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.

Long-Term Outcomes of a Simulation-Based Remediation for Residents and Faculty With Unprofessional Behavior.

Background: There are few studies describing remediation for unprofessional behavior in residents and faculty and none that assess the long-term impact of remediation.

Objective: We implemented a simulation-based personalized remediation program for unprofessional behavior in residents and faculty and collected assessments from participants and referring supervisors.

Methods: Residents and faculty were referred for unprofessional behaviors, including aggressive, condescending, and argumentative communication styles as well as an inability to read social cues.

Defining Medical Student Patient Care Responsibilities Before Intern Year: Results of a National Survey.

Objectives: Program directors have noted that first-year residents struggle with many of the patient care responsibilities they assume as they enter the US graduate medical education system. A national description of medical students' patient care experience in advance of graduation has not been published. We sought to describe the experience of US medical students during their clinical training by surveying the student representatives of each school.

Study Skills and Test Taking Strategies for Coaching Medical Learners Based on Identified Areas of Struggle.

Introduction: Learners in high-performing contexts such as medical school and residency are presumed to have appropriate study skills to be successful. However, for those learners in academic difficulty who are identified as having weak study skills and poor test taking skills, faculty need tools to use to lead these struggling learners to academic success. In coaching learners on study skills, we frequently found that the study skills that helped them get into medical school or residency were no longer sufficient to make them successful in their new program.

A qualitative study of medical educators' perspectives on remediation: Adopting a holistic approach to struggling residents.

Introduction: During residency, some trainees require the identification and remediation of deficiencies to achieve the knowledge, skills and attitudes necessary for independent practice. Given the limited published frameworks for remediation, we characterize remediation from the perspective of educators and propose a holistic framework to guide the approach to remediation.

Methods: We conducted semistructured focus groups to: explore methods for identifying struggling residents; categorize common domains of struggle; describe personal factors that contribute to difficulties; define remediation interventions and understand what constitutes successful completion.

Academic Remediation: Why Early Identification and Intervention Matters.

At our institution, we have developed a remediation team of strong, focused experts who help us with struggling learners in making the diagnosis and then coaching on their milestone deficits. It is key for all program directors to recognize struggling residents because early recognition and intervention gives the resident the best chance of success.

Twelve tips for developing and maintaining a remediation program in medical education.

Remediation in medical education, the process of facilitating corrections for physician trainees who are not on course to competence, predictably consumes significant institutional resources. Although remediation is a logical consequence of mandating, measuring, and reporting clinical competence, many program leaders continue to take an unstructured approach toward organizing effective, efficient plans for struggling trainees, almost all of who will become practicing physicians. The following 12 tips derive from a decade of remediation experience at each of the authors' three institutions.

Heuristic errors in clinical reasoning.

Purpose: Errors in clinical reasoning contribute to patient morbidity and mortality. The purpose of this study was to determine the types of heuristic errors made by third-year medical students and first-year residents.

Methods: This study surveyed approximately 150 clinical educators inquiring about the types of heuristic errors they observed in third-year medical students and first-year residents.

Association of Characteristics, Deficits, and Outcomes of Residents Placed on Probation at One Institution, 2002-2012.

Purpose: To describe the population of residents placed on probation, identify learner characteristics associated with being placed on probation, and describe immediate and long-term career outcomes for those placed on probation as compared with matched controls.

Method: The authors collected data for residents at the University of Colorado School of Medicine placed on probation from July 2002 to June 2012, including postgraduate year placed on probation, deficits identified, mandated evaluation for physical and mental health, duration of probation, disability accommodations requested, and number of additional training months required. They were retrospectively compared with 102 controls matched for specialty, matriculation, and postgraduate year.

Methods and outcomes for the remediation of clinical reasoning.

Introduction: There is no widely accepted structured, evidence based strategy for the remediation of clinical reasoning skills.

Aim: To assess the effectiveness of a standardized clinical reasoning remediation plan for medical learners at various stages of training.

Setting: Learners enrolled in the University of Colorado School of Medicine Remediation Program.

Failure to fail: the institutional perspective.

Purpose: To determine institutional barriers to placing failing students on probation, dismissing students.

Methods: An online survey study was distributed to Student Affairs Deans or the equivalent at allopathic (MD) and osteopathic (DO) medical schools, and physician assistant (PA) and nurse practitioner (NP) schools across the United States. Nineteen (40%) of the 48 schools responded: six MD, four DO, five PA and four NP.

Learner deficits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006-2012.

Purpose: To identify deficit types and predictors of poor academic outcomes among students, residents, fellows, and physicians referred to the University of Colorado School of Medicine's remediation program.

Method: During 2006-2012, 151 learners were referred. After a standardized assessment process, program faculty developed individualized learning plans that incorporated deliberate practice, feedback, and reflection, followed by independent reassessment.

Determining need for remediation through postrotation evaluations.

Introduction: Postrotation evaluations are frequently used by residency program directors for early detection of residents with academic difficulties; however, the accuracy of these evaluations in assessing resident performance has been questioned.

Methods: This retrospective case-control study examines the ability of postrotation evaluation characteristics to predict the need for remediation. We compared the evaluations of 17 residents who were placed on academic warning or probation, from 2000 to 2007, with those for a group of peers matched on sex, postgraduate year (PGY), and entering class.

Evaluation of a hospitalist-run acute care for the elderly service.

Background: Comprehensive care for frail older inpatients may improve selected outcomes and reduce harm.

Objective: To evaluate a Hospitalist-run Acute Care for the Elderly (Hospitalist-ACE) service.

Design: Quasi-randomized, controlled trial.