How We Do It: Remediation Pathways in a Surgical Simulation Curriculum for Competency Improvement.

OBJECTIVE: Validated assessment of procedural knowledge and skills with formative remediation is a foundational part of achieving surgical competency. High-fidelity simulation programs provide a unique area to assess resident proficiency and independence, as well as to assist in identifying residents in need of further practice. While several studies have validated the use of simulation to attain proficiency of specific technical skills, few have validated remediation pathways for their trainees objectively. In this descriptive analysis, we review 2 remediation pathways within our simulation training curricula and how these are used in assessments of resident proficiency. MATERIALS AND METHODS: Two methods of remediation were formulated for use in high-fidelity simulation labs. One remediation pathway was a summative process, where ultimate judgment of resident competency was assessed through intra-operative assessments of a holistic skill set. The second remediation pathway was a formative "coaching" process, where feedback is given at several intervals along the pathway towards a specific technical skills competence. All general surgery residents are enrolled in the longitudinal, simulation curricula. RESULTS: Approximately one-third of surgical residents entered into a remediation pathway for either of the high-fidelity simulation curricula. Both residents and faculty expressed support for the summative and formative remediation pathways as constructed. Residents who entered remediation pathways believed it was a beneficial exercise, and the most common feedback was that remediation principles should be expanded to all residents. Interestingly, faculty demonstrated stronger support for the formative coaching feedback model than the summative assessment model. CONCLUSIONS: Through the complementary use of both formative and summative remediation pathways, resident competence can be enriched in a constructive, nonpunitive method for self-directed performance improvement. Both trainees and faculty express high satisfaction with programs explicitly organized to ensure that skills are rated through a standardized process.

Early Detection and Remediation of Problem Learners.

There are myriad types of problem learners in surgical residency and most have difficulty in more than 1 competency. Programs that use a standard curriculum of study and assessment are most successful in identifying struggling learners early. Many problem learners lack appropriate systems for study; a multidisciplinary educational team that is separate from the team that evaluates the success of remediation is critical. Struggling residents who require formal remediation benefit from performance improvement plans that clearly outline the issues of concern, describe the steps required for remediation, define success of remediation, and outline consequences for failure to remediate appropriately.

Improving reading skills in children with dyslexia: efficacy studies on a newly proposed remedial intervention-repeated reading with vocal music masking (RVM).

In this work, two different studies are examined to evaluate the effectiveness of a novel intervention program for the improvement of reading ability in children with dyslexia, known as repeated reading with vocal music masking (RVM). The proposed remedial approach is inspired by Breznitz's original work. The studies assess a 5-week program of intensive RVM training in a pre-post-test clinical paradigm, as well as a longitudinal paradigm where it is compared to 8 months of the standard remediation program (SRP). The results of both studies support the efficacy of the newly proposed RVM method. Notably in the longitudinal study, the reading speed of children, as well as related phonological, visuo-attentional, and cognitive skills, and attitudes toward reading, were measured regularly. Significant improvements in reading efficiency and related skills were observed, as well as greater motivation to read after RVM training. A modeling of the data specifically linked executive and processing speed skills to be involved in RVM training, suggesting that RVM may help rebalance the phonological and orthographic coding procedures necessary for efficient reading. The short, intensive, and focused nature of RVM training makes it a viable and attractive intervention for clinical practice. As preliminary results are promising, RVM training may prove to be a valuable tool that clinicians can call upon to effectively treat reading fluency disorders, especially when standard programs do not provide results.

Working with underperformance in surgical training: Educational strategies for supervisors.

Underperformance is a significant challenge for surgical educators. This paper outlines some educational strategies to manage the very complex demands presented by underperformance during training in the workplace. Preventative approaches include: setting expectations with early conversations; conscious attention to the workplace curriculum; and building trainee evaluative judgement through assessment and feedback. Once underperformance has been identified, other approaches including: developing a joint action plan; reducing or increasing feedback opportunities; and ensuring the trainee remains motivated. While these strategies cannot prevent failure, they offer the trainee opportunities to succeed.

