Trouble in Paradise? Navigating the Waters of Clinical Remediation
Purpose: An important goal of physical therapy education is to ensure that all students achieve an appropriate level of clinical competency commensurate with their academic preparation. Academic programs must be equipped to offer specific, individualized and organized remediation when a student’s skills fall below specific benchmarks. The challenges of remediation have been explored, and some of these challenges have been associated with involving the student in remedial plan development, academic consequences associated with remediation, and insufficient time and space for remediation activities.1 There is limited evidence in the physical therapy literature related to the optimal format, timing and organization of remediation when a student has clinical performance deficits. Within and beyond physical therapy, variable methods have been used to execute a remediation program. 2,3,4,5 Some of the types of remediation activities identified in the literature include feedback on individual practice with an instructor, role-playing, working through case scenarios, simulation with standardized patients, and reflection with self-assessment.4,5,6 The purpose of this educational session is to describe the format, resources, timing, and decision-making tools of remediation activities of one DPT program utilized to facilitate student learning and performance assessment and apply these to case studies and discussion. Methods and/or Description of Project: The clinical education faculty of the Ohio State Doctor of Physical Therapy program have operationalized a student-centered remediation process, leveraging the resources across our clinical education network. This process involves all faculty of the DPT program, strong clinical partners, and use of simulation activities. Assessment and reflection over the last 10 years has provided an ongoing iterative process in implementing student remediation. The presenters will share both successes and failures as to what processes worked and which did not to achieve our overarching goal of determining an effective course of action. A key skill in the remediation process is being able to diagnose the problem(s) or learning barrier(s) in a timely fashion. We will describe available resources and tools that can be used to help the SCCE, CI, DCE, faculty and student to detect and diagnose behaviors and skills that require remediation. We will facilitate discussion on how to use a collaborative approach with the student and other appropriate stakeholders to build specific behavioral objectives and determine components of an individualized action plan. We will provide examples of how we strategically intersperse the use of simulation for skill competency and reflection, integration of a 360-professional behaviors assessment, student self-assessment, lab practicals and didactic material along with integrated clinical experiences to intervene and assess clinical readiness. We will discuss how we developed and implemented a conceptual model for decision-making within our remediation process. With this conceptual model, timing of interventions and integration of reflection are paramount. Case studies will be utilized to engage learners in discussion of best practices for student remediation, particularly for problem diagnosis, timing of remediation activities, and reflection to determine effectiveness. Results/Outcomes: We will describe outcomes of different types of remediation we have completed over the last 10 years. These outcomes will reflect the student, SCCE, CI, and DCE perspectives. Student outcomes, changes to our process, changes to our academic program and development of clinical partnerships will be described. Conclusions/Relevance to the conference theme: Development of a systematic, collaborative and iterative process for student clinical remediation has been valuable in assuring student competence, maintaining the integrity of the educational process and enhancing strong academic-clinical partnerships. It requires a team effort including the student, DCE, CI, faculty, SCCE and administrators to have all hands on deck to make this happen. We hope that by opening the discussion with our remediation process, participants will appreciate the key components of an effective, comprehensive and collaborative process that has been implemented utilizing best available evidence and experience. This session may prompt further discussion and appraisal of the participants to reflect on their own remediation processes.