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Learners in Difficulty: The “Problem” Student. Joseph O. Lopreiato MD, MPH Associate Dean for Simulation Education Professor of Pediatrics. Acknowledgment. Outline. Definition. Learner /School Dilemma. Conflicts: Student advocate role Societal and professional obligations

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Learners in difficulty the problem student

Learners in Difficulty:The “Problem” Student

Joseph O. Lopreiato MD, MPH

Associate Dean for Simulation Education

Professor of Pediatrics

Learner school dilemma
Learner /School Dilemma

  • Conflicts:

    • Student advocate role

    • Societal and professional obligations

    • Institutional loyalty

  • Tendencies:

    • Minimization and temporization

      • Second chances

      • Will get better if you work harder

      • Difficulty in providing negative evaluation (clinical)

Symptoms in clinical arena
Symptoms: in Clinical Arena

Yao and Wright, 2000

Hpi pmhx

Differential diagnoses1
Differential Diagnoses

Lucey Reference ########

Depression and anxiety
Depression and Anxiety

Liselotte N. Academic Med 2006;81:354-373

Self efficacy

  • Artino & Bandura

    • Choice of activities; effort; persistence




Rhoads, J of Med Ed 1974


  • Artino, A. R., Jr. (2012). Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ, 1(2), 76-85. doi: 10.1007/s40037-012-0012-5

  • Croen, L. G., Woesner, M., Herman, M., & Reichgott, M. (1997). A longitudinal study of substance use and abuse in a single class of medical students. [Comparative Study]. Acad Med, 72(5), 376-381.

  • Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. [Review]. Acad Med, 81(4), 354-373.

  • Ghodasara, S. L., Davidson, M. A., Reich, M. S., Savoie, C. V., & Rodgers, S. M. (2011). Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med, 86(1), 116-121. doi: 10.1097/ACM.0b013e3181ffb056

  • Holmboe. (2008). Practical guide to the evaulation of clinical competence. 1st ed.

  • [edited by] Eric S. Holmboe, Richard E. Hawkins. Mosby/Elsevier in Philadelphia, PA .

  • Ishak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D., & Bernstein, C. (2013). Burnout in medical students: a systematic review. Clin Teach, 10(4), 242-245. doi: 10.1111/tct.12014

  • Rhoads, J. M., Gallemore, J. L., Jr., Gianturco, D. T., & Osterhout, S. (1974). Motivation, medical school admissions, and student performance. [Comparative Study]. J Med Educ, 49(12), 1119-1127.

  • Rosebraugh, C. J. (2000). Learning disabilities and medical schools. Med Educ, 34(12), 994-1000.

  • Yao, D. C., & Wright, S. M. (2000). National survey of internal medicine residency program directors regarding problem residents. JAMA, 284(9), 1099-1104.

Learners in difficulty therapeutic considerations

Learners in Difficulty:Therapeutic Considerations

CAPT Barbara Knollmann-Ritschel

Fundamentals Module Co-Directors

Associate Professor for Pathology and Emerging Infectious Diseases


  • Identify challenges in an ongoing curriculum.

  • Discuss differences of short and long term remediation.

  • Present a strategy for learners with issues in Professionalism, Science, and Clinical Skills.

  • Discuss the cost of remediation.

Remediation challenges in new curriculum
Remediation: Challenges in new Curriculum

  • Old Curriculum:

    • Courses Directors

    • Long time span with regular contact

    • Ongoing remediation: course specific help

    • Failed Course: repeat course/deceleration

New curriculum new challenges
New Curriculum: New Challenges

  • Modules Directors: organize remediation for multiple courses with Course Directors

  • Ongoing curriculum- bigger impact when students are at lower end- need to juggle more courses at the same time

  • Less time for students with denser curriculum:

    • The fire hose

Remediation challenges in new curriculum1
Remediation: Challenges in new Curriculum

  • Remediation is spaced with ongoing curriculum-

    • Student fails Fundamentals- final remediation may not be done until following summer!

      • Remediation may be 10 months later with ongoing curriculum

Remediation challenges in new curriculum2
Remediation: Challenges in new Curriculum

  • Timing is not ideal- what can we do?

    • “Pre grade remediation” – what can we do not in the short term before the end of the module or ongoing remediation

    • Balance with in-depth remediation

Remediation of science knowledge vs clinical skills vs professionalism

Are they the same?

Remediation of Science Knowledge vs. Clinical Skills vs. Professionalism

Remediation of science knowledge
Remediation of Science Knowledge:

  • Summary of exam results with strengths and weaknesses

  • Pre-remediation work summary

  • Reason for requiring additional work

  • Grade issued: Incomplete/Fail

  • Plan:

    • What type of remediation is needed and proposed study block.

    • A Passing score (above 65%) will be required to pass the Fundamental Module.

Remediation of clinical skills
Remediation of Clinical Skills

  • Review data from direct observations and Simcenter

    • Where is the Lesion?

      • Professionalism

      • Reporter

      • Interpreter

      • Manager

      • Educator

  • Increased time at simulation center- Practice skills – residents FNA

    • Remediate skills session as close to time of feedback

    • Focused plan on those skills that are identified as weak

Remediation of professionalism five step a pproach
Remediation of Professionalism: Five-Step Approach

  • Major concern from AAMC

Tiered approach 5 step process
Tiered Approach: 5 Step Process


Student 2