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Clinical Instructor Academy Module 5 – Remediation: An Art and a Science

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©2011 ASRT. All rights reserved. Clinical Instructor Academy Transcript

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©2011 ASRT. All rights reserved. Clinical Instructor Academy

Clinical Instructor Academy Module 5 – Remediation: An Art and a Science

Slide 1 ASRT essential education

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Slide 2 Clinical Instructor Academy Module 5 – Remediation: An Art and a Science Nancy Johnson, M.Ed., R.T.(R)(CV)(CT)(QM) Faculty and Clinical Coordinator Radiologic Technology Program GateWay Community College Phoenix, Arizona

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Disclaimer The carefully researched information contained in this activity is generally accepted as factual at the time of production. The ASRT and the presenter disclaim any responsibility for new or contradictory data that may become available before the next revision. Radiologic technologists must take into account existing state statutes and institutional policies as they relate to the information presented. This activity may be available in multiple formats or from different sponsors. ARRT regulations state that an individual may not repeat a self-learning activity for credit if it was reported in the same or any subsequent biennium.

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Slide 3 Objectives


Good afternoon. Welcome to the next clinical instructor academy module, “Remediation: An Art and a Science.” My name is Nancy Johnson and I’ll be with you this afternoon. I work at GateWay Community College, and I’m a faculty member and clinical coordinator. Today I want to emphasize the art and the science that’s involved with remediation. An art means that you’re a good communicator; you have the ability to be a coach and a mentor. You’re bringing the personal touch. The science component of remediation is the investigative process and the documentation. You’ll be doing a scientific investigation to make good decisions, and they’ll be evidence-based decisions, which is how you keep fairness in the clinical setting and in the educational setting.

Define remediation as it relates to learning outcomes and student development. Our objectives today in remediation work start with the definition. We have to know what we’re talking about, so a definition will be first and how the learning outcomes and student development fit into this role.

List the components and steps to create a remediation plan. There are steps or components that make a remediation plan the best that it can be, so we’ll talk about those steps and how you can incorporate them and make a good remediation plan.

Document remediation and progress. As we all know, in the clinical setting documentation is important to either demonstrate progress or lack thereof, and it’s always the starting point of any due process in the educational system.

Identify one positive and one negative message assigning students some form of remediation. We know that there will be positive and negative messages sent as we are planning and interacting with students. Let’s talk about how to make it as positive an experience as possible.

Identify strategies for a remediation plan that is successful. Is your plan always going to be successful? Well, that depends on how well written the plan is and how much experience that you have. And even though I’ve had lots of experience I can tell you that not every plan I write is successful. We’ll talk about how to determine if your plan is effective and some strategies to build on that to make it better or to improve it as you go along.

Remediation What is remediation? Making change. A plan to improve achievement. Strategy using internal and external factors to promote change. Enrichment activities to promote learning.

What is remediation? It’s simply just making a change. You’re improving something; you’re changing something. There are going to be internal and external factors, and you need to provide opportunities for your students, activities that promote learning. All of those are components of making a change. Before you determine if you want to make a change, make sure that you have an issue and that you do need to have an improvement plan or that you do need to promote learning. Remediation means that you are going to modify, change, do something that will affect how the student is performing in some manner at your clinical.

Remediation Opportunity for change behavior.


Promotes learning in the clinical environment. It is a role in the clinical setting. It’s an opportunity to change behavior, promote learning, and it is in the clinical environment – it’s not in a classroom environment. For you and for the student, it may be a new situation, especially if you’re a new clinical instructor. These opportunities are important that they’re positive and that they will result in the changes that you want, not in changes that you don’t want.

Remediation Plan We need to talk about what a remediation plan is. I have listed five components that you should include.

Determines the goal. The first one is determining the goal. The goal is the outcome – what is it that you want your student to accomplish? How do you want them to accomplish it?

Outlines the objectives that meet the goal. And that is the objectives. And you may have more than one objective. You’ll probably only have one goal and many objectives to support that – ways that you are going to meet that expectation with the student or opportunities that the student can meet.

Provides activities to encourage change. That means that we have to provide some learning experiences, which is the third component that I have listed. These are activities that encourage change, promote change or demonstrate a reason for change that the student needs. It may be observation, it may be performance, it may be doing some research. Learning experiences come in many sizes and shapes.

Evaluates progress. Once we have accomplished a learning experience and objectives and goals, we need to evaluate progress. Each student reacts differently and learns differently, so you must have measurable outcomes, and those measurable outcomes, we have to have a way to evaluate and assess progress. This helps you to demonstrate if progress is moving forward or if you have a lack of progress and that means that you may need to adjust your plan. Modification of a plan is not a problem, but you do need to determine if that’s necessary for the outcome to be met.

Sets a timeline for improvement. The last component in this remediation plan is a timeline for improvement. We really need to set the timeline, otherwise this could go on forever; and that’s not good. We want to determine when we are going to look at the improvement. We’ve got as assessment now, which is step number four, and now we need to set a time. In the classroom, we’ve set a time, which is known as our test days. In your case, it will be an assessment day or it may be a follow-up or a progress report day. All of those things are part of your timeline, so you can segment it, and that might be good for the student.

Determine the Goal The first component is you must determine your goal – what is it and what are your objectives? If you’re new to the educational system, you’ve learned in previous modules that we have goals and objectives and what they are. Many of you may not have had any experience in education, so you may mix up the goal and objectives. That’s OK; as you learn and as you practice, you’ll learn to separate these and you’ll learn to be more specific with the student. However, if you’re just beginning, this may be a one-step process with objectives.


