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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

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
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

Student 2