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A Structured Remediation Program Results in Durable Improvement of American Board of Surgery In-Training Examination (ABSITE®) Performance.

The objective of this study was to assess the results of a structured remediation program for surgical residents scoring poorly on the American Board of Surgery In-Training Examination®. Residents scoring below the threshold (<20th percentile) were placed in a remediation program consisting of textbook-based review and mandatory weekly quizzes overseen by the program director. The effects of the program were assessed over a five-year period (2014-2018). Of 168 tests taken, 23 (13.7%) instances of scoring below the threshold occurred (average percentile 11, range 1-19). Postremediation scores in the subsequent year improved with a median (IQR) percentile increase of 29 [23.5, 46] (P < 0.001). Two residents scored below the threshold twice; all others continued to score above the threshold. Participation in a structured remediation program results in dramatic improvement in American Board of Surgery In-Training Examination® performance, and a single occurrence of poor performance does not necessarily lead to a permanent handicap in academic performance.

The Evolution of Resident Remedial Teaching at One Institution.

Residency program directors and teaching faculty invest an enormous amount of time, energy, and resources in providing underperforming at-risk learners with remedial teaching. A remediation program was created and centralized at the University of Colorado School of Medicine in 2006 and 2012, respectively, that consolidated expertise in and resources for learner assessment and individualized teaching for struggling learners, particularly those placed on probation or receiving letters of warning (called focused review letters) from their residency programs. Since the implementation of the program, the authors have observed a decrease in the number of residents being placed on probation, and, of those on probation, more are graduating and obtaining board certification. In this Article, the authors aim to describe the development and outcomes of the program and to explore possible reasons for the improved outcomes.

To accept or decline academic remediation: What difference does it make?

Introduction: Academic remediation offered after failure in a knowledge-based progress-test assessment is voluntary and involves student-centered individualized support that helps students to learn most effectively for themselves. This paper explores whether accepting or declining the offer of academic remediation given to struggling students impacts their outcomes both short-term and longitudinally. Method: Data was collated from 2015-16, 2016-17, and 2017-18 and included all students offered academic remediation in the third, fourth, and fifth years of a five-year Dentistry program. Z-scores for each stage and test were calculated and centered on a triggering point; the point at which the offer of remediation was made. These students' average performance post-trigger test and longitudinal performance were analyzed. Results: While performance for both groups significantly improved for the immediate post-trigger test after academic remediation, those that accepted remediation sustained longitudinal improvements across subsequent tests compared to those that declined remediation. Discussion: Through the academic remediation support process students appear to increase their mastery of "learning to learn" and are able to implement sustainable effective learning strategies to carry with them throughout their program. Conclusion: Students who accept academic remediation maintain a more successful academic profile compared to those that do not take advantage of this.

Remediation in Canadian medical residency programs: Established and emerging best practices.

BACKGROUND: Policies to guide remediation in postgraduate medical education exist in all Canadian medical schools. This study examines concordance between these policies and processes, and published "best practices" in remediation. METHOD: We conducted a literature review to identify best practices in the area of remediation. We then reviewed remediation policies from all 13 English medical schools in Canada other than our own and conducted interviews with key informants from each institution. Each policy and interview transcript pair was then reviewed for evidence of pre-defined "best practices." Team members also noted additional potential policy or process enablers of successful remediation. RESULTS: Most policies and processes aligned with some but not all published best practices. For instance, all participating schools tailored remediation strategies to individual resident needs, and a majority encouraged faculty-student relationships during remediation. Conversely, few required the teaching of goal-setting, strategic planning, self-monitoring, and self-awareness. In addition, we identified avoidance of automatic training extension and the use of an educational review board to support the remediation process as enablers for success. DISCUSSION: Remediation policies and practices in Canada align well with published best practices in this area. Based on key informant opinions, flexibility to avoid training extension and use of an educational review board may also support optimal remediation outcomes.

