Early predictors of need for remediation in the Australian general practice training program: a retrospective cohort study.

Underperforming trainees requiring remediation may threaten patient safety and are challenging for vocational training programs. Decisions to institute remediation are high-stakes-remediation being resource-intensive and emotionally demanding on trainees. Detection of underperformance requiring remediation is particularly problematic in general (family) practice. We sought to establish early-training assessment instruments predictive of general practice (GP) trainees' subsequently requiring formal remediation. We conducted a retrospective cohort study of trainees from a large Australian regionally-based GP training organization. The outcome factor was requirement for formal remediation. Independent variables were demographic factors and a range of formative assessments conducted immediately prior to or during early-stage training. Analyses employed univariate and multivariate logistic regression of each predictor assessment modality with the outcome, adjusting for potential confounders. Of 248 trainees, 26 (10.5 %) required formal remediation. Performance on the Colleague Feedback Evaluation Tool (entailing feedback from a trainee's clinical colleagues on clinical performance, communication and probity) and External Clinical Teaching Visits (half-day sessions of the trainee's clinical consultations observed directly by an experienced GP), along with non-Australian primary medical qualification, were significantly associated with requiring remediation. There was a non-significant trend for association with performance on the Doctors Interpersonal Skills Questionnaire (patient feedback on interpersonal elements of the consultation). There were no significant associations with entry-selection scores or formative exam or assessment scores. Our finding that 'in vivo' assessments of complex behaviour, but not 'in vitro' knowledge-based assessments, predict need for remediation is consistent with theoretical understanding of the nature of remediation decision-making and should inform remediation practice in GP vocational training.

What is the Prevalence and Success of Remediation of Emergency Medicine Residents?

INTRODUCTION: The primary objective of this study was to determine the prevalence of remediation, competency domains for remediation, the length, and success rates of remediation in emergency medicine (EM). METHODS: We developed the survey in Surveymonkey™ with attention to content and response process validity. EM program directors responded how many residents had been placed on remediation in the last three years. Details regarding the remediation were collected including indication, length and success. We reported descriptive data and estimated a multinomial logistic regression model. RESULTS: We obtained 126/158 responses (79.7%). Ninety percent of programs had at least one resident on remediation in the last three years. The prevalence of remediation was 4.4%. Indications for remediation ranged from difficulties with one core competency to all six competencies (mean 1.9). The most common were medical knowledge (MK) (63.1% of residents), patient care (46.6%) and professionalism (31.5%). Mean length of remediation was eight months (range 1-36 months). Successful remediation was 59.9% of remediated residents; 31.3% reported ongoing remediation. In 8.7%, remediation was deemed "unsuccessful." Training year at time of identification for remediation (post-graduate year [PGY] 1), longer time spent in remediation, and concerns with practice-based learning (PBLI) and professionalism were found to have statistically significant association with unsuccessful remediation. CONCLUSION: Remediation in EM residencies is common, with the most common areas being MK and patient care. The majority of residents are successfully remediated. PGY level, length of time spent in remediation, and the remediation of the competencies of PBLI and professionalism were associated with unsuccessful remediation.

The association of students requiring remediation in the internal medicine clerkship with poor performance during internship.

