NCE’s 2023-2024 fiscal year, illustrating how the College is following through with our commitment to the betterment of education on both a local and national level.
NLU PA Program Student Remediation Documentation and Tracking Form
PHYSICIAN ASSISTANT PROGRAM
STUDENT REMEDIATION DOCUMENTATION, TRACKING, AND ANNUAL AUDIT FORM
ARC-PA Alignment: Standard A3.16(c), A3.16(d), A3.16(e), and A3.16(f) Related Program Processes: Student Performance, Student Progression, Remediation, Professionalism, Academic Records, and Program Completion Record Classification: Confidential Student Educational Record Record Retention: Maintained in accordance with applicable National Louis University record- retention requirements and secure destruction procedures.
SECTION I. STUDENT AND REMEDIATION IDENTIFICATION Student Name: ___________________________________________
Student NLU ID: __________________________________________
Cohort/Graduation Class: __________________________________
Date Concern Identified: ___________________________________
Date Remediation Initiated: _________________________________
Course/Clinical Experience/Program Area:
Type of Remediation: Check all that apply.
☐ Didactic/Academic Performance ☐ Knowledge Deficiency ☐ Clinical Skills Performance ☐ Clinical Reasoning ☐ Professionalism ☐ Communication ☐ Documentation ☐ SCPE/Clinical Performance ☐ Summative Assessment
☐ Program Competency ☐ Program Learning Outcome ☐ Examination Performance ☐ Technical/Procedural Skill ☐ Other: _________________________________________________
Reason for Remediation:
SECTION II. IDENTIFICATION OF PERFORMANCE DEFICIENCY
A. Standard or Requirement Not Met
Identify the specific course objective, competency, Program Learning Outcome, progression requirement, professional expectation, clinical requirement, or other standard that was not met.
Applicable Requirement/Standard:
Expected Performance:
Student's Actual Performance:
Assessment or Evidence Demonstrating Deficiency: ☐ Examination Score ☐ Practical Examination ☐ OSCE ☐ Clinical Skills Assessment
☐ Faculty Evaluation ☐ Preceptor Evaluation ☐ SCPE Evaluation
☐ Professionalism Evaluation ☐ Competency Assessment
☐ Programmatic Assessment ☐ Attendance/Participation Documentation ☐ Other: _________________________________________________
Assessment Date(s): ______________________________________
Score/Performance Result, if Applicable:
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.
A. Remediation Goals
Goal 1:
Goal 2:
Goal 3, if applicable:
B. Required Remediation Activities
Check all activities required.
☐ 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, when appropriate ☐ 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: _________________________________________________
Detailed Description of Required Activities:
C. Remediation Timeline
Remediation Start Date: ____________________________________
Required Completion Date: __________________________________
Reassessment Date: ________________________________________
Responsible Faculty Member(s):
Additional Personnel Involved, if Applicable:
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. The signature does not necessarily indicate agreement with the finding or decision.
Student Name: ___________________________________________
Student Signature: ________________________________________
Date: ___________________________________________________
SECTION V. FACULTY REMEDIATION AUTHORIZATION The faculty member(s) signing below confirm that:
1. The student's performance concern has been documented. 2. The remediation requirement is based upon established Program requirements, assessment data, and/or professional expectations. 3. The remediation plan identifies measurable goals and expected outcomes. 4. The student has been informed of the remediation requirements. 5. Appropriate documentation will be maintained in the student's confidential educational record. 6. The student's progress and remediation outcome will be evaluated according to established Program procedures.
Responsible Faculty Member Name:
Title: ___________________________________________________
Signature: _______________________________________________
Date: ___________________________________________________
Additional Faculty/Program Personnel, if Applicable
Name/Title: ______________________________________________
Signature: _______________________________________________
Date: ___________________________________________________
SECTION VI. REMEDIATION ACTIVITY TRACKING LOG
Remediation Activity Completed
Faculty/Staff Responsible
Student Participation/Performance
Documentation/Evidence Attached
Date
Additional comments:
SECTION VII. REASSESSMENT AND OUTCOME
A. Reassessment Method
☐ 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: _________________________________________
B. Reassessment Results
Expected Performance/Passing Standard:
Student's Reassessment Result:
Outcome:
☐ 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:
SECTION VIII. FINAL DISPOSITION AND PROGRESSION DECISION Following completion and reassessment of the remediation plan, the following disposition was determined:
☐ Student Successfully Completed Remediation and May Continue Progression
☐ Student Successfully Completed Remediation with Continued Monitoring
☐ Additional Remediation Required
☐ Student Placed on Academic or Professional Improvement Plan
☐ Student Referred to the Student Evaluation and Progress Committee
☐ Student Referred for Formal Academic Review
☐ Student Required to Repeat a Course or Educational Experience
☐ Student's Progression Status Changed
☐ Formal Disciplinary Action Initiated or Continued
☐ Other: _________________________________________________
Effective Date of Decision: _________________________________
Final Decision Rationale:
SECTION IX. STUDENT EVALUATION AND PROGRESS COMMITTEE REVIEW Complete when committee review is required.
