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Recommendations for residency programs include the following: Make efforts to understand the challenges of remediation; recognize that the goal is successful correction of deficits but that some deficits are not remediable
Make efforts aimed at early identification of residents requiring remediation
Create objective, achievable goals for remediation and maintain strict adherence to the terms of those plans, including planning for resolution
Involve the institution’s graduate medical education assessment committee early in remediation to assist with planning, obtaining resources, and maintaining documentation
Involve appropriate faculty and educate those faculty about the role and the terms of the specific remediation plan
Ensure appropriate documentation of all stages of remediation
Data from Katz et al.23
Learner difficulties can be divided into 4 categories: Affective disorders: trouble handling life events, self-esteem problems, fear of failure, anxiety, depression
Cognitive disorders: reading problems, spatial-perception problems, oral communication, conceptualization and abstraction (which, for us, includes clinical reasoning), knowledge
Structural or organizational disorders: poor time management, disorganization, poor study methods
Interpersonal disorders: difficulty interacting with others (patients, faculty, staff, colleagues) owing to self-esteem problems, manipulation, prejudices, poor attitude, and problematic behaviour
Adapted from Vaughn et al.27
DIMENSION DESCRIPTION Content of remediation plan Types of difficulties27 Affective, cognitive, structural or organizational, interpersonal Remedial methods used What remediation strategies are identified and are they adequate for the diagnosed difficulty? Severity of the difficulties Slight: 0% to 30% of rotations failed before remediation began
Moderate: 31% to 49% of rotations failed before remediation began
Severe: 50% or more of rotations failed before remediation beganImplementation process Latency and duration of the remediation period Latency: time between the first sign of academic difficulty (poor rotation assessment results, ie, below expectations or failure) and the beginning of the remediation period
Duration: number of remediation periods (1 period is 4 wk)Quality criteria for remediation plans
Good: if it met all criteria or only 1 criterion was unmet
Average: 2 criteria unmet
Poor: > 2 criteria unmet
Criteria:
Duration of remediation is specified
Someone is made responsible for remediation process
A contract is signed by the student and the person in charge of remediation
Specific diagnosis is described
Remediation objectives are stated
Remediation methods are well-defined (coherent, precise)
Action plan and deadlines are included (who does what and when)
Various stages of the remediation plan are documented
Assessment report is included
CHARACTERISTIC GROUP STUDIED N = 21 PEER GROUP N = 205 Sex, n (%) • Female 16 (76) 150 (73) • Male 5 (24) 55 (27) Average age (range), y 33 (24–50) NA Year of residence, n (%) • First 11 (52) 110 (54) • Second 10 (48) 95 (46) Location of medical education, n (%) • IMGs 7 (33) 16 (8) • CMGs 14 (67) 189 (92) CMG—Canadian medical graduate, IMG—international medical graduate, NA—not available.
- Table 4.
Severity of academic difficulties according to location of undergraduate medical study
ORIGIN LEVEL OF SEVERITY, N (%) SLIGHT MODERATE SEVERE IMG 1 (11) 3 (33) 5 (56) CMG 5 (36) 5 (36) 4 (28) CMG—Canadian medical graduate, IMG—international medical graduate.
DIFFICULTY REMEDIAL METHOD REMEDIAL FOCUS FREQUENCY, % Affective Professional counseling Personal behaviour 14 Reduction of direct supervision Organization 4 Review of recorded interviews Communication 4 Cognitive Guided reading program Knowledge 74 Supervision focused on clinical reasoning Clinical reasoning 48 Simulated medical interviews Clinical reasoning 30 Intensified direct supervision Clinical reasoning 26 Observation of faculty Clinical reasoning 22 Lighter clinical load Organization 22 Concept mapping and algorithms Clinical reasoning 17 Regular meetings with a tutor Reflection 14 Review of recorded clinical encounters Clinical reasoning 14 Clinical reasoning exercises Clinical reasoning 13 Self-regulated learning (portfolio or log) Reflection 13 Coaching (interview preparation) Clinical reasoning 13 Modification of clinical duties Organization 4 Objective structured clinical examination Clinical reasoning 4 Participation in a study group Knowledge 4 Professional counseling Personal behaviour 4 Structural or organizational Creation of a directory of resources Organization 8 Time management training workshop Organization 8 Structured coaching Organization 8 Self-guided time management training Organization 4 Exercises in setting priorities Reflection 4 Lighter clinical load Organization 4 Time awareness methods Reflection 4 File writing techniques Organization 4 Use of a weekly agenda Organization 4 Planning upcoming days Organization 4 Interpersonal Professional coaching to correct behaviour Personal behaviour 13