Goal: Outcome you expect the student to achieve.

In the goals, set your outcomes, the expectations and what is it that you want this student to be able to do – very important.

Are you trying to: Influence behavior (e.g., improve attendance). Improve learning (e.g., position patient precisely). Enhance performance (e.g., perform procedure independently).

You must decide if you are trying to influence behavior, improve their learning or enhance performance – what is your objective? We can combine and do learning behavior and performance. That’s not an issue; however, that would be a complex plan. We may want to pick one thing at a time and work on it with the student so it doesn’t overwhelm you or the student.

Objectives: Must support the goal. Must be measurable and observable.

The outcomes, whatever they are, goals and objectives have to be in alignment. They have to support each other. You can’t say that you want the student to do one thing and then give them objectives that are not related. They must be related. The other component that you want to make sure that you relate, and that’s the level of learning that you’re asking the student to do here, or the change that you’re trying to create a situation for. Is it critical thinking? Is it problem solving? Is it high-order learning and high-order thinking that you want to work on with the student, which in the clinical setting because it’s performance-based and applications-based, that’s a common issue that a student might have. If that’s the case, make sure that you set your objectives and your goals at the same level of what your expectation is. Make sure your opportunities match up as well, ‘cause if they don’t, then you won’t be as successful as you would like to be.

Categories of Change Influencing behavior (affective). Current perceptions and professional behavior.

You want to encourage change. Influence behavior is what we call the affective domain. Current perceptions, professional behavior – all things that are viewed much differently in the clinical setting than in the academic setting. I see the student in the classroom; it doesn’t necessarily mean that they have good behavior. However, is it going to affect their learning in the classroom as it will in the clinical setting? Probably not, because my expectation is a little bit different. Does that mean that the student needs to modify? Very possibly, and especially if they are new to health care.

Improving learning (cognitive). Understanding and using knowledge.

Improve learning, our cognitive ability. Can we understand and use the knowledge from the classroom? Some students are excellent in this transition. Others know the classroom but can’t apply it, can’t utilize it in the clinical setting, so need some assistance in learning how the application works, or how to perform the procedure.

Enhancing performance (tactile/psychomotor).


Physical approach to complete task. That goes into enhancing performance, which is tactile. They may have that knowledge in the cognitive situation, but they cannot apply it. There’s a physical approach; they can’t complete the task. It’s chaotic for them. They don’t have an order or they don’t have a sequence and improving or enhancing the performance could be just helping a student come to grips with putting it in an order, coming up with a routine, and as they practice with many different technologists, sometimes that’s a challenge for them. Keep in mind you need to help the student work with and to enhance their learning and that will enhance their performance. There’re many ways we can look at each one of these. Influencing behavior – I’m sure you have some sort of performance evaluation that is completed by the technologist that will tell you about their behavior. Maybe it’s something that you’ve observed. Learning – the technologist comes up and says, “Oh, my gosh. This student doesn’t remember anything! What did they learn in school?” Well, that’s cognitive; they’re not remembering anything. Then the performance side – they can’t complete a procedure in any way, shape or form. All of these things put together make your plan. Remember, keep it simple. You may pick one component, and it may be that only one component is necessary. Make sure you investigate to know what kind of a plan is necessary and what kind of improvement is expected, especially from the staff in your facility.

Influence Behavior Affective domain:

Absences and tardy incidents – responsibility. Let’s talk about the affective domain. There’s an expectation of being on time and being there, a responsibility. Students know from going to school – can they take a day off, can they be late, not much gets said by many folks. In health care, that responsibility is critical. You don’t know what’s going to happen and when you’re going to be needed and you have a shift.

Communication skills – accurate and critical. What about communication skills? Are the students able to accurately and critically ask questions and can they take that information and do something with it? If not, oh, my goodness! You have a big mess on your hands.

Professional behaviors – integrity and dignity. Professional behaviors – do they have integrity, do you they have a dignity, do they follow what they need to as far as protocols and procedures? Do they have respect?

Initiative – motivated to learn, involved. We’ve all had the student who doesn’t seem to be very motivated, that stands in the in the corner or stands aside and never gets their hands on. They seem to be not motivated to learn because of their lack of involvement. Investigate that; because lack of involvement could mean that they’re scared, they don’t know where to start. There’re lots of reasons for it to occur. Through an investigative process you might be able to help that student and get them into the motivated role.

Response to supervision – accepts criticism. Response to supervision is very difficult for many of us. The reason this is difficult for us is we don’t like to accept criticism. We like to think that we are doing things well. When we are told otherwise, it is very difficult. Most students get defensive as most people do. If, in fact, you have supervision issues, you’ll


have to work with the student. I’ve had this issue that because we have many of our students retraining. If they are retraining, they have a knowledge already and have been well respected somewhere along the way. If that’s the case, starting at ground zero again can be very difficult and they find it demeaning, and it’s not meant that way. However, that’s the negative connotation that sometimes goes with things.

Safe practice – adheres to ALARA practices. Last, but not least, in influencing behavior is safe practice. The safe practice – following ALARA standards and making sure we minimize dose to the patient – is ultimately important and can, in fact, be affective domain as well as the performance domain. ALARA practices or safe practices could be multitudes on different levels. That’s important to remember because you may do a plan that is multifaceted, especially if you have a student whom you don’t think has safe practice.