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

This position paper discusses on-going academic remediation challenges within the field of medical education. More specifically, we identify three common contemporary problems and propose four recommendations to strengthen remediation efforts. Selecting or determining what type of remediation is needed for a particular student is akin to analyzing a Gordian knot with individual, institutional and systemic contributors. More emphasis, including multi-institutional projects and research funding is needed. Recommendations regarding language use and marketing of such programs are given.

Dificultades y barreras del terapeuta en el aprendizaje de la Terapia de Aceptación y Compromiso (ACT) / Difficulties and Therapist’s Barriers while Learning ACT

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Contextual therapies are at its peak nowadays, as plenty of workshops, expertise courses, conferences on this matter are given every year around the world. Acceptance and Committment Therapy (ACT) is a contextual therapy that gathers a vast empirical evidence, and its application is currently widespread to multiple contexts. Nevertheless, when learning ACT some difficulties can arise, especially when theory and practice, as the two sides of the same coin, are set apart. Learning ACT involves the theotherical-applied dimension about the laws concerning human behavior, especially about human language. Moreover, about the conditions under which these laws applied to the processes and methods to generate psychological flexibility. While learning ACT, one of the main problems is related to learn ACT methods or tools without a basic, systematic, precise and contextualized training. An additional problem is related to the difficulties that emerge in the therapists themselves when interacting upon their clients behavior. Their actions might not to be frequently adjusted to the function of their clients’ behaviors -and, consequently, there should not be the appropriate context for helping the client to interact with his/her own private events without losing the direction of a valued-life. These latter difficulties have been named "the therapist's barriers". The present article addresses part of this problem. The experience gathered in researching and training professionals in ACT is briefly described, and some effective interventions are presented. This study advances over the need in isolating, experimentally, these ways of proceeding (AU)

Evaluating Nursing Students' Clinical Performance.

This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students to apply knowledge in clinical settings. This article describes aspects of the student evaluation process, which should involve regular feedback and clearly stated performance expectations.

Introducing a curricular program culminating in a certificate for training peer tutors in medical education.

AIM: Student tutorials are now firmly anchored in medical education. However, to date there have only been isolated efforts to establish structured teacher training for peer tutors in medicine. To close this gap, a centralized tutor training program for students, culminating in an academic certificate, was implemented at Heidelberg University Medical School. The program also counts within the scope of the post-graduate Baden-Württemberg Certificate in Academic Teaching (Baden-Württemberg Zertifikat für Hochschuldidaktik). METHOD: Based on a needs assessment, a modular program comprised of four modules and a total of 200 curricular units was developed in cooperation with the Department for Key Competencies and Higher Education at Heidelberg University and implemented during the 2010 summer semester. This program covers not only topic-specific training sessions, but also independent teaching and an integrated evaluation of the learning process that is communicated to the graduates in the form of structured feedback. In addition, to evaluate the overall concept, semi-structured interviews (N=18) were conducted with the program graduates. RESULTS: To date, 495 tutors have been trained in the basic module on teaching medicine, which is rated with a mean overall grade of 1.7 (SW: 0.6) and has served as Module I of the program since 2010. A total of 17% (N=83) of these tutors have gone on to enroll in the subsequent training modules of the program; 27 of them (m=12, f=15) have already successfully completed them. Based on qualitative analyses, it is evident that the training program certificate and its applicability toward the advanced teacher training for university instructors pose a major incentive for the graduates. For successful program realization, central coordination, extensive coordination within the medical school, and the evaluation of the attained skills have proven to be of particular importance. CONCLUSION: The training program contributes sustainably to both quality assurance and professionalism, as well as to solving the issue of resources in medical education. The introduction and continued development of similar programs is desirable.

Predictors of physician performance on competence assessment: Findings from CPEP, the Center for Personalized Education for Physicians.