PURPOSE: To determine whether the Uniformed Services University (USU) system of workplace performance assessment for students in the internal medicine clerkship at the USU continues to be a sensitive predictor of subsequent poor performance during internship, when compared with assessments in other USU third year clerkships. METHOD: Utilizing Program Director survey results from 2007 through 2011 and U.S. Medical Licensing Examination (USMLE) Step 3 examination results as the outcomes of interest, we compared performance during internship for students who had less than passing performance in the internal medicine clerkship and required remediation, against students whose performance in the internal medicine clerkship was successful. We further analyzed internship ratings for students who received less than passing grades during the same time period on other third year clerkships such as general surgery, pediatrics, obstetrics and gynecology, family medicine, and psychiatry to evaluate whether poor performance on other individual clerkships were associated with future poor performance at the internship level. Results for this recent cohort of graduates were compared with previously published findings. RESULTS: The overall survey response rate for this 5 year cohort was 81% (689/853). Students who received a less than passing grade in the internal medicine clerkship and required further remediation were 4.5 times more likely to be given poor ratings in the domain of medical expertise and 18.7 times more likely to demonstrate poor professionalism during internship. Further, students requiring internal medicine remediation were 8.5 times more likely to fail USMLE Step 3. No other individual clerkship showed any statistically significant associations with performance at the intern level. On the other hand, 40% of students who successfully remediated and did graduate were not identified during internship as having poor performance. CONCLUSIONS: Unsuccessful clinical performance which requires remediation in the third year internal medicine clerkship at Uniformed Services University of the Health Sciences continues to be strongly associated with poor performance at the internship level. No significant associations existed between any of the other clerkships and poor performance during internship and Step 3 failure. The strength of this association with the internal medicine clerkship is most likely because of an increased level of sensitivity in detecting poor performance.

How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools.

PURPOSE: Teaching and assessing professionalism is an essential element of medical education, mandated by accrediting bodies. Responding to a call for comprehensive research on remediation of student professionalism lapses, the authors explored current medical school policies and practices. METHOD: In 2012-2013, key administrators at U.S. and Canadian medical schools accredited by the Liaison Committee on Medical Education were interviewed via telephone or e-mail. The structured interview questionnaire contained open-ended and closed questions about practices for monitoring student professionalism, strategies for remediating lapses, and strengths and limitations of current systems. The authors employed a mixed-methods approach, using descriptive statistics and qualitative analysis based on grounded theory. RESULTS: Ninety-three (60.8%) of 153 eligible schools participated. Most (74/93; 79.6%) had specific policies and processes regarding professionalism lapses. Student affairs deans and course/clerkship directors were typically responsible for remediation oversight. Approaches for identifying lapses included incident-based reporting and routine student evaluations. The most common remediation strategies reported by schools that had remediated lapses were mandated mental health evaluation (74/90; 82.2%), remediation assignments (66/90; 73.3%), and professionalism mentoring (66/90; 73.3%). System strengths included catching minor offenses early, emphasizing professionalism schoolwide, focusing on helping rather than punishing students, and assuring transparency and good communication. System weaknesses included reluctance to report (by students and faculty), lack of faculty training, unclear policies, and ineffective remediation. In addition, considerable variability in feedforward processes existed between schools. CONCLUSIONS: The identified strengths can be used in developing best practices until studies of the strategies' effectiveness are conducted.

Sistemas de monitorización continua de la glucosa / Continuous monitoring systems of glucose

La posibilidad de obtener una lectura continua de la glucosa puede representar un gran avance y una herramienta útil para el manejo de la diabetes. Los avances tecnológicos pueden mejorar la calidad de vida y el control metabólico de las personas con diabetes, aunque esto suponga tener que aprender e incorporar nuevos conceptos técnicos, nuevos algoritmos de modificación de pauta y nuevos retos en Educación Terapéutica(AU)

The possibility of obtaining a continuous reading of glucose may represent a breakthrough and a useful tool for the management of diabetes. Technological advances can improve the quality of life and people with diabetes metabolic control, even if this means having to learn and incorporate new technical concepts, new algorithms for pattern modification and new challenges in Therapeutic Education(AU)

Efficacy of a reading and language intervention for children with Down syndrome: a randomized controlled trial.

