دانلود کتاب Remediation in Medical Education: A Mid-Course Correction

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Foreword
Foreword
Preface
Acknowledgments
Contents
Contributors
Part I: Overview and Framing
1: Remediation: The Measure of a Profession
Introduction
Unpacking Remediation
Boundary Practices, Liminal Spaces
In Purgatorio
An Expanding Discourse
Scholarship and Remediation
The Better Angels of Our Nature?
References
2: Toward a Programmatic Approach for Remediation: Evidence-Based Goals for Institutions
Introduction
Phase 1: Setting Up the Institution’s Remediation Process
Goal 1A: Ensure Due Process to Uphold the Professional Compact with Society, While Maintaining Empathy for Individual Learners’ Struggles
Goal 1B: Ensure That Admissions and Selection Processes Correspond with Desired Outcomes, Including Diversifying the Workforce—And Don’t Stop There
Goal 1C: Transparently Align Instructional Paradigms with Defined Outcomes
Goal 1D: Cultivate Effective Support Systems to Avert the Need for Remediation, Including Mentoring and Developing a Culture of Feedback
Mentoring
Culture of Feedback
Goal 1E: Promote the Availability of Remediation Resources to All Learners and Health Professions Education Community Members
Goal 1F: Support Faculty Development Initiatives for All Steps of the Remediation Process, Including Early Identification, Intervention, and Referral
Phase 2: Structural Elements of the Remediation Process
Goal 2A: Tailor Remediation Plans to Individual Learners’ Needs
Goal 2B: Construct Effective and Nonjudgmental Processes to Share Evolving Information About Learners Who Struggle
Goal 2C: Avoid Conflicts of Interest When Distributing Remediation Roles
Phase 3: Supporting the Ultimate Decision
Goal 3A: Develop Compassionate “Off-Ramps” for Learners Who Must Discontinue Training
Conclusion
References
3: Diversity, Inclusion, and Remediation: Excellence Requires Equity
Introduction
The Social Identity Approach
Intrapersonal Work: An Inside Job
Implicit Bias
Interpersonal Work: Interacting with Learners
Start with “Location of Self”
Recognize and Diminish Stereotype Threat and Microaggressions
The Minority Taxes
Remediating Curricula and Systems
Remediation in the Twenty-First Century and Beyond
References
4: The Metacognitive Competency: Becoming a Master Adaptive Learner
Introduction
The Master Adaptive Learner Framework
The Planning Phase: Preparation for Future Learning
The Learning Phase: Aiming for Adaptive Expertise
The Assessment Phase: Feedback Fuels the Self-Regulated Learner
The Adjustment Phase: Learning by Individuals as a Driver for Organizational Change
Drivers of Metacognition and MAL: Curiosity, Motivation, Mindset, and Resilience
Conclusion
References
5: The Learner’s Experience of Remediation
Introduction
What Learners Tell Us
Learners Prefer Active Remediation Approaches
Learners Recognize Skillful Remediation Coaches
Learners Desire Attention to the Impact of Life Context and Emotions on the Remediation Process
What Research Outside Remediation Tells Us
Emotion
Motivation and Feedback Responsiveness
Insight/Accountability
Academic Culture
Where Do We Go from Here?
Normalizing/Destigmatizing the Process of Receiving Help
Gathering Information About Learners’ Experiences
Explicitly Incorporating Emotion/Metacognition into Remediation Programs
Bringing It All Together
References
6: A Stepwise Approach to Remediation for the Frontline Clinician-Educator
Introduction
Phase 1: Identification
Identify the Area(s) Where the Learner Exhibits Inadequate Performance
Acknowledge the Learner’s Emotions, and Commit to Their Success
Phase 2: Clarification
Assess for Systemic Causes of Sub-optimal Performance
Probe for Individual Factors That Affect Academic or Clinical Performance
Gather More Information, Directly Observing the Learner If Possible
Phase 3: Intervention
Collaboratively Develop Learning Goals and Assessment Methods
Incorporate High-Value Interventions During Remediation
Meet Regularly with the Learner
Encourage Self-Regulated Learning Skills
Provide High-Quality Feedback
Set Up for Success
Observe the Learner
Ask for the Learner’s Self-Assessment, Initially Focusing on What They Did Effectively
Respond with Reflection and Empathy
Share Your Assessment and Thoughts
Collaborate on Improvement Strategies
Phase 4: Assessment of the Learner’s Progress
Conclusion
References
Part II: Remediation by Competency
7: “They Need to Read More”: Helping Trainees Who Struggle with Knowledge Base
Introduction
Identification
Clarification
Intervention
Evidence-Based Learning Strategies
Study Skills Interventions
Time Management
Study Skills Coaching
Remediation Roles and Practices
Self-Regulation
Taking Advantage of Aural and Visual Learning
Distracted Learners
Training for Test-Taking
Learners with Anxiety and Low Confidence
Assessment
Conclusion
References
8: Remediation of Physical Examination Skills
Introduction
Identification
Clarification
Intervention
Assessment
Conclusion
References