PURPOSE: To identify factors associated with physician performance in a comprehensive competence assessment. METHOD: The authors conducted a retrospective analysis of 683 physicians referred for assessment at the Center for Personalized Education for Physicians from 2000 to 2010, who were evaluated as either safe or unsafe to return to practice. Multivariate logistic regression was used to determine factors predictive of unsafe assessment outcome. Covariates included personal characteristics (e.g., age), practice context (e.g., solo practice), and referral information (e.g., previous board license action). RESULTS: Older physicians were more likely to have unsafe assessment outcomes (odds ratio [OR] = 1.07; P < .001). Board-certified individuals were less likely to have poor assessment outcomes (OR = 0.40; P = .003) than uncertified individuals. Physicians in solo practice were more likely (OR = 2.15; P = .037) to be deemed unsafe than physicians in other settings. Physicians with a practice scope that matched their training were less likely (OR = 0.29; P = .023) to have unsafe assessment outcomes than those whose did not. Physicians with current or previous board action (suspension, revocation, limitation, or stipulation) were more likely to be deemed unsafe (OR = 2.47; P = .003) than those without. CONCLUSIONS: Findings suggest that important predictors of physician performance on competence assessment include personal characteristics, practice context, and reasons for assessment referral. These findings have implications for development of policies and programs designed to assess risk of poor physician performance and quality of care improvement efforts through organizational/practice design or remedial education.

Remediation practices in Canadian psychiatry clerkships.

OBJECTIVES: There is a lack of information regarding interventions for undergraduate students at Canadian medical schools who require remediation during their psychiatric training. The need for a theoretical framework to guide remediation has been identified. In this study, we sought to characterize remediation taking place in undergraduate psychiatry education, particularly during clerkship. A secondary goal was to ascertain whether those responsible for remediation were aware of the stages of change (transtheoretical) model, and whether they formally incorporated this framework (or another) into their remediation processes. METHODS: A short six-question survey on remediation practices was e-mailed to educators responsible for undergraduate psychiatry education at all 17 Canadian medical schools as identified through the Canadian Organization of Undergraduate Psychiatry Educators (COUPE). RESULTS: The response rate was 67 %. Respondents' overall impressions of their school's remediation process were that it was "highly effective" (25 %), or "somewhat effective" (67 %); 8 % reported being unsure of its effectiveness. While 75 % of survey respondents were aware of the stages of change model, only 17 % reported using this framework: no alternate theoretical frameworks were reported. CONCLUSIONS: The most common form of evaluation was multiple-choice question (MCQ) exams, and the most common form of remediation was exam rewrites. There is little information regarding the long-term outcomes of remediation, and further research would be useful in formulating recommendations regarding best practices.

Factors associated with clinical skill remediation in dental hygiene education programs.

PURPOSE: The purpose of this study was to examine the challenges related to formal clinical remediation in dental hygiene programs, which include timing of student identification, policy development, and the issues of methodology and scheduling. METHODS: A 23 item investigator-designed survey was electronically distributed to all 303 U.S. entry-level dental hygiene program directors. This questionnaire included 23 forced-choice questions with the options to add comments to 8 of the questions. A total of 111 surveys were returned yielding a response rate of 36%. Descriptive statistics and Chi-square analyses were utilized to analyze relationships between responses and the degree earned from the dental hygiene program. RESULTS: All schools reported having a remediation policy; however, 13.6% of the respondents revealed this information was not readily available to students. The majority of respondents (67.8%) reported identifying students with clinical deficiencies in the preclinical semester, and 15.5% identified students in the second year, second clinical semester. Instrumentation technique was identified as the area in greatest need of remediation (81%), followed by critical thinking and problem solving skills (12%). Coordination of faculty and student schedules to conduct remediation was identified as one of the greatest challenges by respondents (25.2%). Results of this study suggest that challenges exist with the process of remediation. Some of these challenges include involving the student in remedial plan development, the academic consequences associated with remediation and scheduling time and space for remedial activities. CONCLUSION: These findings indicate that respondents are well aware of the need for remediation policies in dental hygiene programs. The point in time varies when students in need of remediation are identified. Therefore, further research needs to be conducted to determine the reasons for this difference. Some reasons may include inability to grasp the foundational skills and/or the complexity of advanced instrumentation in the second year. Also, it is suggested that investigation regarding methods used to address the challenge of faculty and student scheduling for remediation sessions would be useful.

