Student Remediation and Records Review

☐ 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