9: Assessment and Remediation of Clinical Reasoning
Introduction
Identification
Clarification: Global and Targeted Appraisal of the Learner Struggling with Clinical Reasoning
Global Appraisal
Targeted Appraisal
Hypothesis Generation
Data Gathering
Problem Representation and Illness Scripts
Management Reasoning
Intervention: Coaching Clinical Reasoning
Hypothesis Generation (Fig. 9.2, Purple Gear)
Data Gathering (Fig. 9.2, Pink Gear)
Problem Representation (Fig. 9.2, Orange Gear)
Hypothesis Refinement (Fig. 9.2, Green Gear)
Working Diagnosis (Fig. 9.2, Blue Gear)
Management Reasoning
Continuing Observation and Reassessment
Conclusion
References
10: Remediation for Technical Skills
Introduction
Identification: Defining Technical Skills Domains
Clarification and Intervention: Cognitive Load Theory in Procedural Skill Learning
Reducing Extraneous Load
Learning Environment
Affective Difficulties
Addressing Intrinsic Load
Addressing Intrinsic Load and Creating Germane Load
Simulation Training
Deliberate Practice
Video-Based Coaching
Structuring Learning Opportunities
Assessment: Intraoperative Remediation
Conclusion
References
11: Evaluation and Remediation of Organization, Efficiency, and Time Management
Introduction
Identification: A Learner Appears \"Disorganized\"
Clarification: Delineating Underlying Causes of  Executive Function Struggles
Intervention
Inefficiency with New Admissions
Inefficiency in Pre-rounding
Inefficiency and Disorganization in Note Writing
Inefficiency in Daily Tasks
Assessment and Continuing Observation
Conclusion
References
12: Remediation of Interpersonal and Communication Skills
Introduction
Identification
Clarification
Intervention and Assessment
Step 1: Set the Stage and Establish Rapport
Step 2: Model the Desired Communication Skills
Step 3: Elicit the Learner’s Perspective
Step 4: Encourage Reflection on Strengths
Step 5: Focus on Small Successes
Step 6: Assist the Learner to Develop Their Own Learning Plan
Step 7: Revisit the Learning Plan
Common Remediation Scenarios
Learners Who Lack Verbal Rapport-Building Skills
Learners Exhibiting Resistance to Learning This Material
Learners with an Autism Spectrum Condition
Other Coaching Considerations
Conclusion
References
13: Professionalism Lapses as Professional Identity Formation Challenges
Introduction
The Evolving Definition of Unprofessional Behaviors
A Theoretical Approach to Professionalism Remediation
The Components of Morality
Measuring Moral Judgment: The Defining Issues Test
Professional Identity Formation (PIF) and the Professional Identity Essay (PIE)
Coaching Using the Professional Identity Essay (PIE)
Establishing the Relationship and Expectation of Active Self-Reflection
Working with the “Alienated Idealist”
With an Eye Toward the “I” in Professional Identity
Remediation of Professionalism Lapses: Coaching Principles and Process
Two Cases Illustrating Coaching Principles, Processes, and Approaches
Clarification Phase
Intervention Phase
Clarification Phase
Intervention Phase
Assessment for Coaching Effectiveness
Summary and Conclusions
References
14: Nuts and Bolts of Professionalism Remediation
Introduction
How to Teach Professionalism?
How to Assess Professionalism?
Four Phases of Professionalism Remediation
Identify and Evaluate
4 I’s Model of Unprofessional Behaviors
Roles and Responsibilities
Do’s and Don’ts for Frontline Educators in the Identify and Evaluate Phase
Explore and Understand
Exploration of Unprofessional Behavior: Ten Questions
Four Patterns of Unprofessional Behavior
Roles and Responsibilities
Do’s and Don’ts for Teachers and Professionalism Remediation Supervisors in the Explore and Understand Phase
Remediate
Distinction Between Coaching and Assessment
Elements of Coaching
Remediation Plan
Documentation
Roles and Responsibilities
Do’s and Don’ts in the Remediate Phase
Gather Evidence for Dismissal
Gatekeeper of the Profession
Dismissal
Roles and Responsibilities
Do’s and Don’ts in the Gather Evidence for Dismissal Phase
Concluding Thoughts
References
15: Reflection and Narrative in Remediation
Introduction
Reflection as a Competency
Frameworks for Understanding the Reflection Competency
The Reflective Practitioner
Kolb’s Cycle of Experiential Learning
Gibbs’ Reflective Cycle: Learning to “Pay Attention” to Concrete Experiences
Narrative in Clinical Education: Deepening Learning and Abstract Conceptualization
Remediation Strategies
Reflective Capacity and Motivation to Learn
Perspective-Taking
Seeking the Trainee’s Perspective
Sharing Narratives to Reinforce and Deepen the Capacity to Learn from Reflection
Sharing Narratives to Address Negative Attitudes
The Perspectives of Others
Framing and Fostering Narrative Coherence
Faculty Development
Conclusion
References
16: Remediation Through the Lens of Systems-Based Practice and Practice-Based Learning and Improvement
Introduction
Identification
Clarification
Intervention
Assessment
Adapting the Approach to Specific Circumstances
Learners Who Have Had Several “Near-Miss” Safety Events