Prediction and prevention of failure: an early intervention to assist at-risk medical students.

BACKGROUND: Consistent identification and prevention of failure for at-risk medical students is challenging, failing courses is costly to all stakeholders, and there is need for further research into duration, timing and structure of interventions to help students in difficulty. AIMS: To verify the value of a new exam two weeks into medical school as a predictor of failure, and explore the requirements for a preventative intervention. METHODS: Students who failed the two-week exam were invited to a series of large-group workshops and small-group follow-up meetings. Participants' subsequent exam performance was compared with non-participants. RESULTS: About 71% of students who performed poorly in the new exam subsequently failed a course. Attendance at the workshops made no difference to short- or long-term pass rates. Attendance at more than three follow-up small group sessions significantly improved pass rates two semesters later, and was influenced by teacher experience. CONCLUSIONS: Close similarity between predictor task and target task is important for accurate prediction of failure. Consideration should be given to dose effect and class size in the prevention of failure of at-risk students, and we recommend a systemic approach to intervention/remediation programmes, involving a whole semester of mandatory, weekly small group meetings with experienced teachers.

Experiencias en un grupo de apoyo para madres con hijos menores de un año / Experiences in a support group for mothers with children under a year

El proceso de la maternidad, según Mercer, implica que la madre nazca psicológicamente, dando lugar a una nueva identidad en constante crecimiento y desarrollo. El modelo de esta autora puede servir a la enfermera para valorar, planificar, ejecutar y evaluar el cuidado enfermero de las madres y sus bebés en sus intervenciones Este estudio cualitativo, de enfoque etnográfico, dirigido a grupos de madres con hijos menores de un año, utilizará la observación participante y el diario de campo para describir y relacionar los contenidos de las dinámicas grupales con el desarrollo del rol maternal. Se identifican 3 categorías y 50 códigos y se destaca que las enfermeras, como profesionales competentes en aspectos conceptuales y técnicos propios de su disciplina, utilizan los modelos de Mercer y Beck para acompañar a las madres coordinándose con otros profesionales(AU)

The process of motherhood, according to Mercer, implies the mother’s psychological birth, creating a new identity under constant growth and development. The model of this author can serve to the nurse to value, plan, implement and assess the nurse care of mothers and their babies in their interventions. This is a qualitative study, of an ethnographic approach, directed to groups of mothers with children under a year that would use the participant observation and the field diary to describe and relate the contents and the group dynamics with the development of the maternal role. Three categories and 50 codes are identified and it is enhanced that nurses, as competent professionals in conceptual and technical aspects of their discipline, use the Mercer’s and Beck’s models to accompany the mothers and coordinating with other professionals(AU)

Sistemas de monitorización continua de la glucosa / Continuous monitoring systems of glucose

La posibilidad de obtener una lectura continua de la glucosa puede representar un gran avance y una herramienta útil para el manejo de la diabetes. Los avances tecnológicos pueden mejorar la calidad de vida y el control metabólico de las personas con diabetes, aunque esto suponga tener que aprender e incorporar nuevos conceptos técnicos, nuevos algoritmos de modificación de pauta y nuevos retos en Educación Terapéutica(AU)

The possibility of obtaining a continuous reading of glucose may represent a breakthrough and a useful tool for the management of diabetes. Technological advances can improve the quality of life and people with diabetes metabolic control, even if this means having to learn and incorporate new technical concepts, new algorithms for pattern modification and new challenges in Therapeutic Education(AU)

Evaluating effects of developmental education for college students using a regression discontinuity design.