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Slide 4 Improve Learning Cognitive domain:

Exam completion – uses knowledge effectively and correctly. Let’s talk about improving learning, the cognitive domain, the thought process of a student. We know that in many cases the students have difficulty with thought processes. This could be demonstrated in the clinical setting through exam completion. They don’t use their knowledge effectively and sometimes not even correctly. It’s very chaotic.

Problem solving – analyzes situations, makes timely decisions and modifies exam as needed. Problem solving – they don’t have the ability to look at it, figure out what’s going on, tear it apart, put it back together again and modify as they need to. They can’t even get through it if there’s no issue. So keep in mind improving learning may start at the very beginning.

Critical thinking – applies classroom knowledge to clinical setting effectively. Critical thinking – this applies taking your classroom knowledge and making it useful in the clinical setting and being effective about it.

Retention – demonstrates adequate recall. Many students have a lot of difficulty in this because they don’t know the information well enough so their knowledge base needs to be improved. Then they can take the next step, but it is based on retention. Retention is really important, however. If they’re the typical student, many of them think they can memorize, take the exam and be done. If that’s the case, we need to look at them because we want them to retain this information so that they can take their boards at the end of their education. The way to find out if they have retention issues is to ask a variety of questions and don’t do it in order. If somebody’s memorized, they can only do things in the order that they memorized; really in the clinical setting, nothing is ever likely to be textbook one-two-three. If they’re having difficulty, it may be that they learned the information in the specific order and can’t do anything when they get out of order. They need to have some improved learning, some cognitive improvement in order to function and put this, their thought processes, into use.

Enhance Performance


Tactile/psychomotor domain:

Exam completion – executes knowledge effectively and correctly. The next domain is enhanced performance. It’s tactile domain; it’s completing the task. It’s a physical performance. Can they use the equipment? Can they complete the exam? Do they know the procedure? Do they know the protocol? Can they execute? Are they effective? Are they correct? Are they accurate?

Problem solving – takes action and modifies exam as needed.

Critical thinking – applies classroom knowledge to clinical setting effectively. Problem solving and critical thinking at this point is the application; it’s the completion of the task no matter what the situation. It means we can tear it apart, we can put it back together again. It really doesn’t matter I know the information – I have enough knowledge that I can do the job.

Safe practice – uses standard practices, employs ALARA and provides for patient’s general safety.

This takes us to the greatest step of safe practice and that’s utilizing all the standard practices – employing ALARA, providing the patient’s general safety within the department. You have to know everything that’s going on in order for that to work. That’s really important – you have to keep in mind these components are difficult for some students because they can’t perform well. Some have never performed on demand. Who does that? Well, we do, because before they go to take boards or exit their clinical, they have to prove performance ability. We have to make sure that they can function in that tactile domain and that they’re doing it with some proficiency.

Timeline We want to make a change. In order to make the change, you must have a timeline. You need to set a pace. You can think a student will do this all by themselves. Well, they don’t. Two reasons: One, they have no idea what the timeline should be. They can’t estimate; they don’t have a “guestimation,” so it’s up to you. Secondly, if there’s no timeline, it will never happen. There’s no check on progress; there’s no follow-up. For each activity:

Establish who, what, where, when and why. Each activity you design you need to talk about the who, what, when, where and why they need to do it. Why do they have to participate? If they don’t see any reason, their tendency is to not participate.

Time frame for completion. Put a time frame on it. If you don’t do that, it won’t get completed. Students will keep putting it off and will not maintain. That’s something you need to help them with – setting the pace. This set of activities, they’re going to make up the total plan and that total plan has to progress in a timely manner. You may have two objectives, and maybe they need to be done simultaneously, or maybe one objective has to be accomplished and then the secondary objective can be accomplished. It’s based on what they learned in the first objective. That’s fine. And in some cases, that’s very important to distinguish and set those activities apart. The student won’t know that, but maybe you can help them with that.

Conduct incremental status reports. Ways to set the pace is to set up incremental status reports. Just where are they? What’s going on? What’s happening? Have an initial plan – they do an activity, assess how that activity went. Did it accomplish what you wanted? Does it need to be modified? Continue in your timeline and do a recheck


later. You’re going to have to do whatever activity, or you need to provide whatever opportunity, more than once for them to get the most satisfaction and information out of that situation.

Set completion date. Eventually we want a completion date and hopefully we’ll determine that the goal was met. If the goal wasn’t met, a modification is going to be required. We’ll modify and possibly rewrite a new plan or extend the original plan. Both are acceptable ways of accomplishing your goal.

Student Progress Assessment:

Clearly stated metrics. Student progress not only has a timeline, but must have some kind of assessment. An assessment is a stated metrics or measureable outcome. Know where you are in the plan. That’s what an assessment is.

Incremental status reports. Incremental status reports – are you going to talk with the student every two weeks and discuss and find out? Are you going to get feedback from other people? What’s the current status? Are we seeing improvement?

Evaluate to determine effectiveness. Evaluate to determine the effectiveness. Maybe your measuring device isn’t working as well as you thought. The student really is progressing, but you don’t see it in the assessment tool you selected, but you’re getting reports that it is. That’s important. Know that you can make adjustments in that assessment tool and maybe use a different assessment tool if this one is not effective.