Performance feedback during writing instruction: A cost-effectiveness analysis.

Students in K-12 settings experience poor writing outcomes, with less than 30% of students writing at the proficient level. Coupled with the pressure to improve academic outcomes with limited resources, schools are in dire need of efficient, universally provided instructional activities that promote writing skills. Performance feedback on writing fluency was designed to be a brief, low-resource universally provided instructional activity to facilitate writing development and has demonstrated moderate to large effects on formative writing measures. The current study was conducted to directly evaluate the extent to which performance feedback on writing fluency is cost-effective. This study uses the ingredients method to estimate the costs of providing performance feedback on writing fluency and calculates incremental cost-effectiveness ratios based on secondary data from a randomized controlled trial. Results suggest that performance feedback is more cost-effective than comprehensive systems reform initiatives and comparable to other universally provided interventions, and therefore should be considered a cost-effective approach to improve writing fluency for all students. Results provide school psychologists with concrete examples of how to support prevention and intervention activities aimed to improve student writing outcomes. Limitations and suggestions for future research are also discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Guidelines: The dos, don'ts and don't knows of remediation in medical education.

INTRODUCTION: Two developing forces have achieved prominence in medical education: the advent of competency-based assessments and a growing commitment to expand access to medicine for a broader range of learners with a wider array of preparation. Remediation is intended to support all learners to achieve sufficient competence. Therefore, it is timely to provide practical guidelines for remediation in medical education that clarify best practices, practices to avoid, and areas requiring further research, in order to guide work with both individual struggling learners and development of training program policies. METHODS: Collectively, we generated an initial list of Do's, Don'ts, and Don't Knows for remediation in medical education, which was then iteratively refined through discussions and additional evidence-gathering. The final guidelines were then graded for the strength of the evidence by consensus. RESULTS: We present 26 guidelines: two groupings of Do's (systems-level interventions and recommendations for individual learners), along with short lists of Don'ts and Don't Knows, and our interpretation of the strength of current evidence for each guideline. CONCLUSIONS: Remediation is a high-stakes, highly complex process involving learners, faculty, systems, and societal factors. Our synthesis resulted in a list of guidelines that summarize the current state of educational theory and empirical evidence that can improve remediation processes at individual and institutional levels. Important unanswered questions remain; ongoing research can further improve remediation practices to ensure the appropriate support for learners, institutions, and society.

Evaluation of the effectiveness of a literacy intervention programme on enhancing learning outcomes for secondary students with dyslexia in Hong Kong.

OBJECTIVE: This quasi-experimental study reported the results of a structured literacy intervention programme designed for secondary school students of Year 7 to Year 9 with dyslexia. Students of the intervention group (n = 116) participated in 40-week sessions of small-size, classroom-based, and split-group intervention setting with 45-min daily lesson on both Chinese and English language compared with students in the control group who received normal classroom instructions (n = 98). RESULTS: Students in the intervention group outperformed the control groups in self-regulated learning scales, which indicated that there was positive change in students' behavioural and cognitive outcomes in learning. Although students demonstrated gains in phonetic skills, posttest results in academic achievement did not exhibit significant improvement when compared with their control group peers. CONCLUSION: The findings provided some encouraging evidence of the effectiveness of intervention programme. Students that demonstrated gains in phonetic skills and improvement in behavioural and cognitive aspects required continuous intervention lessons to become a self-regulated learner, who would be self-motivated to improve methods of learning and adopt strategies for attaining academic goals. The study contributed to the literature by presenting one of the very first school-based, small-size, classroom-based, and split-group intervention programme for secondary school dyslexic students, which included teachers and students training on English and Chinese intervention content (phonological and literacy content), teaching curriculum integrated with school curriculum, and coteaching with school teachers in the mainstream classrooms, whereas most of the existing intervention programmes used pull-out approach involving the first language only.