Learner Who Frequently Over-Orders Diagnostic Testing
Learner Struggles with Handoffs to Colleagues
Conclusion
References
Part III: Special Topics
17: Learning Differences and Medical Education
Introduction
Our Experience
Learning Disabilities vs. Learning Differences
Looking Through an LD Lens
The Americans with Disabilities Act (ADA) and the Health Professions
Looking Through a Mind, Brain, and Education Lens
Reframing Struggles
Saliency Determination and Processing Depth
Memory Strategies and Bottom-Up Processing
Reading and Word Retrieval
The Assessment Process
Psychoeducational Testing
Neuropsychological Testing
Sharing the Assessment with the Learner
Demystification
Learning Plan
Implementing Accommodations
Additional Barriers
Attention Deficit Disorder (ADD) and Executive Function Disorder (EFD)
Anxiety and Depression
Faculty and Learner Attitudes and Frustration
Conclusion
References
18: Trainee Well-Being and Remediation
Introduction
Influences on Trainee Well-Being
Presentations of Distress
Burnout
Compassion Fatigue
Work-Life Tension
Presentations Related to Background and Identity
Imposter Syndrome
Stereotype Threat
Perfectionism
Presentations Related to Mental Health
Depression and Suicide
Alcohol and Substance Use
Other Psychiatric Concerns
Approach to Trainee Well-Being
Advocate
Prevent
Create a Culture of Well-Being
Promote Efficiency of Practice
Encourage Enhanced Personal Resilience
Teach
Education for Well-Being
Monitor
Act and Intervene
Impaired and Disruptive Trainees
Conclusion
References
19: Faculty Development: Preparing to Conduct Remediation
Introduction
Who Should Conduct Remediation?
Faculty Development for Remediation
Specific Competencies for Faculty
What Is Learning? Theories 101
Faculty Skills for Remediation Work
The Teacher as Facilitator of Learning
Coaching
Cognitive Apprenticeship
Judgment
The Best Use of Faculty Raters: In-Training Assessment
Measurement vs. Judgment
Effective Models of Faculty Development for Remediation
A Proposal to Support Effective Faculty Development for Remediation in “Communities of Practice”
Conclusion
References
Part IV: Systems, Legal, and Ethical Considerations: Undergraduate Medical Education and Interprofessional Schools
20: The View from the Medical School Dean’s Office
Introduction
Common Causes of Student Difficulties
Academic Issues
Academic Concerns Arising in the Pre-clerkship Curriculum
Academic Concerns Arising in the Clinical Curriculum
Professionalism Issues
Psychological Distress and Mental Health Issues
Mental Health Disorders
Anxiety, Mood, and Thought Disorders
Personality Disorders
Autism Spectrum Conditions
Substance Use
Fitness for Duty Evaluation
Dean’s Office Resources for Remediation
Considerations for Admissions
Academic and Nonacademic Attributes
Technical Standards in Admissions
Student Financial Considerations
Student Privacy Considerations
The Family Educational Rights and Privacy Act (FERPA)
Forward Feeding of Information: Sensitive and Controversial
Information-Sharing with Admissions
The Official Academic Record
What to Recommend to a Graduating Medical Student
Dismissal of Medical Students
References
21: Commentary on Chapter 20: Perspective from a Brazilian Medical Professor
Reference
22: Commentary on Chapter 20: Perspective from the University of Minnesota Bachelor of Science in Nursing (BSN) Program
23: Commentary on Chapter 20: Perspective from the Nell Hodgson Woodruff School of Nursing, Emory University
24: Commentary on Chapter 20: Perspective from the Purdue University College of Pharmacy
25: Commentary on Chapter 20: Perspective from the School of Physical Therapy, University of California, San Francisco
Part V: Systems, Legal, and Ethical Considerations: Graduate Medical Education
26: The View from the Office of the Designated Institutional Officer (DIO), Washington University in St. Louis
Introduction
Early Identification of the Trainee Who Struggles: Role of Evaluations, Milestones, and Competency Committees
Remediation and Probation
Dismissal and Appeal Processes
Trainees Are Both Learners and Employees
Implications of Probation and Dismissal
Case Examples
Right This Ship: Probation and Successful Remediation
It Follows You
Time to Say Goodbye
Conclusion
References
27: Commentary on Chapter 26: Perspective from the Oman Medical Specialty Board (OMSB)
28: Commentary on Chapter 26: Perspective from the National Healthcare Group Family Medicine Residency, Singapore
Part VI: Systems, Legal, and Ethical Considerations: Preparing for Dismissal
29: When the Prognosis Is Poor: Documentation, the Law, and When and How to Give Up
Limits to Remediation
Zones of Remediation
Standards for Decision-Making
Legal Considerations
Documentation
Due Process
Judicial Deference
Other Legal Issues
Fitness for Duty
When a Trainee Commits a Crime
Dismissal and the Exit Interview
Handling Lawsuits
Aftermath of a Dismissal
For the Learner
For Peers and Faculty
For the Program/Institution
Conclusion
References
Epilogue: A Student’s Perspective on Remediation
Index