Determine progress, re-evaluate to develop next steps. Once you’ve evaluated or assessed, make sure you evaluate and decide what your next steps are. Are you going to recheck in two weeks and are you going to be status quo? Are you going to develop another learning opportunity and set another time frame for it to be done? Or are we completed in our process – we’ve met our goal – and we’ll do a recheck in three months to make sure we don’t slide backwards or make any bad changes. And not that they’re bad changes, but they are changes that we don’t want in our clinical because we’re looking for effective, productive, performing students.

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Slide 5 Remediation – Beginning

Determine if remediation is necessary. Before you do anything, please make sure you know if remediation is necessary.

Investigate or observe the student’s actions. Speak with the supervising staff or technologist.

You must investigate; there’re a number of ways you can accomplish an investigation. Most of it is going to be asking questions, but it can be through observation as well. Speak with a supervisor. Speak with the staff technologists that work with the student, and you must talk with more than one. You’ll find


personalities influence how students perform, and we don’t want to grade somebody’s personality. We want to know what they’re doing.

Talk to the student. Talk with the student. Find out do they think they are having difficulties, or is it just people as far as the staff is concerned. Maybe they’re unaware. Amazingly, students don’t always know when they’re not doing as well as they could and a couple tips might help them, and that’s all it would take.

Review clinical documentation. You also have documentation. You have a way that you maintain an attendance record, competencies or how they’re progressing or completing exams, and even maybe some clinical progress reports. Other types of assessments – look at all of your documents so you can determine if this is one person having an issue, multiple people, is it one student or is it all of your students. Make sure that you know what really the issue is. Very important for you to investigate and use good questioning.

Contact the clinical coordinator or program director. Once you’ve done your investigation, and if you think there is an issue, this might be the appropriate time for you to contact your clinical coordinator. You may or may not have a clinical coordinator, depending on the size of your school. You may be obligated as the clinical instructor to handle these kinds of situations. At our facility, I’m a clinical coordinator, and I would handle this type of situation if a clinical instructor brought it to my attention.

Investigation Effective questioning techniques: The investigation – you want to have the most effective questioning techniques as possible. They’re called Socratic questioning techniques.

Direct. Did you center the body part correctly?

There are three different ways you can ask a question. One is direct, which is the most simple. The problem with it is you get a yes-and-no answer. Make sure it’s open ended and get the most for your money, but ask directly.

Cueing. How does the positioning in this exam compare to the previous exam?

In some cases, however, when you ask that direct question, nobody will know what you’re talking about. So you have to use what we call “cueing technique.” A cueing technique is asking the question in a related, reworded, add some different terminology and possibly even ask the next step in the question. Don’t give away the answer, but see what the student does know. Sometimes you have to go backward in order to get them to the answer. That’s cueing. It’s giving clues without giving the answer, and it’s making relationships that maybe the student hasn’t made and that’s the whole crux of the problem.

Interactive. Can you help me understand what you were thinking during that exam?

Last, and most thorough, is interactive questioning, which is really a discussion starting with a question. You discuss with the student issues, concerns, protocols, whatever it is; you get into an investigative mode. In the investigative mode – the interaction – you will find out the most information. You will find


out what is known and what is unknown by the student just by interjecting, having the student give you as much information as possible. This time spent investigating is well worth it. You build a relationship with your student; you act as a coach, as a mentor; and you promote communication in a positive manner rather than a negative. This questioning or investigation is really important to build your relationships.

Type of Remediation Following your investigation, you and the student need to determine the type of remediation needed. In some cases, the student won’t have input into this; it will be your decision and maybe your clinical coordinator’s, but we can have informal vs. formal remediation.

Informal. Informal remediation through that investigation and through your interactions and interactive questioning, you think you’ve found a problem; the student seems to understand. Now we’ll go and be able to perform the task at hand. For example, I use informal if I see a person has tardies. I will evaluate those tardies; I will talk to the student. If there are reasons that are unavoidable, computer wasn’t available, then it’s an informal setting. However, it’s a warning that I’m watching and that I’m paying attention to what’s going on.

Formal. The formal side would be doing and completing a plan or documentation – whatever’s appropriate. In the case of tardies, our documentation would be a contract and the student would know there are consequences for being tardy. If it’s a continued behavior, because I’ve done documentation, it makes it formal and it sets up your due process – very important to set up your due process. Formal would probably have some goals and objectives, and it would have the plan components that we’ve talked about.

Individual instruction. As I said earlier, in the investigation you’ll have to decide is it an individual issue or is it a group issue. Individual issues are individual instruction and activities and opportunities for learning for one student.

In-service. However, if a group of people or students seem to be unfamiliar or lacking information or knowledge then an in-service is appropriate. An in-service is not as negative, and it also will accomplish getting the message to a number of people rather than just one. Determine in your investigation whether it’s just one individual student who needs help or is it a group of people who need that same assistance because it doesn’t seem that everybody has the same practice standard. That’s important because students are expecting that. I know that that’s not the case and that’s all right, but it has to be standardized to a certain degree in order for students to perform and to learn.

Next Steps Establish the purpose of remediation: Affective (behavior). Cognitive (knowledge). Performance (action).

Your next step is to figure out what the purpose of your remediation is. We’ve talked about effective cognitive performance. Is it a combination? Is it one? Whatever it is, through the investigative process.


Determine the learning activities to: Support the goal and objectives.

Then you need to determine the learning activities or the opportunities that you’re going to provide.

Match student learning style. Make sure they support the goal and objectives; match them with a student learning styles. In a previous module, you talked about learning styles and how students learn differently. Some need to physically touch the equipment, others need to observe, others need to hear. Some people need to read. Make sure that you match your activities with the student learning style.

