Clinical Probation: Supporting the At-Risk Student

A framework to teach self-reflection for the remedial resident

BACKGROUND

Regardless of the area of deficiency, be it in knowledge, skills or attitudes, residents requiring remediation are rarely self-identified. This illustrates a diminished ability for self-reflection. Self-reflection is a cornerstone of adult education. During the remediation process, the remediation curriculum needs to emphasize self-reflection.

AIMS

How can one structure self-reflection in a remediation curriculum?

METHODS

This article describes how to adapt and apply environmental scanning for remedial residents.

RESULTS

Environmental scanning is a rigorous and well-developed business approach that can be adapted for personal continuous quality improvement to foster self-reflection in medical trainees. There are often already existing tools which can form the foundation for regular reflection in medical education using an environmental scanning structure.

CONCLUSIONS

Environmental scanning can be thought of as a structured approach to internal and external reflections.

A theory-based curriculum design for remediation of residents' communication skills

PROBLEM

Residents requiring remediation are often deficient in communication skills, namely clinical interviewing skills. Residents have to digest large amounts of knowledge, and then apply it in a clinical interview. The patient-centered approach, as demonstrated in the Calgary-Cambridge model and Martin's Map, can be difficult to teach. Before implementing a remediation curriculum, the theoretical educational underpinnings must be sound; curriculum evaluation is often expensive. Before establishing metrics for curriculum evaluation, a starting point is to perform a mental experiment to test theoretical adherence.

METHODS

This article describes an experiential remedial curriculum for communication skills. Educational theories of Kolb, Knowles, Bandura, and Bloom are used to design the curriculum into theory-based design components.

CONCLUSIONS

Kolb's experiential cycle models the natural sequence of experiencing, teaching, and learning interviewing skills. A curriculum structured around this cycle has multiple intercalations with the above educational theories. The design is strengthened by appropriately timed use of education strategies such as learning contracts, taped interviews, simulations, structured reflection, and teacher role modeling. Importantly, it also models the form of the clinical interview format desired. Through understanding and application of contemporary educational theories, a program to remediate interviewing skills can increase its potential for success.

A Remediation Process for Nursing Students at Risk for Clinical Failure

The authors propose a remediation process for nursing students at risk for clinical failure. The process is embedded within the context of clinical evaluation and includes the use of a learning contract as an integral component. The strengths and limits of the process and suggestions for further development are included.