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Montreuil J, Lacasse M, Audétat MC, Boileau É, Laferrière MC, Lafleur A, Lee S, Nendaz M, Steinert Y. Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review update: BEME Guide No. 85. MEDICAL TEACHER 2024:1-19. [PMID: 38589011 DOI: 10.1080/0142159x.2024.2331041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Clinical teachers often struggle to record trainee underperformance due to lacking evidence-based remediation options. OBJECTIVES To provide updated evidence-based recommendations for addressing academic difficulties among undergraduate and postgraduate medical learners. METHODS A systematic review searched databases including MEDLINE, CINAHL, EMBASE, ERIC, Education Source, and PsycINFO (2016-2021), replicating the original Best Evidence Medical Education 56 review strategy. Original research/innovation reports describing intervention(s) for medical learners with academic difficulties were included. Data extraction used Michie's Behaviour Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraised used the Mixed Methods Appraisal Tool (MMAT). Authors synthesized extracted evidence by adapting GRADE approach to formulate recommendations. RESULTS Eighteen articles met the inclusion criteria, primarily addressing knowledge (66.7%), skills (66.7%), attitudinal problems (50%) and learner's personal challenges (27.8%). Feedback and monitoring was the most frequently employed BCT. Study quality varied (MMAT 0-100%). We identified nineteen interventions (UG: n = 9, PG: n = 12), introducing twelve new thematic content. Newly thematic content addressed contemporary learning challenges such as academic procrastination, and use of technology-enhanced learning resources. Combined with previous interventions, the review offers a total dataset of 121 interventions. CONCLUSION This review offers additional evidence-based interventions for learners with academic difficulties, supporting teaching, learning, faculty development, and research efforts.
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Affiliation(s)
- Julie Montreuil
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Miriam Lacasse
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Marie-Claude Audétat
- University Institute for primary care (IuMFE), University of Geneva, Geneva, Switzerland
- Unit of Development and Research (UDREM), University of Geneva, Geneva, Switzerland
| | - Élisabeth Boileau
- Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Shirley Lee
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Mathieu Nendaz
- Unit of Development and Research (UDREM), University of Geneva, Geneva, Switzerland
- Department of Medicine, University Hospitals, Geneva, Switzerland
| | - Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Canada
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Scouten RW, Wesson M, Wetherill L, Vance GH, Delk PR. Genetic counseling program remediation practices for students underperforming in clinical skills: An exploratory study. J Genet Couns 2024; 33:4-14. [PMID: 37051800 DOI: 10.1002/jgc4.1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023]
Abstract
Program-level clinical remediation in genetic counseling training programs aims to help students who are underperforming gain clinical skills to successfully manage clinical counseling sessions with patients. Student remediation often requires intervention, including discussions with program leadership and/or a formal remediation plan through the program. This study surveyed genetic counseling program leaders to explore the remediation landscape by identifying skills in which students underperformed, program remediation activities to improve skills, and remediation outcomes. Thirteen participants indicated their program required at least one student to complete program-level clinical remediation during the last 10 years. Eight of the 13 programs (61.5%) required at least one student to participate in clinical remediation for underperformance in professionalism, seven (53.8%) for underperformance in educating patients, six (46.2%) for underperformance in critical thinking, and two (15.4%) for underperformance in demonstrating empathy. Nineteen students were remediated for underperformance in critical thinking. Of those 19 students, one student (5.2%) was dismissed from the training program, and five students (26.3%) chose to withdraw from their program. One of 13 (7.7%) students remediated for underperformance in educating patients and one of 11 (9.1%) students remediated for underperformance in professionalism chose to withdraw from their programs. All students remediated for underperformance in demonstrating empathy successfully completed program-level clinical remediation and graduated. The most frequently endorsed factor positively associated with remediation success was completion of additional in-person patient encounters. The most frequent barrier was a student's poor mental health. Participants most frequently endorsed identification of resources for specific areas of remediation to improve their programs' efficacy in clinical remediation practices. This exploratory study provides valuable information describing clinical skills that require remediation in genetic counseling graduate training, the remediation practices utilized by training programs, and resources that may increase remediation success.
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Affiliation(s)
- Rachel W Scouten
- Hickman Cancer Center, ProMedica Flower Hospital, Sylvania, Ohio, USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Melissa Wesson
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gail H Vance
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paula R Delk
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Best Practices for Remediation in Pulmonary and Critical Care Medicine Fellowship Training. ATS Sch 2022; 3:485-500. [PMID: 36312805 PMCID: PMC9590524 DOI: 10.34197/ats-scholar.2022-0007re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background Remediation of struggling learners in pulmonary and critical care fellowship
programs is a challenge, even for experienced medical educators. Objective This evidence-based narrative review provides a framework program leaders may
use to address fellows having difficulty achieving competency during
fellowship training. Methods The relevant evidence for approaches on the basis of each learner’s
needs is reviewed and interpreted in the context of fellowship training in
pulmonary medicine and critical care. Issues addressed include bias in
fellow assessments and remediation, the impacts of the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the specific
challenges of pulmonary and critical care fellowship programs, a brief
review of relevant legal issues, guidance on building and leveraging program
resources, and a discussion of learner outcomes. Results This results in a concise, evidence-based toolkit for program leaders based
around four pillars: early identification, fellow assessment, collaborative
intervention, and reassessment. Important concepts also include the need for
documentation, clear and written communication, and fellow-directed
approaches to the creation of achievable goals. Conclusion Evidence-based remediation helps struggling learners in pulmonary and
critical care fellowship to improve their ability to meet Accreditation
Council for Graduate Medical Education (ACGME) milestones.