Help bring about change. Participate yourself. Aid in bringing about change. It’s very important for you to do that and keep it in mind that you need to be an active participant as well as the student.

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Slide 6 Positive Messages Remediation sends a message that you:

Care about student success. Positive messages – remediation does send a message. You need to be aware of the art of communicating a positive message. If approached correctly, whether you use an action plan or an individual educational plan or some other type of documentation that you have, you need to demonstrate that you care about your student's success. If you demonstrate that, it will carry a positive message.

Think that they have the ability. The student needs to know that you think they have the ability to do this. Because a technologist may have told them, "Oh, you're stupid," or "Boy, did you learn anything at school?" or "You're going to really struggle with this. This really isn't for you." Those are all negative comments that may have been made because a student didn't understand a situation or is missing some information. They need to know that you think that they can do it. That's building a relationship and sending that positive message.

Are part of their support team. When you help develop that plan (which I hope you will do with the student), however you document it, you become a part of their support team. You are a part of their team. That's a positive result from the student's perception.

Will provide an educational learning environment in the clinical setting. We need to provide an educational learning environment in the clinical setting. Clinical settings tend to be very fast paced, never enough time, always more production than maybe what we can do, and the student has difficulty with that. It's important that you take the time to provide that educational learning situation in the clinical setting and make it positive.

Negative Messages


Students may interpret that you:

Are selectively applying different standards. The negative messages students interpret are that you're treating them differently than anybody else, which means that you're not being fair. That's not a good thing in the student's eye. In your approach, you want to make sure that you're using the same standards throughout for all students so that you don't get in a situation where people think it's unfair.

Do not think they have the ability.

Do not like them as a person. Students that don't think that they're smart enough and have no encouragement will also find this to be negative. It has the negative message that you don't like them, and that's probably not the case. You may not understand them, and the negative message was because part of the art of remediation is missing, and that's your communication, your caring, your investigation, and the time it took to do that. Take the time to interact with the student to make it positive.

Do not have their best interests in mind. What are the student's best interests? We hope that each student when they go to clinical learns to interact with patients, with other professionals, and complete a task in a professional manner, being dignified and treating the patient with the dignity and respect. The student has the same expectations, and negative messages are generally the results of not experiencing a relationship. Nobody cares. Remember, the student's perspective may be skewed if they are feeling treated unfairly. Present the facts that you have investigated, do the documentation, prevent the student from becoming defensive, because that only fuels a negative situation.

Approaches to Remediation Attitude is everything. Caring. Trustworthy. Supportive.

In your approach, remember attitude is everything. Your department has a personality according to who's working there. The attitude needs to be caregiving, trustworthy and supportive. If we go back to any of those negative perceptions, then the attitude is missing that’s positive, and the student will really feel the negative situation and will not progress because they become defensive and usually nonparticipatory.

One success predicts the possibility of future success for the student. One success predicts the possibility of future successes for the student. That's in the art, coaching, mentoring, teaching, taking the time. You can be the best at documenting; however, if you haven't built the relationship, the document may not work. Remediation works best when it has both the art and the science in order to make it happen to be successful and effective.

Affective Behavior Action Item – tardiness. Let's talk about an example – influencing behavior, the affective domain. The student is tardy and you've looked at their attendance and they're showing up tardy. You hear about this student is tardy. You can now look at the affective behavior, current perceptions.


Documentation from clinical record. If it is a tardy issue, I can look at the documentation from clinical records.

Floor supervisor comments. The floor supervisor may comment on a student being late, meaning they weren't ready to start doing procedures when the shift began.

Direct observations. Maybe you, as the clinical instructor, see the student arrive at 7:10 instead of 7. Do we need to get the student to change their behavior in this case? Most people think that work ethics are a part of their education, so I would tell you, yes, this would be important. We would need to take action after we investigated. I've got three different ways that I've determined that the student really is tardy.

Action Plan Informal approach.

Warn. If I wanted to go into an informal situation, I would warn the student, and I might do that on the first couple of tardies if I don't think that it's a continued behavior.

Follow-up. Would I do a follow-up? Would I watch this student? Absolutely. I would continue to look at their clinical record. Make sure that there is not some underlying issue that is causing the student to be late.

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Slide 7 Formal Approach - Action Plan Action item: Student has been tardy on multiple occasions.

Documentation from clinical record. If I need a formal action plan, step one would be to investigate and actually document it. Under action item, the student has been tardy on multiple occasions. One, I have documentation from their clinical record, which is their attendance sheet.

Floor supervisor comments. I have documentation or a report from the floor supervisor. “Student has not been arriving at the appropriate time.”

Clinical instructor sees the student arrive late. I myself as the clinical instructor see the student arrive late. So I have the issue.

Investigate causes. Now, the investigation. Why is the student late? Do they have issues at home? What is going on? Do they have baby-sitting problems? Do they have car problems? Transportation issues? Parking issues? What is the problem? You can't get to step two until you've investigated what you have documented as to the reasons what is influencing this. Sometimes it's internal, sometimes it's external. Internally, a student may have difficulty getting up on time. That's an internal event. They have to learn to do that. Internal and external – make sure that you look at both.


Action taken:

Goal - to arrive prior to the scheduled time. In step two, I need to make my plan. My goal or expectation for the student is to have them arrive prior to the scheduled time.

