Core Concepts in Remediation: Lessons Learned from a 6-Year Case Study

Abstract

With widening access and increased class sizes, there is potential for more struggling medical students in need of remediation. This paper draws together lessons learned from a 6-year case study of a successful remedial intervention programme at one institution. When considered alongside a broad range of literature, this work illuminates some core concepts that can inform remediation work in other contexts. Remediation programmes need to foster development of students' affective, cognitive and metacognitive practices if they are to have long-term effects. The course design should be context dependent, collaborative, adaptive, and combine the learning of process and content. Participation should be mandatory, so that students can meet regularly in small stable groups over an extended period of time, with an experienced faculty facilitator who presses the group to pay close attention to the language of medicine. Successful remediation also needs a systemic perspective with clear administrative support, and transparent policies and expectations for all stakeholders. With all the essential ingredients in place, students who have struggled can go on to become successful, mindful physicians.

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

“…With a few notable exceptions (see below), little is available which dissects the procedure and, most critically, details how to individualize remediation to meet the needs of a specific struggling learner. As noted by Winston [ 30 ] and others, simply teaching to pass the next exam does not work in the longer-term for struggling learners.…”

“…Winston [ 30 ] discussed an in-depth, year long, multi-pronged, intensive program for students repeating a portion of the curriculum involving regular faculty-facilitated, small group work with integration of study skills and presented data indicating their success. Sayer et al [ 38 ] described a small, reportedly successful program in a UK medical school specifically targeting academic issues with lengthy one-on-one tutoring, a collaboratively designed remediation plan and a careful individualized assessment process.…”

Physician remediation: accepting and working with complementary conceptualisations

“…Stigmatisation, loss of autonomy and the resulting sense of ‘de‐professionalisation’ are well‐founded concerns raised in relation to physician remediation . A systemic approach to remediation has been recommended as one way of addressing the challenges that are part of implementing physician remediation . This requires the full involvement of stakeholders at all levels, from the remediating student and his or her teachers to the various levels of the institution and the society within which it is situated, so that the idea of remediation becomes normalised and accepted at all levels.…”

“…2,3 A systemic approach to remediation has been recommended as one way of addressing the challenges that are part of implementing physician 1 remediation. 4,7,8 This requires the full involvement of stakeholders at all levels, from the remediating student and his or her teachers to the various levels of the institution and the society within which it is situated, 4,7 so that the idea of remediation becomes normalised and accepted at all levels. Still, even within a well-designed systemic approach, there will be a need for both supportive and regulatory components of remediation.…”

“…This type of coaching relationship requires openness and trust between the physician under remediation and the remediation coach, trust being the foundation of any professional development support. 8,10,11 Therefore, the regulatory mechanism that sends a physician into remediation and provides the assessment that signals the completion of remediation needs to be separate from this coaching role: the regulatory process has to consider the welfare of stakeholders other than the remediating physician. Systemic processes can manage these regulatory decisions, leaving the coaching relationship to focus on the professional development aspect, and allowing the coach to avoid challenging conflicts of interest.…”