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Lim J, Ko H, Park J, Ihm J. Effect of active learning and online discussions on the academic performances of dental students. BMC MEDICAL EDUCATION 2022; 22:312. [PMID: 35468763 PMCID: PMC9035504 DOI: 10.1186/s12909-022-03377-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND COVID-19 caused significant confusion around the world, and dental education was no exception. Therefore, in line with the demands of the times, this study sought to determine the applicability of online active learning to dental education. METHODS This study was conducted in the second semester of 2020 at a school of dentistry in a selective university in Korea. A total of 114 dental students were recruited. Participants were assigned to four different groups (lecture and discussion [LD], lecture and discussion with instructor's worksheet [LW], self-study and discussion [SSD], and self-study and discussion with instructor's worksheet [SW]) using the random breakout room function in the Zoom video conference application. Their final test scores were then analyzed using analysis of variance and the online active learning results were compared with the offline learning results. RESULTS The scores were highest for the transfer type items in the SSD group, followed by the SW group and the two lecture groups, which had no significant differences. These scores and pattern differences between the groups were similar for all items. The results suggested that studying by oneself rather than simply listening to lectures enhanced the effects of the discussions and led to higher learning outcomes. In addition, the effect of the instructor's intervention in the middle of the discussion varied depending on the pre-learning activities of discussion. As with previous offline experiments, self-study followed by group discussion had higher learning outcomes for both the verbatim and transfer type items. CONCLUSIONS In agreement with the Interactive, Constructive, Active, and Passive (ICAP) framework and other active learning theories, the findings clearly indicated that online active learning was applicable to dental students, and when self-study precedes discussion, the learning is richer and the learning outcomes are better.
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Affiliation(s)
- Jaeseo Lim
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hyunwoong Ko
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, 08826, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jooyong Park
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, 08826, Republic of Korea.
- Department of Psychology, Seoul National University, Seoul, 08826, Republic of Korea.
| | - Jungjoon Ihm
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, 08826, Republic of Korea.
- Dental Research Institute, Seoul National University School of Dentistry, Seoul, 03080, Republic of Korea.
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Parsons AS, Warburton KM, Martindale JR, Rosenberg IL. Characterization of Clinical Skills Remediation: A National Survey of Medical Schools. South Med J 2022; 115:202-207. [PMID: 35237839 DOI: 10.14423/smj.0000000000001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Clinical skills instruction is a standard part of medical school curricula, but how institutions address learners who struggle in this area is less clear. Although recommendations for the remediation of clinical skills at an institutional level have been published, how these recommendations are being implemented on a national scale is unknown. In this descriptive study, we characterize current clinical skills remediation practices at US medical schools and US-accredited Caribbean medical schools. METHODS We conducted a cross-sectional survey of medical educators who work with struggling students. From March 24, 2020 to April 9, 2020, the Directors of Clinical Skills Remediation Working Group conducted an e-mail survey incorporating four aspects of remediation program design and function: identification, assessment, active remediation, and ongoing evaluation. RESULTS In total, 92 individuals representing 45 institutions provided descriptive information about their respective remediation programs. The majority of respondents have a formal process of identifying (75%) and assessing (86%) students who are identified as struggling with clinical skills, but lack a standardized method of categorizing deficits. Fewer institutions have a standardized approach to active remediation and ongoing evaluation of struggling learners. Fifty-two percent of institutions provide training to faculty involved in the remediation process. CONCLUSIONS Although most institutions are able to identify struggling students, they lack a standardized approach to intervene. Remediation effectiveness is limited by a lack of student buy-in and institutional time, expertise, and resources. These findings highlight the need for more formalized structure and standardization in remediation program design and implementation.
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Affiliation(s)
- Andrew S Parsons
- From the Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, and the Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Karen M Warburton
- From the Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, and the Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - James R Martindale
- From the Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, and the Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Ilene L Rosenberg
- From the Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, and the Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
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Yonder S, Pandey J. 'Remediation of pre-clerkship clinical skill performance using a hybrid coaching model'. MEDICAL EDUCATION ONLINE 2021; 26:1842660. [PMID: 33121393 PMCID: PMC7643744 DOI: 10.1080/10872981.2020.1842660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 06/11/2023]
Abstract
We reviewed the effect of a hybrid remediation model combining co-regulated learning and deliberate practice on future exam performance of pre-clerkship medical students who had been unsuccessful on a previous clinic skills exam. With this remediation model, we aimed to strengthen students' self-regulated learning to improve future exam performance and support sustained and improved learning. Educational problem addressed: Observing that some students who initially performed well post remediation with deliberate practice, still struggled on future exams, we looked to address a method that could improve both short-and long-term clinical skills learning success with sustained performance. Intervention outcome: Comparing the remediated students' exam scores pre- and post-coaching to their cohort's performance, we observed the majority of students post remediation performed above their cohort's exam average. Lessons learned: Combining learning models resulted in improved learning outcomes.