Objective - to be ready to conduct patient exams. Their objective is to be ready to participate at 7 a.m. and be ready, meaning that they're going to be ready to start doing a patient if there's a patient that needs to have a procedure completed.

Activities - leave home earlier, drop children at day care earlier, plan ahead, adjust shift start. Activity that would support this: Leave home earlier. Drop off children at day care earlier. Plan ahead. Get things out the night before. And last, you might adjust the shift start time. I tend not to like to do that because many facilities want their students to all come at the same time. However, if you have a student that there's no way that they're going to be successful with the time that you've set, it's probably in both of your best interests to make an adjustment. I like the half-hour adjustments. Instead of 7, I would have the student arrive at 7:30 and work a half an hour later than students in the afternoon. Sometimes that change of half an hour in a student's life is a lifesaver because they will now be on time. Sometimes it's those external circumstances that are creating the issues, and you might be able to change the behavior just by adjusting the shift.

Timeline/evaluation criteria – follow up in two weeks, no tardy incidences. How would I set my timeline and evaluate? I would look in two weeks, and I would be looking that there are no current tardy incidents. Did we take care of it? If there are no new tardy incidents, we are done. This action plan was effective and it worked.

Consequences – consequences are specified if behavior continues. Consequences might be attached, and that's part of the progress. If they're not progressing, consequences could be another action plan. Sometimes consequences are tied to grades and to grade adjustments because the student does not have the ability to report to work in a timely manner. You have to determine all of those components with your facility and with your program. What's most important for you? You've seen a formal and an informal setting of affective domain. Trying to modify a behavior that is a work habit seems to be a very important component for those of us in the health care field.

Cognitive Domain Action item:

Student not performing as expected. The second example I have is the cognitive domain, the understanding and using information. The staff says, "This student does not know anything. What are they doing here?" You know the student has some knowledge; however, are they using it wisely? Probably not. So it's important to determine those things. Where do you start?

Investigate and Document Step 1:

Question the technologist who identified a problem.


In this case, you need to investigate to determine where we're at. Assess the student, assess with the technologist. What do you mean that the student doesn't know anything? What happened? What did you see that makes you feel this way about the student?

Ask other technologists about the student. It's important to get that information from the technologist that they're working with and find out if other technologists feel the same way.

Observe the student in action. Also, observing the student might help you to determine what the issues are.

Review performance evaluations. Clinical records, if you have some kind of performance evaluation that's done weekly or biweekly, may give you some added information that's already been documented and indicate a lack of movement or progress. No matter what we're looking at, investigation is very important.

Individual Education Plan (IEP) Certifications:

Number attempted, completed, required.

Comment on progress If we're using an individual education plan, which is my choice in my particular instance, I'm going to look at the first level of completion, which is our number of certifications or exams attempted, completed and needed. What is the student's progress? Competencies:

Status of completion. I will look at the competency, which is the second level, to see what status of completion the student is within. I will compare certifications and competencies to the syllabus to find out where the student is standing in progress for completing that semester. Performance:

Comment from technologist: Student does not appear to know how to complete the exams. If it's performance-based – you know how to complete the exams – then we'll work on the performance side of things. When you're commenting on progress, always look at are they ahead of schedule? Are they on target? Are they lagging behind schedule? Give the student some feedback. Their status of completion depends on where you are in the semester, and that's important to the student to know where they are so that they can pick up the pace or slow down, whichever is necessary. In this case, if it's remediation, they're probably lagging behind schedule.

Goal – to complete exams in a timely manner to meet course requirements. My plan is to complete exams in a timely manner to meet course requirements. That is my goal.

Activities: Review text to relearn exams. Review department protocols. Practice using room equipment/setup. Use proper exposure factors using technique charts.


Complete department electronic documentation. My activities, maybe my objectives, are to review the text to relearn the exams. What are all the steps I need to know? Review the department protocols. What is it that's expected at the facility? What are their protocols? Can a student go in and practice in the room – what we call buttonology – how to use the room so that they're not trying to get the equipment to work and not know how. Very important. Exposure factors, technique charts, the way that you complete your paperwork process or lack thereof, your electronic charting, your electronic records, how all of that's done. Depending on what the staff tells you and what you observe and what the student tells you, would any of these five activities be supportive of completing your exams in a timely manner? It doesn't matter which one is lacking. If any one of these components is lacking, it will interfere with the completion process.

Timeline/evaluation criteria – follow up in two weeks. Completion of four certification exams. Completion of one competency exam.

I want the timeline and I want my criteria and I'm going to follow up in two weeks. We'll review the clinical record for progress. Have they completed some certifications? Have they completed a competency exam? I'm going to set the number because it's measurable. I don't want to say "more." I want to say "how many." Then, at the end of two weeks, I'm going to reevaluate this student to see if, in fact, by reviewing this information they were more successful. If these activities didn't work and we were not successful, then I have to reevaluate and determine what will be more successful. On the flip side of that, instead of getting four certifications, they got two. Did we make some progress? We need to be positive about that and take the student to the next step. All improvement or all progress is positive. You have to build on that to continue the success for this particular student.

Tactile/Psychomotor Domain Action item:

Student does not complete the exam in a timely manner. Where do you start? The tactile domain or the physical performance, this student does not know anything and they don't know what they're doing here. Am I going to go through this same process I just did with cognitive? I need to investigate a little bit further. I need to look at what's wrong with the performance. Is it because they don't have a routine? Is it because they don't know the protocols? Have the student practice in some way activities that will increase their ability to do the exam. Maybe the performance just needs to be changed or modified, improving in the amount of time it takes them to complete the procedure.

