and ex pected outcomes; the student has been informed of the requirements; documentation will be maintained in the student’s confidential educational record; and progress and outcome will be evaluated per established Program procedures. Responsible Faculty Member Name / Title / Signature / Date: _______________________________________________________ Additional Faculty/Program Personnel Name/Title / Signature / Date, if applicable: _______________________________________________________ Section VI. Remediation Activity Tracking Log
Remediation Activity Completed
Faculty/Staff Responsible
Student Participation/Performance
Evidence Attached
Date
Section VII. Reassessment and Outcome Reassessment method (check one): written examination; practical examination; OSCE; clinical skills assessment; faculty observation; standardized assessment; preceptor evaluation; SCPE evaluation; competency assessment; professionalism evaluation; portfolio review; other. Date of Reassessment / Faculty/Assessor: _______________________________________________________ Expected Performance/Passing Standard: _______________________________________________________ Student's Reassessment Result: _______________________________________________________ Outcome (check one): successfully met remediation requirements; partially met remediation requirements; did not meet remediation requirements; additional remediation required; referred to Student Evaluation and Progress Committee; other. Narrative Description of Outcome: _______________________________________________________
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