BACKGROUND: This study evaluates the effects of a language and literacy intervention for children with Down syndrome. METHODS: Teaching assistants (TAs) were trained to deliver a reading and language intervention to children in individual daily 40-min sessions. We used a waiting list control design, in which half the sample received the intervention immediately, whereas the remaining children received the treatment after a 20-week delay. Fifty-seven children with Down syndrome in mainstream primary schools in two U.K. locations (Yorkshire and Hampshire) were randomly allocated to intervention (40 weeks of intervention) and waiting control (20 weeks of intervention) groups. Assessments were conducted at three time points: pre-intervention, after 20 weeks of intervention, and after 40 weeks of intervention. RESULTS: After 20 weeks of intervention, the intervention group showed significantly greater progress than the waiting control group on measures of single word reading, letter-sound knowledge, phoneme blending and taught expressive vocabulary. Effects did not transfer to other skills (nonword reading, spelling, standardised expressive and receptive vocabulary, expressive information and grammar). After 40 weeks of intervention, the intervention group remained numerically ahead of the control group on most key outcome measures; but these differences were not significant. Children who were younger, attended more intervention sessions, and had better initial receptive language skills made greater progress during the course of the intervention. CONCLUSIONS: A TA-delivered intervention produced improvements in the reading and language skills of children with Down syndrome. Gains were largest in skills directly taught with little evidence of generalization to skills not directly taught in the intervention.

Autoeficacia y utilidad percibida como condiciones necesarias para un aprendizaje académico autorregulado / Self-efficacy and perceived utility as necessary conditions for self-regulated academic learning

En el marco de la teoría social cognitiva, en este trabajo se investiga en qué medida el rendimiento escolar (Lengua y Matemáticas) puede ser explicado por el uso de estrategias de aprendizaje autorregulado y cómo este tipo de comportamiento deseable puede estar condicionado por la utilidad percibida de su uso y por la competencia percibida para su ejecución. Para completar el modelo de ecuaciones estructurales, se plantea que los niveles de estas variables hipotéticamente centrales en el aprendizaje están significativamente influenciados por el tiempo de estudio, el curso actual y el grado de fracaso escolar (número de cursos repetidos). El ajuste del modelo se ha llevado a cabo en base a una muestra de 750 estudiantes de enseñanza básica (entre 12 y 15 años) seleccionados aleatoriamente por grupo de un total de diez colegios. Los resultados obtenidos muestran, en la dirección de lo hipotetizado, que a mayor uso de estrategias de autorregulación del proceso de aprendizaje mayor es el rendimiento, y viceversa, y que el uso de dichas estrategias depende fuertemente de la utilidad percibida de tal comportamiento y de la autoeficacia para su uso efectivo. Estos datos sugieren la importancia de que los profesores utilicen estrategias de autorregulación en las tareas previstas en el currículo, aplicándolas a situaciones concretas de aprendizaje y entrenando su transferencia para otros contextos y tareas escolares, ya que esto hará más visible su utilidad y la práctica generará competencia percibida en los alumnos (AU)

Grounded on the social cognitive perspective, the current investigation aims at evaluating, through a structural equation model, the extent to which school achievement (Portuguese and Math) can be explained by using self-regulated learning strategies and how those self-regulated behaviors can be affected by perceived instrumentality as well as by students’ perceived competence to manage learning strategies adequately. In order to develop the structural equation model the hypothesized learning variables previously referred are supposed to be significantly affected by students’ study time, grade level and school underachievement (number of years failed at school). The EQS model has been developed with a sample of 750 Portuguese students attending compulsory education (12 to 15 years old) randomly selected among a larger group of students from ten different schools. Data confirm the importance of teachers’ using embedded self-regulated strategies in the academic tasks assigned to their students, promoting their transference to other contexts and different academic activities, once this teaching practice will be a privileged way to make learning strategies’ usefulness clear and to ensure the promotion of students’ perceived competence (AU)

Los Trastornos Graves de Conducta en el contexto educativo / Serious Behavior Disorders in the educational context