BACKGROUND: Annually, American colleges and universities provide developmental education (DE) to millions of underprepared students; however, evaluation estimates of DE benefits have been mixed. OBJECTIVES: Using a prototypic exemplar of DE, our primary objective was to investigate the utility of a replicative evaluative framework for assessing program effectiveness. RESEARCH DESIGN: Within the context of the regression discontinuity (RD) design, this research examined the effectiveness of a DE program for five, sequential cohorts of first-time college students. Discontinuity estimates were generated for individual terms and cumulatively, across terms. SUBJECTS: Participants were 3,589 first-time community college students. MEASURES: DE program effects were measured by contrasting both college-level English grades and a dichotomous measure of pass/fail, for DE and non-DE students. RESULTS: Parametric and nonparametric estimates of overall effect were positive for continuous and dichotomous measures of achievement (grade and pass/fail). The variability of program effects over time was determined by tracking results within individual terms and cumulatively, across terms. Applying this replication strategy, DE's overall impact was modest (an effect size of approximately .20) but quite consistent, based on parametric and nonparametric estimation approaches. A meta-analysis of five RD results yielded virtually the same estimate as the overall, parametric findings. Subset analysis, though tentative, suggested that males benefited more than females, while academic gains were comparable for different ethnicities. CONCLUSION: The cumulative, within-study comparison, replication approach offers considerable potential for the evaluation of new and existing policies, particularly when effects are relatively small, as is often the case in applied settings.

Student supports: developmental education and other academic programs.

Low rates of college completion are a major problem in the United States. Less than 60 percent of students at four-year colleges graduate within six years, and at some colleges, the graduation rate is less than 10 percent. Additionally, many students enter higher education ill-prepared to comprehend college-level course material. Some estimates suggest that only one-third of high school graduates finish ready for college work; the proportion is even lower among older students. Colleges have responded to the poor preparation of incoming students by placing approximately 35 to 40 percent of entering freshmen into remedial or developmental courses, along with providing academic supports such as summer bridge programs, learning communities, academic counseling, and tutoring, as well as student supports such as financial aid and child care. Eric Bettinger, Angela Boatman, and Bridget Terry Long describe the role, costs, and impact of these college remediation and academic support programs. According to a growing body of research, the effects of remedial courses are considerably nuanced. The courses appear to help or hinder students differently by state, institution, background, and academic preparedness. The mixed findings from earlier research have raised questions ranging from whether remedial programs, on average, improve student academic outcomes to which types of programs are most effective. Administrators, practitioners, and policy makers are responding by redesigning developmental courses and searching for ways to implement effective remediation programs more broadly. In addition, recent research suggests that colleges may be placing too many students into remedial courses unnecessarily, suggesting the need for further examining the placement processes used to assign students to remedial courses. The authors expand the scope of remediation research by discussing other promising areas of academic support commonly offered by colleges, including advising, tutoring, and mentoring programs, as well as supports that target the competing responsibilities of students, namely caring for dependents and balancing employment with schoolwork. They conclude that the limited resources of institutions and equally limited funds of students make it imperative for postsecondary institutions to improve student academic supports and other services.

[Creation and implementation of a remediation tool in a family medicine residency program]. / La création et l'implantation réussie d'un outil de remédiation en résidence de médecine familiale.

PROBLEM BEING ADDRESSED: As is true in most postgraduate medical education programs, about 10% of the residents in the family medicine residency program at Université de Montréal encounter considerable difficulties in developing their skills. OBJECTIVE OF PROGRAM: In order to more adequately support the program's teachers in diagnosing these difficulties and in designing, planning, and following up on a remediation strategy, the Residency Program Evaluation Committee devised a tool consisting of a sample remediation plan and a guide to its use. PROGRAM DESCRIPTION: The remediation tool consists of 2 documents. The first is a sample remediation plan made up of a contract followed by 4 sections: diagnosis of learning problems, intention to improve, ways to improve, and evaluation of improvement with an interim and a final report. The second is a guide to drafting and systematizing the remediation plan. CONCLUSION: The favourable response to the tool and the use that was made of it during the year in which it was implemented demonstrate that the processes we had chosen were a success. Support from the faculty, implementation of the co-construction method to create the tool, as well as training and support for users were all factors in this success. A research project is under way to document the impact that use of this tool will have on our residency program.

