Kalet Adina, Chou Calvin L, Ellaway Rachel H
Program on Medical Education Innovation and Scholarship, New York University School of Medicine, New York, USA.
Department of Clinical Medicine, Academy of Medical Educators University of California, San Francisco, USA.
Perspect Med Educ. 2017 Dec;6(6):418-424. doi: 10.1007/s40037-017-0385-6.
Remediating failing medical learners has traditionally been a craft activity responding to individual learner and remediator circumstances. Although there have been moves towards more systematic approaches to remediation (at least at the institutional level), these changes have tended to focus on due process and defensibility rather than on educational principles. As remediation practice evolves, there is a growing need for common theoretical and systems-based perspectives to guide this work.
This paper steps back from the practicalities of remediation practice to take a critical systems perspective on remediation in contemporary medical education. In doing so, the authors acknowledge the complex interactions between institutional, professional, and societal forces that are both facilitators of and barriers to effective remediation practices.
The authors propose a model that situates remediation within the contexts of society as a whole, the medical profession, and medical education institutions. They also outline a number of recommendations to constructively align remediation principles and practices, support a continuum of remediation practices, destigmatize remediation, and develop institutional communities of practice in remediation.
Medical educators must embrace a responsible and accountable systems-level approach to remediation if they are to meet their obligations to provide a safe and effective physician workforce.
传统上，补救学业不佳的医学生一直是一项需根据学生和补救者的具体情况来开展的工作。尽管已朝着更系统的补救方法迈进（至少在机构层面），但这些变化往往侧重于正当程序和可辩护性，而非教育原则。随着补救实践的发展，越来越需要基于共同理论和系统的视角来指导这项工作。
本文从补救实践的具体操作中抽身出来，从批判性系统视角审视当代医学教育中的补救问题。在此过程中，作者认识到机构、专业和社会力量之间复杂的相互作用，这些力量既是有效补救实践的促进因素，也是障碍。
作者提出了一个将补救置于整个社会、医学专业和医学教育机构背景下的模型。他们还概述了一些建议，以建设性地使补救原则与实践保持一致，支持连续的补救实践，消除对补救的污名化，并在机构内发展补救实践的共同体。
如果医学教育工作者要履行其提供安全有效的医师队伍的义务，就必须采用一种负责且可问责的系统层面的补救方法。
