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      Multifaceted remediation program: experience of a residency program to rescue residents who failed the American Board of Anesthesiology basic examination

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          Abstract

          Problem

          Passing the American Board of Anesthesiology (ABA) basic examination is required to progress through anesthesiology training in USA. Failing the test may be related to medical knowledge gaps, presence of negative psychosocial factors, and/or individual approaches to learning. This article describes the experience of development and implementation of a multifaceted remediation program (MRP) in residents who failed the ABA basic test.

          Intervention

          This is a retrospective analysis of four cases of residents who failed the ABA basic test between 2016 and 2017. The MRP is described. Pedagogical diagnosis, objectives, teaching strategies and assessment, and their constructive alignment are presented. Information regarding test performance is also presented.

          Context

          This study involves accredited anesthesiology residency program in USA. Outcomes: Four subjects (11% of program residents) failed the ABA basic test. Superficial approach to learning was observed in 100% of cases. The total possible number of participants was 4. The actual number of participants was 4, and the response rate was 100%. Four residents fell under 10th percentile on the first attempt, and 100% passed the test on the second attempt. There was 38% improvement in the number of failed keywords between the two attempts.

          Lessons learned

          Implementation of the MRP developed at our institution is successful to remediate anesthesiology residents who fail the ABA basic examination. We learned that the deep analysis of learning approaches, psychosocial factors, and medical knowledge gaps can be used to develop a remediation program based on the constructive alignment between objectives, curriculum, and assessment.

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          Most cited references29

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          Examining perceptions of academic stress and its sources among university students: The Perception of Academic Stress Scale

          The development of a scale to measure perceived sources of academic stress among university students. Based on empirical evidence and recent literature review, we developed an 18-item scale to measure perceptions of academic stress and its sources. Experts (n = 12) participated in the content validation process of the instrument before it was administered to (n = 100) students. The developed instrument has internal consistency reliability of 0.7 (Cronbach’s alpha), there was evidence for content validity, and factor analysis resulted in four correlated and theoretically meaningful factors. We developed and tested a scale to measure academic stress and its sources. This scale takes 5 minutes to complete.
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            "Problem residents": prevalence, problems and remediation in the era of core competencies.

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              Situating Remediation: Accommodating Success and Failure in Medical Education Systems.

              There has been a widespread shift to competency-based medical education (CBME) in the United States and Canada. Much of the CBME discourse has focused on the successful learner, with relatively little attention paid to what happens in CBME systems when learners stumble or fail. Emerging issues, such as the well-documented problem of "failure to fail" and concerns about litigious learners, have highlighted a need for well-defined and integrated frameworks to support and guide strategic approaches to the remediation of struggling medical learners.This Perspective sets out a conceptual review of current practices and an argument for a holistic approach to remediation in the context of their parent medical education systems. The authors propose parameters for integrating remediation into CBME and describe a model based on five zones of practice along with the rules of engagement associated with each zone. The zones are "normal" curriculum, corrective action, remediation, probation, and exclusion.The authors argue that, by linking and integrating theory and practice in remediation with CBME, a more integrated systems-level response to differing degrees of learner difficulty and failure can be developed. The proposed model demonstrates how educational practice in different zones is based on different rules, roles, responsibilities, and thresholds for moving between zones. A model such as this can help medical educators and medical education leaders take a more integrated approach to learners' failures as well as their successes by being more explicit about the rules of engagement that apply in different circumstances across the competency continuum.
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                Author and article information

                Journal
                Adv Med Educ Pract
                Adv Med Educ Pract
                Advances in Medical Education and Practice
                Advances in Medical Education and Practice
                Dove Medical Press
                1179-7258
                2018
                26 November 2018
                : 9
                : 865-871
                Affiliations
                Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA, eriverosperez@ 123456augusta.edu
                Author notes
                Correspondence: Efrain Riveros-Perez, Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, BI-2144, Augusta, GA 30912, USA, Tel +1 706 721 7361, Email eriverosperez@ 123456augusta.edu
                Article
                amep-9-865
                10.2147/AMEP.S180627
                6263215
                30538598
                6dcf4dbc-4429-443c-ac5a-f22d71d5cc5d
                © 2018 Riveros-Perez et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                remediation,medical education,anesthesiology residency,learning,evaluation

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