Committee Review Date: ____________________________________
Committee Determination:
Committee Chair/Designee Name:
Signature: _______________________________________________
Date: ___________________________________________________
Supporting Documentation Attached or Linked:
☐ Committee Meeting Minutes/Decision ☐ Student Performance Data ☐ Remediation Plan ☐ Reassessment Results ☐ Student Communication ☐ Other: _________________________________________________
SECTION X. STUDENT FINAL ACKNOWLEDGMENT The student acknowledges that the remediation process and final outcome have been communicated.
The student's signature acknowledges receipt of the final remediation outcome and does not necessarily indicate agreement with the decision.
Student Name: ___________________________________________
Student Signature: ________________________________________
Date: ___________________________________________________
☐ Student declined or was unavailable to sign. Documentation of communication attached.
SECTION XI. FINAL FACULTY/PROGRAM SIGN-OFF The undersigned confirm that the remediation process has been documented and that the final outcome has been recorded in accordance with NLU PA Program policies and procedures.
Responsible Faculty Member
Name: ___________________________________________________
Title: ___________________________________________________
Signature: _______________________________________________
Date: ___________________________________________________
Director of Didactic Education, Director of Clinical Education, or Designee
Name: ___________________________________________________
Title: ___________________________________________________
Signature: _______________________________________________
Date: ___________________________________________________
Program Director or Designee
Name: ___________________________________________________
Title: ___________________________________________________
Signature: _______________________________________________
Date: ___________________________________________________
SECTION XII. ARC-PA A3.16 DOCUMENTATION CHECKLIST This checklist is completed to ensure that the student record contains documentation required for the remediation process.
Required Documentation
Complete Not Applicable Date Verified Verified By
Student performance concern identified
☐
☐
Performance data included
☐
☐
Deficiency documented
☐
☐
Remediation plan documented
☐
☐
Measurable remediation goals documented
☐
☐
Required activities documented
☐
☐
Student notified
☐
☐
Student acknowledgment obtained or documented ☐
☐
Faculty authorization completed
☐
☐
Remediation activities tracked
☐
☐
Reassessment completed
☐
☐
Reassessment results documented
☐
☐
Final outcome documented
☐
☐
Progression decision documented, if applicable
☐
☐
Committee decision documented, if applicable
☐
☐
Student final acknowledgment completed
☐
☐
Faculty/Program final sign-off completed
☐
☐
Record filed in secure student educational record ☐
☐
SECTION XIII. ANNUAL REMEDIATION RECORD AUDIT
NLU PA PROGRAM ANNUAL AUDIT CYCLE
The NLU PA Program will conduct an annual audit of completed remediation records to verify that student remediation documentation is complete, securely maintained, accessible to authorized Program personnel, and consistent with ARC-PA Standard A3.16 and applicable NLU policies.
Audit Period
Academic Year: ___________________________________________
Audit Start Date: _________________________________________
Audit Completion Date: ____________________________________
Audit Conducted By: _______________________________________
Title: ___________________________________________________
A. Remediation Records Audit Summary
Total Number of Students Requiring Formal Remediation: _______
Total Number of Completed Remediation Records Reviewed: ______
Number of Records with Complete Documentation: _____________
Number of Records Requiring Follow-Up: _____________________
Number of Records Missing Student Acknowledgment: __________
Number of Records Missing Faculty Sign-Off: ________________
Number of Records Missing Outcome Documentation: __________
Number of Records Missing Reassessment Documentation: ______
Number of Records Requiring Corrective Action: _____________
B. Audit Findings
☐ All audited records were complete and compliant.
☐ Minor documentation deficiencies were identified and corrected.
☐ Documentation deficiencies required corrective action.
☐ A process or policy revision was recommended.
☐ Faculty/staff training was recommended.
☐ Additional monitoring was required.
Description of Findings:
SECTION XIV. CORRECTIVE ACTION AND CONTINUOUS QUALITY IMPROVEMENT When an annual audit identifies a deficiency in the remediation documentation process, the Program will implement corrective action and monitor completion.