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.

Reading Instruction for English Learners With Learning Disabilities: What Do We Already Know, and What Do We Still Need to Learn?

This paper reviews findings from four research syntheses that report the effects of academic language and/or reading interventions on language and reading outcomes for English learners who have or are at risk for learning difficulties. Studies included in the syntheses varied in research design and addressed multiple areas of reading and language. There was disagreement between syntheses as to the extent of research evidence in favor of particular instructional practices. For ELs with learning difficulties in kindergarten and first grade, however, there was strong consensus that multiple-component reading instruction that includes phonological awareness and phonics instruction is associated with improved word reading outcomes. It may also be beneficial to provide oral language, vocabulary, and reading comprehension instruction; nevertheless, there is a need for future research on instructional interventions that aim to improve reading comprehension outcomes for this population.

Comparing the effects of incremental rehearsal and traditional drill on retention of mathematics facts and predicting the effects with memory.

The purpose of this study was to examine the effects of Incremental Rehearsal (IR) and traditional drill (TD) on retention of multiplication facts with 29 students in third and fourth grades with low mathematical skills. Results indicated that IR led to significantly more facts being retained, and was essentially equal to TD for efficiency as measured by number of facts retained per instructional minute. Memory scores accounted for 34% of the variance beyond mathematics calculation scores in retention of multiplication facts for the TD condition, but only 2% of the variance for the IR condition. Thus, retention of multiplication facts seems largely influenced by a student's memory skills when using less effective instructional techniques such as TD, while approaches like IR are likely effective regardless of memory skills. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Training RAN or reading? A telerehabilitation study on developmental dyslexia.

Rehabilitation procedures recommended for developmental dyslexia (DD) are still not fully defined, and only few studies directly compare different types of training. This study compared a training (Reading Trainer) working on the reading impairment with one (Run the RAN) working on the rapid automatized naming (RAN) impairment, one of the main cognitive deficits associated with DD. Two groups of DD children (N = 45) equivalent for age, sex, full IQ, and reading speed were trained either by Reading Trainer (n = 21) or by Run the RAN (n = 24); both trainings required an intensive home exercise, lasting 3 months. Both trainings showed significant improvements in reading speed and accuracy of passages and words. Bypassing the use of alphanumeric stimuli, but empowering the cognitive processes underlying reading, training RAN may be a valid tool in children with reading difficulties opening new perspectives for children with severe impairments or, even, at risk of reading difficulties.

Longitudinal outcomes of an individualized and intensive reading intervention for third grade students.

Early intervention is known to reduce reading disabilities; however, treatment response is variable, and some students have persistent deficits that require intensive supports. This study examined the immediate and 1-year outcomes of an individualized and intensive reading program for third grade students, which was delivered throughout the school day for an average of 189 hr of instruction over 3 months. These students' performances were compared with two comparison groups, including poor readers who received small group supports and good readers who did not have additional reading instruction. The intensive group showed an improvement in word recognition and decoding fluency immediately after the program and 1 year later, and there was a decrease in significant reading impairments from 62% before intervention to 35% at follow-up. Furthermore, baseline reading, spelling, phonological awareness, and rapid naming skills were predictive of persistent reading deficits at a later time point. Although improvements in reading skills were shown, a significant gap between poor and good readers persisted in the third and fourth grades. This study illustrates the importance of a tertiary intensive reading program, but also the need for continuing supports.

