Lessons learned from a study-group pilot program for medical students perceived to be ‘at risk’

DeVoe, Pamela; Nilès, Christopher; Andrews, Nicholas L.; Benjamin, Alana; Blacklock, Lisa C.; Brainard, Andrew; Colombo, E.; Dudley, Benjamin; Koinis, Cheri; Osgood, Marcy P.

doi:10.1080/01421590601034688

Cited by 36 publications

(44 citation statements)

References 8 publications

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“…In addition to the paucity of studies on how to best identify students at risk at the earliest possible time, the literature also reveals how challenging the task of preventing failure long term is (Tekian and Hruska 2004;Devoe et al 2007;Stegers-Jager et al 2013), and currently there seems to be little evidence to support 'best practice' in remediation (Hauer et al 2009;Cleland et al 2013;Winston et al 2014). On the optimistic side, active learning curricula have been found to improve program completion rates and times (Iputo and Kwizera 2005;Schmidt et al 2009), and it seems that prevention and remediation strategies which encourage student participation and ownership are worth examining further (Cleland et al 2005, Stegers-Jager et al 2013Winston et al 2014;Bierer et al 2015;Patel et al 2015;Gonsalvez et al 2015).…”

Section: Perspectives and Future Researchmentioning

confidence: 96%

“…In Danish universities struggling students have traditionally been handled by administrators and counsellors in the The validity of student tutors' judgments in early… university support system, in which students seek support on their own initiative. The problem is that students with the most severe shortcomings may be the ones with the least amount of self-insight, coping abilities, and help-seeking behaviour (Dunning et al 2003;Cleland et al 2005;Devoe et al 2007;Winston et al 2010). It is wellknown from research in both psychology and medical education, that it is particularly difficult for the poorest performing students to recognize their own incompetence in advance (Hodges et al 2001;Dunning et al 2003;Cleland et al 2005).…”

Section: Incremental Validitymentioning

confidence: 97%

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The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study

O’Neill

Mørcke

Εika

2016

Adv in Health Sci Educ

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Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4-1/3 of the students who eventually failed or dropped out, and for ¾ of the strugglers they identified, they were correct in their judgments. Informal student tutor's judgements showed incremental validity for both outcomes when controlling for grades obtained in preceeding exams. Lack of participation, lack of commitment, poor academic performance, poor social interactions and general signs of distress were the main indicators of struggling identified. Teachers' informal judgements of in-class behavior may be an untapped source of information in the early identification of struggling medical students with added value above and beyond formal testing.

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Section: Perspectives and Future Researchmentioning

confidence: 96%

Section: Incremental Validitymentioning

confidence: 97%

The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study

O’Neill

Mørcke

Εika

2016

Adv in Health Sci Educ

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“…Such failures to perform satisfactorily in medical school could reflect problems within the admission process – or issues that might be addressable during the admission process or early in students’ matriculation (10, 11). Because the human and financial costs of medical students’ academic failure are high (12), it is incumbent upon medical school administrators and admission committee members in general, and admissions officers in particular, to undertake a careful review of each component of their admission model.…”

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confidence: 99%

A holistic review of the medical school admission process: examining correlates of academic underperformance