Goal – to complete exams in a timely manner.

Activities: Practice exams following department protocols. Set up room equipment, perform exam. Select proper exposure factors for specific conditions. Complete department electronic documentation.

The individual education plan, the goal, would be to do the exams in a timely manner. I have different activities this time – their practice, their setup, their completing, meaning that there's an activity associated and the student is going to complete that activity. Would I want to put all four of these together if the student was going to complete performance? Absolutely. However, if that was my first approach, might I overwhelm the student?


Timeline/evaluation criteria – follow up in two weeks. - Completion of four certification exams. - Completion of one competency exam.

Select carefully what your activity is going to be, evaluate and build. In this case, would I use the same criteria and the same timeline? Probably. I would want to do a recheck in two weeks to see if anything was helping or what was helping the most and focus on those activities. I hope that I have shared a number of different perspectives with you and that you will, in fact, build a relationship with your students through the remediation process of a teacher, a mentor and a coach, and communicate those activities with your students. From the science perspective, remember that this is a document. Your decisions need to be evidence-based or scientific in order to be deemed fair. You have now set up the due process that you need for your students to demonstrate progress or lack thereof. Thank you for listening. I hope that you have gained some knowledge today.

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Slide 8 The icons on the following page link to audio recordings from fellow educators. Click on each icon to listen to the recording. Once you have listened to all the recordings, click on the continue button to go to the last section of the module.

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Slide 9

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Slide 10


“Well, the many students that you see that you have high expectations for and high hopes for and that many times they don’t meet those expectations that you have for them. When they have the ability and every tool necessary, you really, well, it hurts you, it hurts me as an educator to see those students who fail when they should succeed – those that you can’t motivate when you have higher expectations for their success than they do.”

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Slide 11 “My interest in becoming an educator was from my own personal struggles being a nontraditional student, and I just thought that some things could be taught either differently or made easier to understand. I also really enjoyed when I was first out of school working with students in the hospital, and as a new grad, it was easy for me to remember all the body parts and positionings and such. And it just kinda caught on and I felt like I was being truly helpful with the students in helping them to understand in an easier way.”

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Slide 12 “Probably having a student very early on in my career as a program director, who the year that this young lady graduated I’ll never forget. She came to me and said, “You know, Mr. G, if I don’t ever see you again, it will be too soon.” Having had a lot of experience with that student in terms of discipline problems, and I’m sure that everybody has those students, I felt likewise. But the very next year that student came and knocked on my door, and she came to me and told me that she wanted to thank me for what I had done for her because she had gone on and completed her education in ultrasound, and she had a very, very good job. And she thanked me and came back to me to tell me that if I had not been as rigid with her and as disciplined with her, she would not be where she was at today. And I’ll never forget that because it goes to show that when you think students least appreciate you, they can always come back and show you that they really do appreciate what you do for them.”

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Slide 13

Panel Discussion Part 1

Kevin: It's time once again to spend a few minutes with our panel of subject matter experts. I'd like to start our conversation by asking Nancy what she feels is one of the most important topics for users to take away from her presentation. Nancy: One of the key components is the art of remediation. Remediation is more than just a science. You have to communicate, you have to build relationships and trust in order for remediation plans to work and to be positive. We need to keep in mind that it's more than a science and incorporate the relationship building and communication into our remediation plan. Kevin: We shot two sample exchanges between Lynette, our clinical instructor, and a sample student, Candice. And I'd like you to comment on what you feel would be the level of trust relationship that would be built up between Lynette and Candice as a result of the exchange that you'll see on these vignettes.

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Slide 14

SCENARIO 1 – While pouring coffee, clinical instructor Lynette sees a student, Candice, passing by and calls her over. Lynette: Hey, Candice, do you have a minute? Candice: Hi, Miss Lynette. Lynette: I have a couple of things for you. After looking at the repeat logs for the month and talking with the two techs you’ve been working with, it appears that you’re having difficulty with lumbar spines.


Candice: Yeah, I can’t quite seem to get those obliques right on the first attempt. Lynette: OK, well here’s what I’ve decided to do to help you get more practice with the exams. I’m going to post your name in the workroom and inform the day supervisors that any lumbar spines that come in for the next three weeks will be assigned to you. Also, with the number of pre-employment physicals that we’re getting I think you’ll get a lot of practice in sharpening your skills. Candice: OK. SCENARIO 2 – While pouring coffee, clinical instructor Lynette sees a student, Candice, passing by and calls her over. Lynette: Hey, Candice, do you have a minute? Candice: Hi, Miss Lynette. Lynette: I have a couple of things. After looking at the repeat logs for the month and talking to the techs you’ve been working with, it appears that you’re having difficulty with lumbar spines. Candice: Yeah, I can’t quite seem to get those obliques right on the first attempt. Lynette: OK, so what we’re going to do is tomorrow. XR Corp is sending over some workers for pre-employment physicals, and I’ll set up a room for the both of us so we can work together on helping you improve those techniques for the lumbar spines. Candice: OK, that would be great.