Insuficiencias en el desarrollo de la independencia cognoscitiva del estudiante de Medicina con bajo rendimiento académico / Insufficiencies in the development of the cognitive independence in the medical student with low academic performance

Fundamento: El desarrollo de la independencia cognoscitiva en los estudiantes de la carrera de Medicina puede contribuir a la formación de un profesional más independiente y capaz de enfrentar situaciones en su contexto de actuación, en estrecha relación con el perfil del profesional.Objetivo: Diagnosticar las insuficiencias en el desarrollo de la independencia cognoscitiva de los estudiantes de la carrera de Medicina en la Universidad de Ciencias Médicas de Sancti Spíritus.Metodología: Se realizó un estudio descriptivo transversal en la Universidad de Ciencias Médicas de Sancti Spíritus, se tomó como población a los profesores que imparten la asignatura Anatomía Patológica y a 38 estudiantes de 2.do año de la carrera de Medicina del curso 2015-2016. Se emplearon métodos del nivel teórico, empírico y estadístico con procedimientos matemáticos, para medir la variable actuación de estudiantes y profesores se utilizó la escala de Siempre, Algunas Veces y Nunca para estudiantes y de nada, poco, En Alguna Medida, Bastante y Mucho para los profesores(AU)

Insuficiencias en el desarrollo de la independencia cognoscitiva del estudiante de Medicina con bajo rendimiento académico / Insufficiencies in the development of the cognitive independence in the medical student with low academic performance

Fundamento: El desarrollo de la independencia cognoscitiva en los estudiantes de la carrera de Medicina puede contribuir a la formación de un profesional más independiente y capaz de enfrentar situaciones en su contexto de actuación, en estrecha relación con el perfil del profesional.Objetivo: Diagnosticar las insuficiencias en el desarrollo de la independencia cognoscitiva de los estudiantes de la carrera de Medicina en la Universidad de Ciencias Médicas de Sancti Spíritus.Metodología: Se realizó un estudio descriptivo transversal en la Universidad de Ciencias Médicas de Sancti Spíritus, se tomó como población a los profesores que imparten la asignatura Anatomía Patológica y a 38 estudiantes de 2.do año de la carrera de Medicina del curso 2015-2016. Se emplearon métodos del nivel teórico, empírico y estadístico con procedimientos matemáticos, para medir la variable actuación de estudiantes y profesores se utilizó la escala de Siempre, Algunas Veces y Nunca para estudiantes y de nada, poco, En Alguna Medida, Bastante y Mucho para los profesores(AU)

Brief homework intervention for adolescents with ADHD: Trajectories and predictors of response.

In the present study, we sought to examine response trajectories to brief (11-week) school-based homework interventions and factors that may help schools predict responses. Participants included 222 middle-school students (72% boys; Mage = 12.00 years, SD = 1.02) who had been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and had received either a contingency-management or skills-based intervention for homework problems. Both interventions included 16 20-min student meetings with a school counselor and two parent meetings. Trajectories of response for ratings of homework problems and assignment completion were examined from baseline to a 6-month follow-up using growth-mixture models. Baseline variables routinely measured in school settings, including grade-point average (GPA), math and reading achievement, and externalizing and internalizing symptoms, were examined as predictors of treatment-response trajectories. The majority of students (68-81%) showed positive treatment response across outcomes. However, trajectories of students who did not respond to intervention were identified for each outcome. Baseline GPA significantly predicted trajectories for all outcomes and achievement scores significantly predicted trajectories of teacher-reported homework performance and parent-reported homework problems, such that youth with relatively higher baseline GPAs and achievement were most likely to respond. In contrast, neither externalizing nor internalizing symptoms were significant predictors of response trajectories. Schools can use GPA and academic-achievement data to determine whether brief school-based interventions for homework problems are likely to succeed. Students with ADHD who display severe academic impairment (i.e., GPA lower than 2.0 at baseline) may benefit from a more long-term, intensive intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Replication of an Experimental Study Investigating the Efficacy of a Multisyllabic Word Reading Intervention With and Without Motivational Beliefs Training for Struggling Readers.

