Design: Remediation

 

You may want to design a modified learning pan for use outside of a remedial context. Alternatively, if you are embarking on a remediation, you will need to design both the Remediation and the Modified Learning Plan that will support it. 

Designing a Good Remediation

Once you have assessed the difficulty, think about what you need to make a fair and robust plan.

Know the Policies

Gather More Data

  • You may need to gather more data before you can implement a formal modified learning plan.

General Structure of the Remediation

Many remediations have traditionally been a repeat of exactly the same clinical experience with perhaps some closer monitoring or specific goals upon which to focus.  For some situations this is indeed sufficient, but for most it is not.  We may want to structure the entire experience differently, and will definitely want some targeted interventions- called a Modified Learning Plan.  The goal of a remediation is to try to get the trainee back to their expected trajectory. 

In designing a remediation, you should first think about the general considerations of structure, timing and environment. 

Structure  | Timing | Environment | Interventions | Modified Learning Plan


Structure

When the trigger event is not the failure of a specific rotation, that naturally leads to more creative thinking about what new experience would help to address the issue.  Even when it is a specific rotation in a time-based program that is being remediated, there is latitude.  It is neither necessary nor often desirable to simply reproduce the original rotation.  Your goal would be to be able to say, at the end of the remediation, that the trainee has fulfilled the goals of that rotation.  Consider whether modifying the schedule would help, such as dedicated study days, more or less call, shorter days or different accountability for time.  You might consider adding or removing certain elements, for example a surgical resident who fails a rotation because of poor ward management might be excused from clinic or the OR to focus on ward issues.


Timing

The most important point to be made about timing is to start as soon as possible.  There are many very tempting reasons to delay the start of a remediation, but delays create confusion.  What do you with the intervening time?  If the trainee fails, there is a pretty good point to be made that you set them up for that by allowing them to continue in training with a known challenge.  If the trainee continues and does well in the interim, does that suggest that they have fixed their own problem and the remediation is now moot?  Even if some of the specific interventions you have planned will take some time to arrange, it is best to start immediately with what you have.

The duration of a remediation should be given careful consideration.  The time it will take to fix a problem is based on the nature of the problem, and not the time it took to notice it. Some issues that lead to remediation are simple and lend themselves to simple solutions with short timelines.  However, it is a common scenario that a fairly global deficiency remains relatively unnoticed until it emerges in a specific environment, perhaps a short senior rotation.  Thus, a two-week rotation might unearth a problem that requires a three-month solution.


Environment

It is often desirable to allow a remediation to proceed in another venue that can provide a similar experience.  For example, if a trainee were to encounter difficulties in the OR at HSC, you might consider setting up the remediation at St Boniface, the Grace, or even Brandon.  There is no universally right or wrong approach to this and it must be individualized.  General advantages of changing venue would be allowing a “fresh start”, without the potential for residual bias, possible interpersonal issues with specific teachers, or a difficult professional environment.  On the other hand, it also creates new stresses with needing to adapt to a new environment.  It is also a reality of education that the site in which the problem was finally noticed is the site that puts the most effort into assessment.


Interventions
  • Further Assessment:  is there a need for referral to student services for a formal learning assessment, or for an assessment of a possible Mental Health issue? The Associate Dean of Students is also a valuable resource to help with these decisions.
  • Schedule Change: should you add or remove specific elements from the normal structure of the rotation, to allow more focus on the problem under remediation.  Increasing or decreasing evening/night work, more clinic, less OR etc.
  • Increased Observation & Feedback:  most remediations cite increased feedback as one of the key resources.  That is perfectly legitimate but be specific; how often, when and how will it be documented?  You need to strike a balance between actually providing support, and setting a bar so high it will not be met.
  • Peer Support/Mentor:  it is usually useful to have a mentor in place, who is not responsible for the conduct or assessment of the remediation, but who can be available to the trainee for advice and support.  This is typically a faculty member with whom the trainee has a positive relationship. However, there is sometimes a role for a faculty member from outside the department, a senior resident, or a resident from another program through PARIM.
  • Student Services: It is often the case there is a concern about an underlying issue that is causing the ultimate performance problem. Many of these are outside the scope of PD's.  is a very useful resource that can help both with identifying the problem and getting access to resources. Trainees can meet with Student Services, either at the behest of the PD, or on their own initiative. They can arrange; general health, mental health assessment, assessment of learning style and coaching, formal psychodiagnostic assessment for learning disabilities and coaching on interpersonal and communication strategies through the Office of Human Rights and Conflict Management.
  • Associate Dean, Student Affairs: The Associate Dean Student Affairs work closely with Student Services to coordinate the above, and to provide advise on career paths and academic trajectory. All Trainees being placed on Remediation or Probation are automatically scheduled to meet with the Associate Dean, however you may want to consider referring the trainee to the Associate Dean at an earlier stage...
  • Leave of Absence:  it is sometimes best to initiate a leave of absence prior to starting a remediation, particularly when there are extenuating circumstances such as a health issue or significant learning challenge.  These also tend to be complicated and should be discussed with the EAC Chair, the Associate Dean of Students, and the Associate Dean, PGME.

Modified Learning Plan

Having completed the overall structural plan, it is almost always more appropriate to add some specific intervention(s) targeted toward the identified deficiency, with some consideration of the learning style of the trainee.  These need not always be heroic, but can range from fairly simple to very extensive, as resources and needs dictate.

The process of building a MLP is described separately in the Modified Learning Plan page of the EAC website. Construction of a modified learning plan (MLP) for use within a remediation or probation follows the same principles as construction of a MLP for non-remedial use.  The only difference would be in the rigor of the design.  MLPs for non-remedial use are typically fairly flexible and learner-driven, and less likely to include resources that put a specific onus on the program, such as one-on-one teaching sessions or simulation.  Inside a remediation there would be a trend toward more structure with clear expectations on the part of both the program and the learner and a greater likelihood of active instruction methods.  Similarly, there is also some specific assessment of achievement.