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Affiliation(s)
- Sarah Yonder
- Assistant Professor of Family Medicine, Central Michigan University School of Medicine, Mt. Pleasant, MI, USA
| | - Jyotsna Pandey
- Professor of Pathology, Central Michigan University School of Medicine, Mt. Pleasant, MI, USA
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Harmon KS, Gonzales AD, Fenn NE. Remediation and reassessment methods in pharmacy education: A systematic review. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:81-90. [PMID: 33131623 DOI: 10.1016/j.cptl.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 06/24/2020] [Accepted: 07/14/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Colleges of pharmacy are currently required to implement a remediation program within their curricula, but no specifications are provided on the ideal methodology. While the need for successful remediation strategies continues to grow, literature describing positive or negative outcomes of different approaches is significantly lacking. The objective of this literature review was to describe and evaluate remediation methodologies in pharmacy education. METHODS This literature review was completed following PRISMA criteria. A search of the PubMed, Cochrane Library, Cumulative Index of Nursing and Allied Health, Academic Search Complete, PsycInfo, Scopus, and ProQuest Central databases was conducted in July 2019. Studies were included if they involved pharmacy student education and described either remediation or reassessment. RESULTS The evaluated studies discussed a range of course types being remediated, a large variety of remediation strategies and timeframes, and differing overall outcomes. No studies provided comparison of remediation techniques or provided details on the implementation of their chosen approaches. A consistent finding within the evaluated studies was the inclusion of prevention strategies to attempt to avoid the need for remediation preemptively. Overall outcomes for each remedial program were inconsistent and no clear patterns were evident other than an improvement in student performance following remediation. IMPLICATIONS Remediation strategies included course repetition, summer restudy, reassessment, and individualized plans. Outcomes varied significantly between studies, making methodology comparisons difficult. Future studies that include more detail and consistency in the reported outcomes would be beneficial to students and help clarify remediation for colleges of pharmacy.
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Affiliation(s)
- Kiersi S Harmon
- The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799, United States.
| | - Alessa D Gonzales
- The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799, United States.
| | - Norman E Fenn
- The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799, United States.
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Lim J, Ko H, Yang JW, Kim S, Lee S, Chun MS, Ihm J, Park J. Active learning through discussion: ICAP framework for education in health professions. BMC MEDICAL EDUCATION 2019; 19:477. [PMID: 31888595 PMCID: PMC6937678 DOI: 10.1186/s12909-019-1901-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/08/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND The ICAP framework based on cognitive science posits four modes of cognitive engagement: Interactive, Constructive, Active, and Passive. Focusing on the wide applicability of discussion as interactive engagement in medical education, we investigated the effect of discussion when it was preceded by self-study and further investigated the effect of generating questions before discussions. METHODS This study was conducted in the second semester of 2018 and was participated in by 129 students majoring in health professions, including medicine, dentistry, veterinary medicine, and nursing. The students were assigned to four different trial groups and were asked to fill out a Subjective Mental Effort Questionnaire after completing each session. Their performance in posttest scores was analyzed using Bonferroni test, and mental effort was analyzed using mediation analysis. RESULTS These results indicated that the self-study and question group had the highest performance and that the lecture and summary group had the lowest performance when comparing the total score. Using the analysis of mental effort, it was confirmed that the relationship between different study conditions and post-test performance was mediated by mental effort during test. CONCLUSIONS Our findings support the ICAP framework and provide practical implications for medical education, representing the fact that students learn more when they are involved in active learning activities, such as self-study and question generation, prior to discussions.
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Affiliation(s)
- Jaeseo Lim
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, South Korea
- Department of Psychology, Seoul National University, Seoul, South Korea
| | - Hyunwoong Ko
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, South Korea
- School of Dentistry, Biomedical Knowledge Engineering Laboratory, Seoul National University, Seoul, South Korea
| | - Ji Won Yang
- Department of Psychology, Seoul National University, Seoul, South Korea
| | - Songeui Kim
- Department of Psychology, Seoul National University, Seoul, South Korea
| | - Seunghee Lee
- Department of Medical Education, College of Medicine, Seoul National University, Seoul, South Korea
| | - Myung-Sun Chun
- Research Institute for Veterinary Science, Seoul National University College of Veterinary Medicine, Seoul, South Korea
| | - Jungjoon Ihm
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, South Korea.
- School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea.
| | - Jooyong Park
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, South Korea.
- Department of Psychology, Seoul National University, Seoul, South Korea.
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