This randomized control trial examined the efficacy of an intervention aimed at improving multisyllabic word reading (MWR) skills among fourth- and fifth-grade struggling readers ( n = 109, 48.6% male), as well as the relative effects of an embedded motivational beliefs training component. This study was a closely aligned replication of our earlier work. The intervention was replicated with a three-condition design: MWR only, MWR with a motivational beliefs component, and business-as-usual control. Students were tutored in small groups for 40 lessons (four 40-min lessons each week). When we combined performance of students in both MWR conditions, intervention students significantly outperformed controls on proximal measures of affix reading and MWR, as well as standardized measures of decoding, spelling, and text comprehension. Furthermore, there was a noted interaction between English learner status and treatment on spelling performance. There were no statistically significant main effects between the MWR groups on proximal or standardized measures of interest. Findings are discussed in terms of their relevance to MWR instruction for students with persistent reading difficulties and considerations for future research related to the malleability of motivation.

Efficacy of a Word- and Text-Based Intervention for Students With Significant Reading Difficulties.

We examine the efficacy of an intervention to improve word reading and reading comprehension in fourth- and fifth-grade students with significant reading problems. Using a randomized control trial design, we compare the fourth- and fifth-grade reading outcomes of students with severe reading difficulties who were provided a researcher-developed treatment with reading outcomes of students in a business-as-usual (BAU) comparison condition. A total of 280 fourth- and fifth-grade students were randomly assigned within school in a 1:1 ratio to either the BAU comparison condition ( n = 139) or the treatment condition ( n = 141). Treatment students were provided small-group tutoring for 30 to 45 minutes for an average of 68 lessons (mean hours of instruction = 44.4, SD = 11.2). Treatment students performed statistically significantly higher than BAU students on a word reading measure (effect size [ES] = 0. 58) and a measure of reading fluency (ES = 0.46). Though not statistically significant, effect sizes for students in the treatment condition were consistently higher than BAU students for decoding measures (ES = 0.06, 0.08), and mixed for comprehension (ES = -0.02, 0.14).

Successful Remediation of an Advanced Pharmacy Practice Experience for an At-risk Student.

Objective. To describe a successful remediation for an Acute Care Medicine advanced pharmacy practice experience (APPE) in a student with multiple learning deficits. Methods. A literature review of pharmacy and medical experiential remediation was conducted to identify best practices to implement prior to designing the remediation for our student case. Based on this search and experience as preceptors, a three-phase remediation was designed: one week for assessment, two weeks for development of learning skills and strategies and six weeks for an on-campus APPE. Success of the remediation was determined by student performance, as defined by the APPE preceptor, in all relevant 2013 Center for the Advancement of Pharmacy Education (CAPE) educational outcomes. Results. Baseline assessment indicated that the student was below minimal competency in six of 13 relevant 2013 CAPE educational outcomes. Upon completion of the three-part remediation, the student repeated the Acute Care Medicine APPE, achieving better than minimal competency in all 13 outcomes. The student demonstrated significant improvement in nine of 13 CAPE educational outcomes. Conclusion. This student case provides a novel and successful blueprint for remediation of APPE. However, more evidence-based literature is needed to guide educators in experiential remediation.

Effect of an Individualized Post-Examination Instructor Remediation on Pharmacy Student Performance in a Biochemistry Course.

Objective. To assess the effectiveness of a post-examination, one-on-one instructor remediation process on student performance in a pharmacy biochemistry course by measuring the degree of score improvement on a subsequent examination. Methods. Students who scored below 70% on any examination were encouraged to meet with the course coordinator. A typical remediation session lasts about 30 minutes, and covers academic preparation, study habits, concept understanding, application, critical thinking, time management, and stress control. Scores in two consecutive examinations were compared between students who underwent remediation and those who did not. All scores were adjusted for level of difficulty. Results. At-risk students with relatively lower scores are more likely to seek remediation. After receiving a score below 70%, students perform better on the next examination regardless of remediation. However, the remediation process results in a statistically significant 43% increase in the degree of improvement in student performance on the next examination. Conclusion. A post-examination, one-on-one remediation is effective in enhancing student performance in the biochemistry course. As this course is one of the two with the highest failure rates in the PharmD program, current intervention might improve student retention.