El presente artículo hace un recorrido sintético sobre el abordaje que se realiza en el contexto escolar con el alumnado que presenta necesidades educativas especiales en Trastornos Graves de Conducta. el análisis se realiza desde la perspectiva práctica de un equipo de orentación educativa especializado en dichos trastornos, que tiene una función fundamentalmente asesora, y cuya actuación de ámbito provincial e internivelar, ofrece una visión de conjunto de esta compleja problemática en todas sus dimensiones, incluyendo aspectos relacionados con la detección, evaluación, escolarización respuesta educativa y coordinación interinstitucional. Así mismo se resalta la importancia de la formación y capacitación de los profesionales de la enseñanza para el desarrollo de proyectos educativos inclusivos de este alumnado, así como la mejora de otros aspectos importantes tales como la actualización de las categorías del censo educativo, el desarrollo de modalidades de escolarización específicas en los casos necesarios, y el desarrollo de protocolos óptimos de coordinación de las instituciones implicadas en la atención a este alumnado(AU)

This article talks about the synthetic approach is performed in the school with students having special educational needs severe behavioral disorders. analysis is done from the practical perspective of a team of specialized educational orentación in these disorders, which has a mainly advisory role, and whose performance at provincial and internivelar, provides an overview of this complex problem in all its dimensions, including aspects of detection, assessment, school education response and coordination. It also highlights the importance of education and training of teaching professionals to develop educational projects inclusive of these students, as well as improving other important aspects such as updating the census categories of education, the development of specific forms of schooling where necessary, and the development of optimal protocols for coordination of the institutions involved in the care of these students (AU)

Personal Background Preparation Survey for early identification of nursing students at risk for attrition.

During 2004 and 2005 orientations, all 187 and 188 new matriculates, respectively, in two southwestern U.S. nursing schools completed Personal Background and Preparation Surveys (PBPS) in the first predictive validity study of a diagnostic and prescriptive instrument for averting adverse academic status events (AASE) among nursing or health science professional students. One standard deviation increases in PBPS risks (p < 0.05) multiplied odds of first-year or second-year AASE by approximately 150%, controlling for school affiliation and underrepresented minority student (URMS) status. AASE odds one standard deviation above mean were 216% to 250% those one standard deviation below mean. Odds of first-year or second-year AASE for URMS one standard deviation above the 2004 PBPS mean were 587% those for non-URMS one standard deviation below mean. The PBPS consistently and significantly facilitated early identification of nursing students at risk for AASE, enabling proactive targeting of interventions for risk amelioration and AASE or attrition prevention.

Impact of neurofibromatosis type 1 on school performance.

School functioning of 86 Dutch neurofibromatosis type 1 children (7-17 years) using teacher questionnaires was analyzed to determine the impact of neurofibromatosis type 1 on school performance. In all, 75% of the neurofibromatosis type 1 children performed more than 1 standard deviation below grade peers in at least one of the domains of spelling, mathematics, technical reading or comprehensive reading. Furthermore, neurofibromatosis type 1 children had a 4-fold increased risk for attending special education and a 6-fold increased risk for receiving remedial teaching for learning, behavior, speech, or motor problems. Children without apparent learning disabilities still frequently displayed neuropsychological deficits. Only 10% of the children did not show any school-functioning problems. Finally, it was found that the clinical severity of neurofibromatosis type 1 correlated with the cognitive deficits. Taken together, it was shown that neurofibromatosis type 1 has profound impact on school performance. Awareness of these problems may facilitate timely recognition and appropriate support.

Behaviour, attention and cognition in severe dyslexia.

