Implementation of a Progressive Structured Remediation Following a Clinical Failure Using Validated Outcome Measures
Purpose: The purpose is to describe a structured remediation process following a student’s full-time clinical experience failure using validated assessment tools.
Methods/Description: A student failure in a terminal full-time clinical experience, in the non-ambulatory setting, occurred due to assessment ratings at the beginner level on the midterm Clinical Performance Instrument (CPI) in the areas of safety, clinical reasoning and communication. A structured remediation program was created based on: 1) the midterm CPI, 2) student self-identified areas of struggle and 3) areas of challenges based on the Acute Care Confidence Survey. Remediation progressed from written case studies and basic skills practice to simulation practice, culminating with a simulation practical. Total one-on-one remediation time was 25 hours.
Results/Outcomes: The student successfully completed the structured remediation with noted improvements in 14 of the 15 domains of the Acute Care Confidence Survey. The greatest improvements were noted in the areas of bed mobility, transfers, ambulation, lab value assessment and interprofessional communication. The student was placed in another non-ambulatory clinic and was rated at entry-level or beyond in all domains on the CPI by midterm. The student was able to graduate, pass the NPTE on the first attempt and secured employment. As a result of the success of this remediation, a varying credit level course is currently being developed to standardize and maintain sustainability of an intensive remediation process and to account for student and faculty time, responsibility and efforts.
Conclusions/Relevance to the conference theme: This structured remediation plan was successful for a student with a one-time clinical experience failure in a non-ambulatory setting. Successful remediation may be contributed to the use of outcome measures, rigor and time commitment from the student and faculty. In order to maintain sustainability and standardization of such a remediation process, implementation of a varying credit course may be substantiated.