Remediation of at-risk medical students: theory in action

BMC Medical Education

Albert JJA Scherpbier²  Cees PM Van Der Vleuten¹  Kalman A Winston³ 

[1] Chair, Department of Educational Development and Research, Maastricht University, Maastricht Netherlands;Dean, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht Netherlands;Study Skills Centre, Room 202, Main Arts Library, College Road, Bangor University, Bangor, Gwynedd LL57 2DF, UK

关键词: Pedagogical context knowledge;    Teaching experience;    Facilitation skills;    Classroom discourse;    Small group teaching;    Remediation;    At-risk students;   

Others  :  1138663
DOI  :  10.1186/1472-6920-13-132

 received in 2013-06-03, accepted in 2013-09-25,  发布年份 2013

【 摘 要 】

Background

Previous work has shown that a programme that draws on a blend of theories makes a positive difference to outcomes for students who fail and repeat their first semester at medical school. Exploration of student and teacher perspectives revealed that remediation of struggling medical students can be achieved through a cognitive apprenticeship within a small community of inquiry. This community needs expert teachers capable of performing a unique combination of roles (facilitator, nurturing mentor, disciplinarian, diagnostician and role model), with high levels of teaching presence and practical wisdom. Yet, despite participants’ convergent opinions on the elements of effective remediation, significant differences were found between outcomes of students working with experienced and inexperienced teachers. The current study explores the actual practice of teachers on this remediation course, aiming to exemplify elements of our theory of remediation and explore differences between teachers.

Methods

Since it is in the classroom context that the interactions that constitute the complex process of remediation emerge, this practice-based research has focused on direct observation of classroom teaching. Nineteen hours of small group sessions were recorded and transcribed. Drawing on ethnography and sociocultural discourse analysis, selected samples of talk-in-context demonstrate how the various elements of remediation play out in practice, highlighting aspects that are most effective, and identifying differences between experienced and novice teachers.

Results

Long-term student outcomes are strongly correlated to teacher experience (r, 0.81). Compared to inexperienced teachers, experienced teachers provide more challenging, disruptive facilitation, and take a dialogic stance that encourages more collaborative group dynamics. They are more expert at diagnosing cognitive errors, provide frequent metacognitive time-outs and make explicit links across the curriculum.

Conclusions

Remediation is effective in small groups where dialogue is used for collaborative knowledge construction and social regulation. This requires facilitation by experienced teachers who attend to details of both content and process, and use timely interventions to foster curiosity and the will to learn. These teachers should actively challenge students’ language use, logical inconsistencies and uncertainties, problematize their assumptions, and provide a metacognitive regulatory voice that can generate attitudinal shifts and nurture the development of independent critical thinkers.

【 授权许可】

   
2013 Winston et al.; licensee BioMed Central Ltd.

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