Information about coexisting problems in dyslexia may be vital for diagnostic and remedial procedures. There are few studies in this area, and to our knowledge none for the students in focus in this study. They all have phonological deficits and severely impaired reading abilities, in spite of prolonged educational remediation. The aim was to assess if these students have more behavioural/emotional problems than normal reading students. A clinical sample of 70 students, 59 males and 11 females, were compared to a normal reading control group. The groups were pair-wise matched on age, gender, cognitive level, and whether they lived in rural or urban areas. Mean age for the two groups was 150 months, and mean IQ scores approximately 100. Information on behaviour/emotions was obtained from parents, teachers and participants by means of the Child Behavior Checklist, Teacher's Report Form and Youth Self Report. The dyslexia group showed significantly more problems in all areas than the controls. This was reported from all three groups of informants. Parents reported most problems, internalizing behaviour for more than 50% of the participants and total problem behaviour for nearly 45%. Significantly more attention problems were also reported for the dyslexia group from all informants. Parents reported that nearly half the group demonstrated attention problems. Both groups of participants had more problems reported for those with IQ scores of 100 or lower. Further research is needed in this area, but the results clearly indicate that identifying additional behavioural/emotional problems may be imperative for students with severe reading problems.

An evaluation of intensive intervention for students with persistent reading difficulties.

To evaluate the effects of an intensive tertiary reading intervention, 27 students with severe reading difficulties and disabilities, 14 of whom had demonstrated an inadequate response to 1-2 tiers of prior reading instruction, received a 16-week intervention package involving decoding and fluency skills. The decoding intervention was provided for 2 hours per day for 8 weeks and was based on the Phono-Graphix program. The fluency intervention followed the decoding intervention and involved 1 hour of daily instruction for 8 weeks based on the Read Naturally program. The 16-week intervention resulted in significant improvement in reading decoding, fluency, and comprehension. Although individual responses to the intervention were variable, 12 of the 27 students showed a significant response to these interventions. Students who had participated in previous Tier 1 plus Tier 2 interventions but remained impaired had a stronger response to intervention in the current study than students who had previously participated only in Tier 1 intervention and students who had not received prior intervention outside of special education.

A method for testing group differences of scale validity in multiple population studies.

A method for testing equality in validity of multi-component measuring instruments across populations is outlined. The approach is developed within the framework of covariance structure modelling and complements earlier research on examining group differences in scale reliability. The procedure is particularly useful for purposes of ascertaining comparability of validity when constructing and developing measuring instruments. The method also provides ranges of plausible values for differences in composite validity across several populations and allows one to evaluate group discrepancies in validity of behavioural scales. The approach is illustrated using data from a cognitive intervention study.

An innovative approach to remedial continuing medical education, 1992-2002.

The authors describe the process of remedial retraining programs organized and planned for Quebec physicians by the College des medecins du Quebec (CMQ) and report the outcomes of these efforts from April 1992 to March 2002. The CMQ (the Quebec medical licensing authority) developed a process to identify physicians who had shortcomings in their clinical performance, determine their educational needs, propose, in collaboration with the four medical schools in the province, personalized retraining programs (clinical training programs, tutorials, focused readings, workshops, and refresher courses), and subsequently evaluate the impact of these retraining programs. During the ten-year period reported, 305 physicians (216 family physicians and 89 specialists) were referred to the Practice Enhancement Division of the CMQ for personalized remedial retraining. The vast majority of these physicians were men (81%). The following difficulties were identified: therapeutic knowledge (37%), diagnostic knowledge (32%), record-keeping (14%), technical skills (10%), clinical judgment (5%), and communication skills (2%). A total of 329 personalized retraining programs were completed: 273 clinical training programs, 41 tutorials, and 15 focused readings. A reevaluation of all these physicians showed that 70% of the retraining programs had succeeded, 15% were partially successful and only 13% had failed. The remaining 2% involved missing data or withdrawal of physicians. The authors conclude that the collaborative CME process described has important and effective original features.

California's minority majority and the White face of nursing.

Of the 33 million people in California, the nation's most populous state, minority groups now constitute the majority of the population. Many sources predict that by 2060, the entire country will mirror the diversity of California today. Like the rest of the country, California is experiencing a critical shortage of nurses that is predicted to increase in the coming years, and California's nursing workforce does not represent the racial and ethnic diversity of the state's population as a whole. If the nursing profession is to thrive in the coming years, educators and leaders must create a way to embrace people from diverse ethnicities and cultures. The purposes of this article are to determine whether ethnic minority groups have different success rates in California nursing programs, whether nursing programs with high percentages of diverse students have differing success rates, and to describe the institutional predictors of on-time completion rates, attrition rates, and NCLEX-RN first-time pass rates in California community colleges.

