Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

Nixon, L. James; Gladding, Sophia P.; Duffy, Briar L.

doi:10.1007/s11606-016-3758-3

Cited by 8 publications

(6 citation statements)

References 17 publications

(31 reference statements)

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“…Many of the students perceived problems in more than one domain. Similar findings were also noted in another study [35]. Previous studies have also shown that underperformers lack the necessary study skills to perform well in examinations.…”

Section: Discussionsupporting

confidence: 89%

Effects of targeted remediation in anatomy for first year medical students

Shankar

Ravindranath

et al. 2019

Anat Cell Biol

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The aim of this study was to assess the effectiveness of a questionnaire to guide targeted remediation among undergraduate medical students in anatomy. Seventy-five students from a medical college in South India who failed in the first internal theory examination were administered a validated 35-item questionnaire. The total and domain specific questionnaire scores were calculated. Specific weekly interventions for each student based on the questionnaire scores were conducted by appointed academic mentors for three months prior to the second internal examination. The dependent variable was performance in the second internal examination. The students were re-administered the questionnaire after the second internal examination. The independent variables were the marks obtained in the first internal examination, domain specific and total questionnaire scores, sex, and regularity of the student in attending the remedial sessions. Inferential statistical tests used were the chi-square test, independent sample t test, paired t test, multiple regression and binomial logistic regression. Of the 75 students who underwent remediation, 54 (72%) passed in the second internal examination. The scores in the second internal examination among these students was found to be significantly higher as compared to the first internal examination. The total, subject related and study skills questionnaire score were significantly lower after remediation. Students who were irregular had a significantly lower pass rate. The multivariate analysis showed that only the first internal marks added significantly to the prediction about second internal performance. This study provides evidence to show that struggling students perceive a benefit from targeted remediation.

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Section: Discussionsupporting

confidence: 89%

Effects of targeted remediation in anatomy for first year medical students

Shankar

Ravindranath

et al. 2019

Anat Cell Biol

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“…In addition to insufficient knowledge, students in clerkships can struggle with patient presentation skills, foundational communication skills (e.g. introducing oneself), physical examination skills, and the application and synthesis of knowledge to create individualized patient plans [8, 9]. For residents and foundation years (the 2 years immediately after medical school in the UK), knowledge can continue to be a major area of struggle [5, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

Guidelines: The dos, don’ts and don’t knows of remediation in medical education

et al. 2019

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Introduction Two developing forces have achieved prominence in medical education: the advent of competency-based assessments and a growing commitment to expand access to medicine for a broader range of learners with a wider array of preparation. Remediation is intended to support all learners to achieve sufficient competence. Therefore, it is timely to provide practical guidelines for remediation in medical education that clarify best practices, practices to avoid, and areas requiring further research, in order to guide work with both individual struggling learners and development of training program policies. Methods Collectively, we generated an initial list of Do’s, Don’ts, and Don’t Knows for remediation in medical education, which was then iteratively refined through discussions and additional evidence-gathering. The final guidelines were then graded for the strength of the evidence by consensus. Results We present 26 guidelines: two groupings of Do’s (systems-level interventions and recommendations for individual learners), along with short lists of Don’ts and Don’t Knows, and our interpretation of the strength of current evidence for each guideline. Conclusions Remediation is a high-stakes, highly complex process involving learners, faculty, systems, and societal factors. Our synthesis resulted in a list of guidelines that summarize the current state of educational theory and empirical evidence that can improve remediation processes at individual and institutional levels. Important unanswered questions remain; ongoing research can further improve remediation practices to ensure the appropriate support for learners, institutions, and society.

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“…In our analysis, the critical deficiency Binefficiency^was present in 8 (19%) of our 43 students who failed the medicine clerkship. 1 The lower frequency of this critical deficiency in our sample as compared to the frequency of difficulties with efficiency/organization noted by residency program directors 2 may reflect, as they suggest, that efficiency is not yet expected from medical students. It is also possible that behaviors one might interpret as inefficient are actually represented in other domains and coded in our study as deficiencies such as Blate,^Bfailure to complete course work,^or even perhaps Bdisinterested^or Binadequate documentation.^Perhaps one could even attribute NBME Subject Exam failure to inefficient or disorganized study habits.…”

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confidence: 58%