Step #4: Educational Strategies

A. Identifying Learning Strategies

The goal of remediation is to provide the resident the time and means to work on specific competencies through a focused program and prepare them to re-enter their regular program track successfully. Often, rotations will be modified to accommodate the implementation of the plan and learner’s need such as:

  • Removal from other academic responsibilities that are not part of the focused remediation objectives
  • Reduced responsibilities or patient load with a gradual increase over time
  • Use of strategic rotations which will maximize exposure to certain skills needing practice
  • Additional protected time for additional focused practice (such as SIM labs, study time, or to attend meetings, coaching sessions, or counselling)
  • Access to an assigned remedial mentor (who is NOT involved in assessment) for extra support
  • Regular scheduled meetings with the Program Director and/or Remediation Supervisor throughout remediation to clarify objectives and track progress

Educational strategies are informed by objectives and specify the learning content and methods in which content will be delivered and objectives will be addressed. Teaching strategies provide formal opportunities and designated program support around targeted areas of deficit and can include:

  • Take-home tasks or off-rotation homework (case studies, reading schedule, online modules)
  • Additional testing (regular written or oral tests focused on areas of deficit)
  • On rotation integrated real-time approaches (one minute preceptor or SNAPPS preceptor probing/quizzing framework, case presentations, teaching, direct observation, role-modelling)
  • Simulated additional practice during protected time (computer simulations, dissections, simulators, role-plays, standardized patients, additional OSCEs)
  • One-on-one coaching, mentoring, or advising around areas of deficit (communication coaching, professionalism coaching)
  • Reflective activities (reflective essay, journaling, goal-setting, self-assessments)
  • Monitoring activities (maintaining a patient log, an on-call log, regular check-ins)

For additional ideas, visit the Teaching Tools page and the Recommended Resources page. Ensure that the strategies selected are in alignment with the identified learning objectives outlined in the plan.

B. Developing an Assessment Schedule

It is important identify appropriate assessments and develop an assessment & feedback schedule during the plan development stage. Assessment is both formative and summative and both should be included during the remediation period.

Generally, remediation requires a more intensive assessment program such as daily or weekly formative assessments and modified summative assessment instruments with a focus on remedial objectives. Some typical assessments that have been included in a learning plan include:

  • Weekly face-to-face progress meetings (documented)
  • More direct supervision and immediate feedback (documented)
  • Additional written and/or oral exams, additional OSCEs
  • Additional assessment tools such as 360-evaluations, the P-MEX, the Mini-CEX
  • Written regular feedback such as encounter cards or field notes
  • Modified ITERs focusing on the learning objective areas only
  • EPAs or other assessments using an “entrustment” scale
  • O-scores for surgical procedures
Feedback

In addition, establishing clear criteria in the plan for successful completion or unsuccessful competition is necessary to articulate in the plan, in advance of implementation. Here are some examples of criteria leading to unsuccessful completion of a remedial period:

 - An OVERALL failure (i.e. global score) in any of the remediation blocks as indicated on the remediation ITER

 - More than 1 “Borderline Passes” (i.e. in global score) identifying continuing concerns with performance throughout remediation (i.e. no overall improvement)

 - A “failed” area of competence (i.e. “rarely meets” or “inconsistently meets”) in all remediation blocks, specifically in the areas identified as critical parts of the remedial objectives (i.e. no significant improvement demonstrated in this domain)

 - A score cut-off score of __% on all administered tests specific to remediation.

 - The occurrence of any serious patient safety incidents in any remediation block.

 - Failing to score “I needed to be there just in case” or “I did not need to be there” on EPAs required in the Remediation.

Establishing clear pass/fail criteria in advance is particularly important when it is time for the RTC to determine whether the learner has completed the remedial program successfully.

The following table provides examples of a Remediation Plan with 2 objectives, suggested learning strategies, and structured feedback.

Specific Learning Objectives Learning Strategies Feedback and Assessment
1. Demonstrate knowledge of the pathophysiology, clinical presentation, and standard treatments for common presentations listed in the objectives for this rotation by scoring a minimum of 70% on end-of-rotation written tests and OSCEs by the end of the 3-month remedial period.

Review rotation resources provided.

 

 

Formative written and OSCE tests every 4 weeks.

Final summative written test and OSCE in the final week of the Remediation period.

Weekly ITERs
2. By the final block of the remediation period, be able to manage and prioritize patient tasks for ~4 patients per day by completing all tasks by handover.

Time management coaching

Using templates for prioritizing tasks and reviewing them at the end of the day to ensure all tasks are complete.

Weekly ITERs

 

 

C. Foster Insight and Independence

Per adult learning theories, learning experiences can be more salient when they include a component of reflection to encourage self-directed learning and the development of insight. Learner insight is important to foster during remediation so remedial plans should always include a component of reflection, goal-setting, or self-assessment to encourage self-regulated learning behavior and develop insight. Sharing and discussing these, such as in a weekly meeting with the remedial supervisor, mentor, or coach, will ensure that the learner and the program have a shared understanding of where the learner is currently at with respect to the remedial expectations.