Identified Issue Corrective Action Responsible Person Due Date Completion Date Outcome/Verification
CQI Review Date: __________________________________________
CQI Recommendation:
Reviewed by: ☐ PA Faculty and Staff Committee ☐ Student Evaluation and Progress Committee ☐ Program Director ☐ Program Assessment/CQI Process ☐ Other: _________________________________________________
SECTION XV. RECORD MAINTENANCE AND RETENTION TRACKING
A. Record Location
Primary Electronic Record System/Location:
Secondary or Supporting Record Location, if Applicable:
Paper Record Location, if Applicable:
Record Custodian: _________________________________________
B. Authorized Access
Access to this remediation record is limited to authorized personnel with a legitimate educational or administrative need to access the information.
Authorized access may include, as applicable:
☐ Program Director ☐ Director of Didactic Education ☐ Director of Clinical Education
☐ Principal Faculty ☐ Course Director ☐ Student Evaluation and Progress Committee Members ☐ Program Manager ☐ Appropriate University Personnel ☐ Other: _________________________________________________
C. NLU Record Retention Tracking
Student's Last Date of Attendance or Degree Date:
Record Retention Category: ☐ PA Program Student Educational Record
☐ Admissions Record ☐ Academic Record ☐ Remediation/Progression Record ☐ Disciplinary Record ☐ Other: _________________________________________________
Required Retention Period: _________________________________
Scheduled Record Review Date: ______________________________
Scheduled Destruction Date, if Applicable: ___________________
Permanent Record: ☐ Yes ☐ No
Record Destruction Method, When Applicable: ☐ Secure Electronic Deletion ☐ Secure Shredding ☐ Other NLU-Approved Secure Destruction Method
Record Retention Verified By: ______________________________
Verification Date: _________________________________________
SECTION XVI. ANNUAL RECORD-MAINTENANCE AUDIT The Program will annually review the status of remediation records to ensure that records are maintained for the applicable NLU retention period and are securely stored.
Academic Year
Audit Date
Records Reviewed
Retention Requirements Met
Security Requirements Met
Corrective Action Needed
Auditor Initials
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
PROCEDURE STATEMENT FOR STUDENT REMEDIATION, SIGN-OFF, RECORD MAINTENANCE, AND ANNUAL AUDIT
1. Purpose
The purpose of this procedure is to ensure that the NLU PA Program consistently documents, implements, tracks, evaluates, and securely maintains records of student remediation efforts and outcomes. This procedure supports compliance with ARC-PA Standard A3.16 by ensuring that student academic records contain documentation of student performance, remediation efforts and outcomes, formal actions affecting student progression when applicable, and completion of applicable program requirements.
2. Initiation of Remediation
When a student does not meet an established academic, clinical, professional, competency, or progression requirement, the responsible faculty member, course director, clinical education faculty member, or appropriate Program committee will document the concern and determine whether formal remediation is required under Program policy. The identified performance deficiency and supporting assessment data will be documented on the Student Remediation Documentation, Tracking, and Annual Audit Form or maintained as an associated record.
3. Development of the Remediation Plan
The responsible faculty member or designated Program authority will develop a remediation plan that:
1. Identifies the specific performance deficiency; 2. Identifies the applicable standard, objective, competency, or requirement;
3. Establishes measurable remediation goals; 4. Identifies required remediation activities;
5. Establishes a timeline for completion; 6. Identifies the reassessment method; 7. Identifies the individual(s) responsible for remediation and reassessment; and 8. Defines the expected outcome or passing standard.
The remediation plan will be communicated to the student.
4. Student Acknowledgment and Sign-Off
The student will be provided the opportunity to review the remediation plan and acknowledge receipt and understanding by signing the Student Remediation Agreement. The student's signature indicates that the student has received and reviewed the remediation requirements. It does not indicate that the student agrees with the findings, remediation requirement, or final decision. If the student declines or is unavailable to sign, the responsible faculty member will document that the remediation plan and requirements were communicated to the student and will retain documentation of the communication in the student's record.
5. Faculty Sign-Off
The responsible faculty member will sign the remediation plan to confirm that:
• The performance concern has been documented; • The remediation plan is based on established Program requirements; • The remediation activities are appropriate to the identified deficiency; • The student has been informed of the requirements; • Measurable outcomes have been established; and • The remediation process will be documented.
Additional faculty or Program leadership sign-off will be obtained when required by Program policy or when the remediation involves progression, clinical performance, professionalism, repeated deficiencies, or committee review.
6. Tracking of Remediation Activities
The responsible faculty member or designated Program personnel will document completion of remediation activities and the student's participation in the Remediation Activity Tracking Log.