A educação nutricional nas séries iniciais de escolas públicas estaduais de dois municípios do oeste de Santa Catarina / Education on nutrition in the first grades of public schools of two towns in the west of the state of Santa Catarina

The education sector, given its scope, is an importantally in solidifying the promotion of health care geared towards capacitating individuals, towards the creation of healthy environments, seeking the construction of a new health care culture. Nutritional Education is an essential part of this education to health care, since physical and mental health depend upon the nutritional status of the individual. The present study was carried out in two municipalities in western Santa Catarina, Brazil. Its objective was to verify how teachers of initial grades within the state public school system seek information concerning the theme of food and nutrition and how this content is approached in the classroom. Of the 37 teachers involved in the five participating schools in this study, 81.1% affirmed that the theme of food and nutrition is present in their lesson plans, while 89.2% of the teachers work with this subject with their students. Besides, this study highlights that the subject is connected to teaching sciences, principally in the 3rd and 4th grades, with the textbook and the internet serving as the main sources of information utilized by these teachers. The results of this study indicate that teachers are working with the theme food and nutrition and in their opinion this activity should be developed collectively in some schools, involving the entire school community. We conclude that teaching about food and nutrition in the public school network is important and should be given encouraged by public policymaking organizations through courses which prepare professionals and work proposals.

El sector educacional, dada su cobertura, es un aliado importante para la concreción de la promoción de la salud por medio de capacitación de individuos en la creación de ambientes sanos, visando la construcción de una nueva cultura de salud. La Educación Nutricional es parte esencial de la educación para la salud, una vez que la salud física y mental depende del estado nutricional del individuo. El presente estudio fue realizado en dos municipios del oeste de Santa Catarina, Brasil, y tuvo como objetivo verificar de que manera los profesores de las series inicialesde la enseñanza fundamental de escuelas públicas estatales buscan informaciones sobre la temática alimentación y nutrición y cómo este contenido es abordado en sala de clases.De los 37 profesores investigados en las cincoescuelas participantes de la investigación, el 81,1% afirmaron que la temática alimentación y nutrición, está presente en su planificación de enseñanza, y el 89,2% de los profesores trabajan con sus alumnos este tema. Además, se destaca también que la misma está ligada a la enseñanza de ciencias y ocurre principalmente en la 3a y 4a series, siendo el libro didáctico y la internet las principales fuentes de informaciones utilizadas por los profesores. Los resultados de la investigación indican que los profesores están trabajando la temática alimentación y nutrición y son de opinión que la actividad en algunas escuelas debería ser desarrollada de forma colectiva, involucrando toda la comunidad escolar. Se concluye que es importante que la enseñanza sobre alimentación y nutrición en lãs escuelas públicas sea incentivada por los órganos públicos, a través de cursos de capacitación y propuestas de trabajo.

O setor educacional, dada a sua abrangência, é um aliado importante para a concretização da promoção da saúde voltada para a capacitação de indivíduos, para a criação de ambientes saudáveis, visando à construção de uma nova cultura da saúde. A Educação Nutricional é parte essencial da educação para a saúde, uma vez que a saúde física e mental dependem do estado nutricional do indivíduo. O presente estudo foi realizado em dois municípios do oeste do Estado de Santa Catarina e teve como objetivo verificar de que maneira os professores das séries iniciais do ensino fundamental de escolas públicas estaduais buscam informações sobre a temática alimentação e nutrição e como esse conteúdo é abordado em sala de aula. Dos 37 professores pesquisados nas cinco escolas participantes desta pesquisa, 81,1% afirmaram que a temática alimentação e nutrição está presente em seu planejamento de ensino, e 89,2% dos professores trabalham com seus alunos este tema. Além disso, destaca-se também que ela está ligada ao ensino de ciências e acontece principalmente nas 3ª e 4ª séries, sendo o livro didático e a internetas principais fontes de informação utilizadas pelos professores. Os resultados da pesquisa indicam que os professores estão trabalhando o tema alimentação e nutrição e, na opinião deles, essa atividade em algumas escolas deveria ser desenvolvida de forma coletiva, envolvendo toda a comunidade escolar. Conclui-se que é importante que o ensino sobre alimentação e nutrição nas escolas públicas seja incentivado pelos órgãos públicos, através de cursos de capacitação e propostas de trabalho.