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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

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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)

Usuhs pre clinical magnitude

USUHS Pre-clinical: Magnitude

Usuhs clinical magnitude

USUHS clinical: Magnitude

Approach to evaluation

Approach to evaluation

Symptoms potential problem noted

Symptoms: Potential Problem Noted

Symptoms in clinical arena

Symptoms: in Clinical Arena

Yao and Wright, 2000

Hpi pmhx


Differential diagnoses

Differential Diagnoses

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

Approach to evaluation1

Approach to evaluation



  • 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

Creating a remediation plan

Creating a Remediation Plan

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

Learners in difficulty the problem student


Student 2



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