Documentation may include:
Faculty meeting records;
•
Attendance records;
•
Skills assessment documentation;
•
• Simulation or laboratory performance; • Examination results; • Reflective assignments; • Clinical evaluations; • Preceptor evaluations; • Reassessment documentation; and • Other evidence demonstrating completion of required remediation activities.
7. Reassessment and Outcome
Upon completion of the remediation activities, the student will undergo the identified reassessment process.
The reassessment outcome will be documented as:
• Successfully met remediation requirements; • Partially met remediation requirements; • Did not meet remediation requirements; • Requires additional remediation; or • Requires referral for further academic, progression, or disciplinary review.
The responsible faculty member will document the reassessment result and recommend the appropriate next step.
8. Final Student and Faculty Sign-Off
Following completion of the remediation process, the student will be informed of the outcome and provided the opportunity to acknowledge receipt of the final decision. The responsible faculty member and appropriate Program leadership will complete final sign-off to verify that: • Required remediation activities were documented; • Reassessment occurred; • The outcome was documented; • Any progression decision was documented; • Any required committee review was completed; and • The completed record was placed in the appropriate secure student educational record.
A student's refusal to sign will not delay implementation of a properly authorized Program decision. The refusal and the method of communication will be documented.
9. Secure Record Maintenance
Completed remediation records will be maintained as confidential student educational records in a secure NLU University-approved electronic system or other secure Program-approved location. Access will be limited to authorized personnel with a legitimate educational or administrative need to access the information. Electronic records will be protected through applicable University security measures, including restricted access and role-based permissions when available. Paper records, if necessary, will be maintained in a locked and secure location accessible only to authorized personnel. Remediation records containing sensitive student information will not be maintained in unsecured locations or shared with individuals who do not have an authorized educational or administrative need to know.
10. Record Retention
The NLU PA Program will maintain remediation records in accordance with applicable NLU institutional record-retention requirements. The Program will track applicable retention requirements using the Record Maintenance and Retention Tracking section of this form or an equivalent University-approved record-management system. When records are eligible for destruction, they will be destroyed using secure NLU-approved methods and in accordance with applicable institutional requirements. The Program will coordinate with the appropriate University offices to ensure that records involving formal disciplinary action, academic records, admissions records, or other specialized record categories are retained according to the applicable institutional retention schedule.
11. Annual Audit Cycle
The NLU PA Program will conduct an annual audit of completed student remediation records.
The annual audit will occur at least once during each academic year and will evaluate whether:
1. Required remediation records are present; 2. Performance deficiencies are documented; 3. Remediation plans contain measurable goals; 4. Student acknowledgment or documentation of notification is present; 5. Faculty authorization is present; 6. Remediation activities are documented; 7. Reassessment results are documented; 8. Final outcomes are documented; 9. Progression or committee decisions are documented when applicable; 10. Records are maintained in a secure location; 11. Access is limited to authorized personnel; 12. Records are retained according to applicable NLU requirements; and 13. Identified deficiencies have been corrected.
The audit may be conducted by the Program Director, a designated Program administrator, the Program Manager, or another individual authorized by the Program Director.
12. Audit Findings and Corrective Action
Audit findings will be documented using the Annual Remediation Record Audit and Corrective Action sections of this form.
When deficiencies are identified, the Program will:
1. Document the identified deficiency; 2. Determine the cause; 3. Develop a corrective action; 4. Assign responsibility for corrective action; 5. Establish a completion timeline; 6. Verify completion; and 7. Evaluate whether a broader policy, procedure, training, or system improvement is needed.
Significant findings or recurring trends will be incorporated into the NLU PA Program's continuous quality improvement process.
13. Annual Review and Oversight
The results of the annual remediation-record audit will be reviewed by appropriate PA Program leadership and, when applicable, the Student Evaluation and Progress Committee and/or PA Faculty and Staff Committee.
The Program Director will maintain oversight of the remediation documentation and audit process.
The Program will use annual audit findings to improve:
Faculty documentation practices; Student remediation processes; Student progression procedures;
•
•
•
Record security;
•
Record accessibility;
•
Record-retention practices; and
•
• Compliance with ARC-PA accreditation requirements.
APPROVAL AND IMPLEMENTATION
Program Director: _________________________________________
Signature: _______________________________________________
Date: ___________________________________________________
Date of Implementation: ___________________________________
Review Cycle: Annually or sooner as required by changes in ARC-PA Standards, NLU policy, or Program operations.
Next Scheduled Review Date: ________________________________
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20Powered by FlippingBook