabulary development among kindergartners with different ability levels

Our goal was to investigate the growth of vocabulary and morphological awareness over time in the context of an intervention for kindergartners with different ability levels in these skills. Participants in this exploratory study were 108 children from schools serving socioeconomically disadvantaged neighborhoods. Results indicated that children significantly improved their morphological awareness skills and vocabulary over a period of 4 months ( eta(p)(2) = .61 for morphological awareness and eta(p)(2) = .53 for vocabulary), with the greatest gains made by children who were initially low on these measures. Morphological awareness and vocabulary skills were reciprocally related; each made a unique contribution to growth in the other. The results suggest that it may be beneficial to combine instruction in vocabulary and morphological awareness and that kindergarten teachers can successfully do so with guidance.

Prediction and prevention of failure: an early intervention to assist at-risk medical students

BACKGROUND

Consistent identification and prevention of failure for at-risk medical students is challenging, failing courses is costly to all stakeholders, and there is need for further research into duration, timing and structure of interventions to help students in difficulty.

AIMS

To verify the value of a new exam two weeks into medical school as a predictor of failure, and explore the requirements for a preventative intervention.

METHODS

Students who failed the two-week exam were invited to a series of large-group workshops and small-group follow-up meetings. Participants' subsequent exam performance was compared with non-participants.

RESULTS

About 71% of students who performed poorly in the new exam subsequently failed a course. Attendance at the workshops made no difference to short- or long-term pass rates. Attendance at more than three follow-up small group sessions significantly improved pass rates two semesters later, and was influenced by teacher experience.

CONCLUSIONS

Close similarity between predictor task and target task is important for accurate prediction of failure. Consideration should be given to dose effect and class size in the prevention of failure of at-risk students, and we recommend a systemic approach to intervention/remediation programmes, involving a whole semester of mandatory, weekly small group meetings with experienced teachers.

The effects of a multilinguistic morphological awareness approach for improving language and literacy

The purpose of this study was to examine the effectiveness of a multilinguistic intervention to improve reading and spelling in primary grade students who struggle with literacy. Twenty second-grade students with spelling deficits were randomly assigned to receive a multilinguistic intervention with a phonological and orthographic awareness emphasis, or one with an additional morphological awareness focus. The morphological intervention group performed better on standardized measures of reading comprehension, and spelling, and on a nonstandardized spelling test of morphological patterns. Both groups improved and no between-group differences were found on a standardized measure of word identification and word attack, as well as on a nonstandardized spelling test of orthographic patterns.

Long-term outcomes of a remedial education program for doctors with clinical performance deficits

INTRODUCTION

Medical regulatory authorities need reliable methods of assessing and remediating doctors where there are concerns over competence. There's a small but growing literature describing remediation programs and documenting their effectiveness. This article adds to that literature by describing a program associated with the Medical Council of New Zealand (MCNZ) and reporting outcomes for 24 consecutive doctors required to undergo remediation.

METHODS

Over the 18-month period covered in this study, 24 doctors were required by the MCNZ to enter remediation after a performance assessment. The data set used in this study was drawn from these 24 consecutive cases and included the nature of concerns, severity of concerns, results of remediation and outcome of a second assessment when such an assessment was ordered.

RESULTS

Of 24 doctors who underwent initial assessment, 5 failed to engage with remediation and withdrew from clinical work. A 12-month education remediation program was completed by all remaining 19 doctors. Of these, 13 were considered to be practicing at an acceptable standard at the end of remediation on the basis of sequential supervisor reports. Six doctors were required to have a second performance assessment. Of these, only 1 was considered to be functioning at an acceptable standard. Concurrent health concerns were common among this cohort of doctors.

DISCUSSION

Seventy-five percent of doctors who entered remedial education were considered to be practicing at an acceptable standard at the end of remediation. This accords well with international data. A small number of doctors appear to be unresponsive to remediation.

Remediation of at-risk medical students: theory in action

BACKGROUND

Previous work has shown that a programme that draws on a blend of theories makes a positive difference to outcomes for students who fail and repeat their first semester at medical school. Exploration of student and teacher perspectives revealed that remediation of struggling medical students can be achieved through a cognitive apprenticeship within a small community of inquiry. This community needs expert teachers capable of performing a unique combination of roles (facilitator, nurturing mentor, disciplinarian, diagnostician and role model), with high levels of teaching presence and practical wisdom. Yet, despite participants' convergent opinions on the elements of effective remediation, significant differences were found between outcomes of students working with experienced and inexperienced teachers. The current study explores the actual practice of teachers on this remediation course, aiming to exemplify elements of our theory of remediation and explore differences between teachers.

METHODS

Since it is in the classroom context that the interactions that constitute the complex process of remediation emerge, this practice-based research has focused on direct observation of classroom teaching. Nineteen hours of small group sessions were recorded and transcribed. Drawing on ethnography and sociocultural discourse analysis, selected samples of talk-in-context demonstrate how the various elements of remediation play out in practice, highlighting aspects that are most effective, and identifying differences between experienced and novice teachers.

RESULTS

Long-term student outcomes are strongly correlated to teacher experience (r, 0.81). Compared to inexperienced teachers, experienced teachers provide more challenging, disruptive facilitation, and take a dialogic stance that encourages more collaborative group dynamics. They are more expert at diagnosing cognitive errors, provide frequent metacognitive time-outs and make explicit links across the curriculum.

CONCLUSIONS

Remediation is effective in small groups where dialogue is used for collaborative knowledge construction and social regulation. This requires facilitation by experienced teachers who attend to details of both content and process, and use timely interventions to foster curiosity and the will to learn. These teachers should actively challenge students' language use, logical inconsistencies and uncertainties, problematize their assumptions, and provide a metacognitive regulatory voice that can generate attitudinal shifts and nurture the development of independent critical thinkers.