Clinical Remediation: An Overview.
Clinical education and remediation. The primary goal of clinical education is to graduate clinically competent practitioners. However, what happens to the learner when he or she does not achieve clinical competency during their tenure? When the learner does not meet the threshold of clinical competency then the process of clinical remediation follows.
Defining competence. What is competence? A program based on competencies require clear definitions of the domains, explicit standards and understanding of how to maximize learning value of assessment.
Institutional expectations and clinical competence. As faculty, do you know your institution’s clinical philosophy and goals for your graduates? Do you know what is expected for your students as they progress to the next level of their clinical education? Are you familiar with your institution’s clinical remediation policy and program? Are you aware of the respective educational accreditation standards that address clinical remediation within your institution?
The learning curve. It represents the relationship between episodes of practice and level of performance. Crossing the competency threshold. The competency threshold consists of basic knowledge, skills and traits that are essential for performing a task or job. It requires deliberate practice with feedback, and the learner must have significant motivation and self-regulation skills to continue to improve the skill of interest.
Here we have Dreyfus and Dreyfus model of skill acquisition. As you can see, when a student enters into the program they become at the level of being a novice. And then they progress through the next stage, which is advanced, which is practice with full supervision. And then we graduate them as minimally competent; practice with supervision on call. And after they graduate, what will happen is as they continue to practice they will become proficient without supervision, which means this is what happens to them in clinical practice. And, as they progress over the years, they become experienced and they supervise others in that same role.
Clinical remediation. Clinical remediation is the recognition of the need to implement intervention strategies to improve student performance that if otherwise left unattended would result in adverse consequences. The remediation process begins with identifying the student at risk through failure on examination or identification in the clinical area by the clinical instructor.
Clinical remediation. One study indicated that only 54 percent of the 181 respondents reporting having any type of written policy on clinical remediation. Skill development is competency based and occurs in conjunction with didactic learning, critical for the dental profession. When a student is unable to demonstrate an adequate skill development in order to move to the next level, then remediation becomes necessary.
Components of clinical remediation. One is to define goals and objections. Two, establish a realistic timeframe. Three, how and where remediation will be addressed. Four, feedback and evaluation. Five, ongoing explicit documentation at every session. It is important that all of these components are part of the remediation process and should be included in a student remediation contract.
Accreditation standards. Respective educational accreditation agencies require certain standards that address remediation within the curriculum. So, when designing a remediation plan in relation to accreditation standards faculty need to keep in mind the various components that need to address the remediation process including how students are identified for the process, remediation plan development and communication, and the implementation of a remediation plan, and, finally, some type of teaching methodology to employ.
Determining success. Achieving minimum competency when compared to their peers and demonstrating sustained improvement over a period of time.
Faculty reassessment. So, whenever possible, reassessment strategies should be recommended by the remediation team but performed by an unbiased group of educators who are not aware that the learner had deficits or underwent remediation.
Documentation. Absolutely essential. It builds a remedial strategy, builds information for a dismissal, protects individuals and the institution. Institutional policies must be followed and maintained.
Recap. Know your institution’s goals and objectives in clinical education. What are the institution’s expectation of a graduate of your program? Know your institution’s remediation plan. Have periodic meetings to review and revise the remediation plan. And, finally, documentation is paramount.
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