Stratton

Elam²

2014

Medical Education Online

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BackgroundDespite medical school admission committees’ best efforts, a handful of seemingly capable students invariably struggle during their first year of study. Yet, even as entrance criteria continue to broaden beyond cognitive qualifications, attention inevitably reverts back to such factors when seeking to understand these phenomena. Using a host of applicant, admission, and post-admission variables, the purpose of this inductive study, then, was to identify a constellation of student characteristics that, taken collectively, would be predictive of students at-risk of underperforming during the first year of medical school. In it, we hypothesize that a wider range of factors than previously recognized could conceivably play roles in understanding why students experience academic problems early in the medical educational continuum.MethodsThe study sample consisted of the five most recent matriculant cohorts from a large, southeastern medical school (n=537). Independent variables reflected: 1) the personal demographics of applicants (e.g., age, gender); 2) academic criteria (e.g., undergraduate grade point averages [GPA], medical college admission test); 3) selection processes (e.g., entrance track, interview scores, committee votes); and 4) other indicators of personality and professionalism (e.g., Mayer-Salovey-Caruso Emotional Intelligence Test™ emotional intelligence scores, NEO PI-R™ personality profiles, and appearances before the Professional Code Committee [PCC]). The dependent variable, first-year underperformance, was defined as ANY action (repeat, conditionally advance, or dismiss) by the college's Student Progress and Promotions Committee (SPPC) in response to predefined academic criteria. This study protocol was approved by the local medical institutional review board (IRB).ResultsOf the 537 students comprising the study sample, 61 (11.4%) met the specified criterion for academic underperformance. Significantly increased academic risks were identified among students who 1) had lower mean undergraduate science GPAs (OR=0.24, p=0.001); 2) entered medical school via an accelerated BS/MD track (OR=16.15, p=0.002); 3) were 31 years of age or older (OR=14.76, p=0.005); and 4) were non-unanimous admission committee admits (OR=0.53, p=0.042). Two dimensions of the NEO PI-R™ personality inventory, openness (+) and conscientiousness (−), were modestly but significantly correlated with academic underperformance. Only for the latter, however, were mean scores found to differ significantly between academic performers and underperformers. Finally, appearing before the college's PCC (OR=4.21, p=0.056) fell just short of statistical significance.ConclusionsOur review of various correlates across the matriculation process highlights the heterogeneity of factors underlying students’ underperformance during the first year of medical school and challenges medical educators to understand the complexity of predicting who, among admitted matriculants, may be at future academic risk.

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“…That teachers are key to educational success is not new [8,9], and neither is the finding that experience matters [10], since development of expertise, practical wisdom and teaching presence is a lifelong process [11-13]. The significance lies in the fact that it is typical to delegate remediation work to inexperienced teachers or student tutors, despite lack of improved long-term outcomes in such ventures [14,15] and evidence that experience may be required to maximize the effect of academic support [7]. However, when teachers themselves use similar language to interpret their own behaviours while their students attain differing outcomes, and when so many studies substitute self-report measures of satisfaction or belief for measures of performance, how are practitioners and administrators to distinguish who and what is most likely to be effective?…”

Section: Introductionmentioning

confidence: 99%

Remediation of at-risk medical students: theory in action

2013

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BackgroundPrevious work has shown that a programme that draws on a blend of theories makes a positive difference to outcomes for students who fail and repeat their first semester at medical school. Exploration of student and teacher perspectives revealed that remediation of struggling medical students can be achieved through a cognitive apprenticeship within a small community of inquiry. This community needs expert teachers capable of performing a unique combination of roles (facilitator, nurturing mentor, disciplinarian, diagnostician and role model), with high levels of teaching presence and practical wisdom. Yet, despite participants’ convergent opinions on the elements of effective remediation, significant differences were found between outcomes of students working with experienced and inexperienced teachers. The current study explores the actual practice of teachers on this remediation course, aiming to exemplify elements of our theory of remediation and explore differences between teachers.MethodsSince it is in the classroom context that the interactions that constitute the complex process of remediation emerge, this practice-based research has focused on direct observation of classroom teaching. Nineteen hours of small group sessions were recorded and transcribed. Drawing on ethnography and sociocultural discourse analysis, selected samples of talk-in-context demonstrate how the various elements of remediation play out in practice, highlighting aspects that are most effective, and identifying differences between experienced and novice teachers.ResultsLong-term student outcomes are strongly correlated to teacher experience (r, 0.81). Compared to inexperienced teachers, experienced teachers provide more challenging, disruptive facilitation, and take a dialogic stance that encourages more collaborative group dynamics. They are more expert at diagnosing cognitive errors, provide frequent metacognitive time-outs and make explicit links across the curriculum.ConclusionsRemediation is effective in small groups where dialogue is used for collaborative knowledge construction and social regulation. This requires facilitation by experienced teachers who attend to details of both content and process, and use timely interventions to foster curiosity and the will to learn. These teachers should actively challenge students’ language use, logical inconsistencies and uncertainties, problematize their assumptions, and provide a metacognitive regulatory voice that can generate attitudinal shifts and nurture the development of independent critical thinkers.

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Lessons learned from a study-group pilot program for medical students perceived to be ‘at risk’

Cited by 36 publications

References 8 publications

The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study

The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study

A holistic review of the medical school admission process: examining correlates of academic underperformance

Remediation of at-risk medical students: theory in action

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