Assessment Date(s) / Score or Performance Result: _______________________________________________________
Description of Deficiency: _______________________________________________________
Section III. Remediation Plan The remediation plan must be individualized to address the identified performance deficiency and must include measurable expectations and a method for determining the outcome of remediation. Remediation Goal(s): _______________________________________________________ Required remediation activities (check all that apply): faculty-directed review; individual faculty meeting; small-group instruction; individualized tutoring; independent study; assigned readings; directed learning modules; skills practice; simulation; standardized patient encounter; clinical skills laboratory; additional patient encounter/clinical experience; documentation review; reflective assignment; professional development activity; study plan development; repeat or supplemental assessment; additional examination; repeat practical examination; repeat OSCE; additional faculty observation; other. Remediation Start Date / Required Completion Date / Reassessment Date: _______________________________________________________
Responsible Faculty Member(s) / Additional Personnel Involved: _______________________________________________________ Section IV. Student Remediation Agreement
The student acknowledges receipt of the remediation plan and understands the identified performance deficiency, required remediation activities, expected outcomes, and reassessment process. The student’s signature acknowledges receipt and understanding of the remediation plan; it does not necessarily indicate agreement with the finding or decision. Student Name / Signature / Date: _______________________________________________________ Section V. Faculty Remediation Authorization The signing faculty member(s) confirm that the performance concern has been documented; the remediation requirement is based on established Program requirements, assessment data, and/or professional expectations; the plan identifies measurable goals
44
Powered by FlippingBook