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Slide 15

Panel Discussion Part 2 Kevin: I’m sure after looking at those two little scenarios you have some opinions about the level of trust or relationship that built up between Lynette and Candice. Andrew, what’s your opinion of that first exchange? Andrew: To post a student’s name and their deficiencies anywhere in the department is not going to earn any trust. It’s really a negative thing to do and something that you’ll want to avoid. If the student doesn’t trust you, you’re really never going to be able to make a connection to help them learn how to improve. Kevin: Angie, what’s your opinion of that second vignette? Angela: The second exchange was much better. It’s definitely going to lead to a much more positive relationship between the instructor and the student. That trust is key. If that student needs help with something, they need to feel comfortable coming to the clinical instructor so they get the help they need rather than being fearful that they’re going to be ridiculed or mocked or publically humiliated.


Kevin: Barb, what’s your opinion of the two vignettes? Barbara: As Andrew and Angie both said, the first vignette showed very poor interaction between the clinical instructor and the student because that’s not going to make the student trust that instructor all, and if there’s any future problems that’s going to be the last person that student is going to want to talk to. Whereas, in the second case, the clinical instructor showed a real willingness to work with the student and help that student out. Kevin: Nancy, in our previous conversations, you mentioned the importance of investigating the student’s performance prior to doing a remediation with the student. Can you expand upon that for us, please? Nancy: Interestingly enough, the second vignette at least our clinical instructor has begun an investigation process and that they’re going to work with the student and maybe see what the problems are, but more than just looking as the results of repeated images, talking with other staff and the supervisor, getting all the perspectives – is it a particular type of patient that the student is having difficulty with, is it overall, what kind of tips do they need? Investigation is important so you can help the student in as many ways as possible, and you can’t do that if you haven’t done an investigation. Kevin: One of the other key elements in your presentation, Nancy, dealt with setting up remediation plans and setting definite timelines for the remediation plan. I’d like to ask each one of you based upon your experience, what has been your success in conducting a remediation plan with a set timeline and holding the student to the timeline – what has been the outcome you’ve seen as a result of that? Let’s start with Andrew. Andrew: When I’ve laid out a timeline, sat down with the student, and with a tremendous amount of specificity this is what you need to do, and if you do this with relative certainty, you’ll be successful. But ultimately, it comes down to the student making that commitment to the plan you’ve developed. If the student isn’t willing to make that commitment, the likelihood is they won’t be successful. I can say of the ones who’ve followed the plan in my years of experience have been successful. The students that haven’t made the commitment have not been successful. Kevin: Do you find that at times when you’ve tried to introduce the plan to the student, taking time to fully explain the details and the metrics that you’ve set up for the plan has helped students to understand what you’re trying to get at as far as outcomes for the plan? Andrew: Absolutely critical – once you break it down and explain why they need to do this, they do understand. But their understanding and their willingness to make a commitment aren’t necessarily congruent with each other. Kevin: Barb, how about your experience with setting remedial plans? Barbara: As Andrew was saying, once we sit down with the student and go over the particular issue that needs to be dealt with, they’re much more amendable to following the plan when they’re following something that’s written out that has very specific objectives and has a very specific goal. A lot of times that’s missing in clinical because they go out there and there’s so many different things for them to do, unlike the classroom. Usually classrooms are very regimented and the clinic isn’t and it’s never going to be, and for some students they need a little more guidance and this gives it to them, although


eventually they will have to get beyond that. But especially for students in the beginning, putting out these plans really helps direct them to what they need to do. Kevin: Angie, how about your experience? Angela: Our experiences have been similar to those already expressed. Again, it’s got to be a two-way partnership. The faculty member has to take responsibility for laying out the plan, laying out the remediation. But the student has ownership in it, too. The one thing that a clinical instructor needs to remember, especially a new one, is that the student does have a part in it, because too many times new faculty members beat themselves up when a student doesn’t do their part and they feel like they’re failing rather than the student not doing their part. Kevin: Nancy, your experience with the remedial plans? Nancy: If we develop some good learning opportunities, hopefully this is going to be a team sport and that is that everybody is going to work toward it. We’ve talked about commitment today; commitment is obviously important from the student, but it’s also important from the clinical instructor or faculty member that’s helping with this. Those accomplishments are things to celebrate, but the timeline is ultimately important because if you don’t have that and if you don’t do the follow up, nothing will ever happen. The timeline is a key component of this. It may be that they didn’t meet whatever standard or expectation you meant on the first timeline or first follow-up, but they’re moving in that direction. They need the positive feedback to continue that positive movement in making that accomplishment. Without that feedback, sometimes it does fall through the cracks because they’re not seeing the little goals they only see the big goal and they’re not there yet. It doesn’t seem positive to them or that they’ve accomplished anything. Kevin: There’s that fine balancing act between that art and science that you mentioned in your main presentation. I did like the term you used in your last description – and that is celebration. The opportunity the remedial plans give you to acknowledge along with the student that they’ve improved their performance and they’ve been successful at overcoming something that they found difficult in the past – an opportunity to put the past in the past and move on to a higher level of performance or expectation in the clinical setting. It’s really a fun experience to go through with a student. Nancy: It can be very rewarding if we do it well. Kevin: What do you feel about the threat level that the students have, having gone through a positive experience through one of these remedial plans? What is their receptivity to a remedial plan that they may have imposed upon them later on in the program, Nance? Nancy: The threat is always going to be there. However, you can minimize it if they’ve had a positive experience, and they know that it’s not going to be held against them. Remediation is supposed to help them make change and accomplish whatever expectation is that we’re setting forth at that time. You have to build that trust in order for them to know that it’s not going to be threatening. Kevin: Thank you all very much for your comments. This adds a lot to the overall experience today, and this brings to close our panel discussion for this module.


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Slide 16 Production Credits

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Slide 17

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