Remediation of at-risk medical students: theory in action

Abstract

BackgroundPrevious 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.MethodsSince 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.ResultsLong-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.ConclusionsRemediation 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.

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

“…Interestingly, although students and teachers both described teacher behaviours similarly [9], a strong correlation (R=0.81) was found between teacher experience and long-term student outcomes [9,10]. Others have commented on the difference between teachers' beliefs and behaviours [11,12], suggesting that direct observation and analysis of classroom action are essential components of educational research, providing insight into what actually happens rather than what people say or believe happens.…”

“…Analysis of classroom talk [10] showed how experienced teachers elicited new understanding by pressing for the exact meaning of technical terms, by constantly reminding students to notice word roots and by demanding precision in the use of common language. Experienced teachers also took a more dialogic stance [10], framing and conducting discourse in the classroom in ways that prompted all group members to participate and engage critically, with an expectation of high-quality exploratory talk that includes questioning, clear reasoning and explicit justification of rationale [47].…”

“…Students often fail to appreciate that others may think differently [27], so a key advantage of group work is the opportunity for students to be confronted with multiple and diverse viewpoints [51], to think together [47], to be challenged, to exchange ideas and scaffold each other's learning, and thus gain insight into, and develop, their own thinking [9,10,27]. Furthermore, in an atmosphere that encourages mutual feedback and critique, the students learn to call out each other's mistakes, to make metacognitive suggestions, to regulate each other [10].…”

“…Others have commented on the difference between teachers' beliefs and behaviours [11,12], suggesting that direct observation and analysis of classroom action are essential components of educational research, providing insight into what actually happens rather than what people say or believe happens. Analysis of classroom talk revealed that, despite students' and teachers' convergent claims, the extensive pedagogical context knowledge of experienced teachers leads to clear differences in classroom interactions that positively impact student outcomes [10]. This qualitative work illuminated the essential ingredients of successful remediation practice, which are elaborated in the ensuing discussion.…”

“…This paper draws together the findings from a 6-year design-based practitioner-research project that followed the development of an Essential Lifelong Learning Skills (ELLS) course for at-risk medical students [4,[7][8][9][10]. Before elaborating on the core concepts that seem to be essential to successful Electronic supplementary material The online version of this article (doi:10.1007/s40670-015-0149-z) contains supplementary material, which is available to authorized users.…”