Problem driver remediation: a meta-analysis of the driver improvement literature.

PROBLEM: Given the public safety risk posed by violation and crash repeaters and the substantial costs for state driver improvement programs, it is important that their effectiveness be scientifically demonstrated and that intervention programs are based on sound research findings. METHOD: Crash and traffic violation standardized effect sizes (d) representing 106 individual interventions were coded from 35 methodologically sound studies and analyzed using meta-analysis. RESULTS: Driver improvement intervention in general was associated with small but significant reductions in both crashes (dw = 0.03) and violations (dw = 0.06). Significant effects were found on both measures for warning letters, group meetings, individual hearings, and license suspense/revocation. Of the driver improvement interventions studied, license suspension/revocation was by far the most effective treatment for both crashes and violations (dw = 0.11 and 0.19). Since one of the objectives of license suspension/revocation is to eliminate driving for the period of suspension, it is possible that much or all of the effect is due to reduced exposure and/or more careful driving during the suspension interval. Results were mixed for other types of interventions, although distributing educational or informational material was not associated with any reductions. Interventions associated with violation reduction tended to also be associated with crash reduction, although the relationship was not very strong (r = .30). DISCUSSION: Although interpretation of the effect size estimates was complicated by almost ubiquitous heterogeneity, the results do suggest an overall positive impact of driver improvement interventions in general. IMPACT ON INDUSTRY: The results support the continued use of driver improvement interventions, chiefly warning letters, group meetings, individual hearings, and especially license suspension/revocation. The results also suggest that court-triggered traffic violator programs are less effective than interventions triggered by drivers license agencies.

Explicit phoneme training combined with phonic reading instruction helps young children at risk of reading failure.

BACKGROUND: We evaluate the effectiveness of three theoretically motivated programmes for the teaching of reading to four-year-old children. METHOD: Four hundred and ten children, of pre-kindergarten age, in 20 UK Reception-year classrooms were divided into four matched groups and randomly assigned to one of three experimental teaching conditions, Reading with Rhyme, Reading with Phoneme, Reading with Rhyme and Phoneme, or to a taught control condition (Reading). In each condition the Reading element contained a strong phonic component. RESULTS: There were no selective effects of the different experimental teaching programmes for normally developing children. However, for those children identified as being at risk of reading failure, training in phoneme skills resulted in selective gains in phoneme awareness and in reading skills. CONCLUSIONS: A reading programme that contains a highly structured phonic component is sufficient for most 4.5-year-old children to master the alphabetic principle and to learn to read effectively, without additional explicit phonological training. In contrast, for young children at risk of reading delay, additional training in phoneme awareness and linking phonemes with letters is beneficial.

Faculty members' provision of instructional accommodations to students with LD.

The existing research on the instructional accommodation process of college students with learning disabilities focuses on attitudes and theoretical models without delineating actual practices. To date, the discussion of facilitating factors and barriers to this process has been broad and lacking specificity. Surveys were mailed to 485 faculty members at the University of Massachusetts, Amherst, who received an instructional accommodation form from the office of Learning Disabilities Support Services in the fall of 1995. The survey focused on faculty members' reported degree of ease or difficulty in implementing instructional accommodations, their perceptions regarding adequacy of support, and their own beliefs and understandings concerning the need for and benefit of providing instructional accommodations. The results indicate that beliefs about the helpfulness of and need for instructional accommodations were associated with the provision of the accommodations. Also, a perception of support from the University influenced the ease of providing instructional accommodations. A significant difference was found between the behavior of tenure-track faculty and non-tenure-track faculty.