Assessment Date(s) / Score or Performance Result: _______________________________________________________ Description of Deficiency: _______________________________________________________ Section III. Remediation Plan The re mediation 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; addi tional 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 r emediation 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
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