Capsule Commentary on Nixon et al., Describing Failure in a Clinical Clerkship: Implications for Identifying, Assessing and Remediating Struggling Learners
Capsule Commentary on Nixon et al., Describing Failure in a Clinical Clerkship: Implications for Identifying, Assessing and Remediating Struggling Learners
Patrick Rendón 0 1
0 Compliance with Ethical Standards:
1 Division of Hospital Medicine, University of New Mexico School of Medicine , Albuquerque, NM , USA
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F robust method of i dentifying and successfully
or some time, medical educators have sought the most
remediating struggling learners. In the study by Nixon et al.,
the authors conducted an in depth assessment of the reasons
for failure within an internal medicine clerkship.1 They
examined various critical deficiencies and the frequency of those
deficiencies across multiple domains: knowledge for practice,
interpersonal and communication skills, overall knowledge
and skill, patient care, personal and professional development,
professionalism, practice-based learning and improvement,
interprofessional collaboration, systems-based practice and
overall conduct. All students who failed had deficiencies in
at least two competency domains, with the most frequently
noted critical deficiencies being interpersonal and
communication skills, insufficient knowledge and patient
care.1 Findings were similar in a study of remediating learners
and practicing physicians by Guerrasio et al., where subjects
were found to have more than one deficit.2
Medical educators may then ask the very practical question,
Bhow do educators identify such students?^ The authors
submit that direct observation and a thorough assessment of
medical students in the aforementioned competency domains
are key in identifying such deficiencies. Thus, a model of
direct observation to identify and remediate failing students
could be essential, especially given the underutilization of
direct observation that occurs on clerkships.3 The authors
propose that once a student is identified as failing to meet
expectations in one area, this should prompt an examination of
competencies in other areas. Effective identification of the
struggling learner will allow educators to design a remediation
program of a proactive nature. A proposed model of
remediation was suggested in a thematic review by Hauer et al.,
which includes development of a learning plan that integrates
deliberate practice, feedback, reflection and reassessment.4
Although many questions remain in the search to
determine the best approach to struggling learners, this
study sets the stage for future research, which should
examine methods to improve identification and
remediation of medical students.
Conflict of Interest: The author has no conflicts of interest with the
material in this article.
1. Nixon LJ , Gladding SP , Duffy BL . Describing failure in a clinical clerkship: implications for identifying, assessing and remediating struggling learners . J Gen Intern Med. doi:10.1007/s11606-016-3758-3
2. Guerrasio J , Garrity MJ , Aagaard EM . Learner deficits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006 - 2012 . Acad Med . 2014 ; 89 : 352 - 358 .
3. Howley LD , Wilson WG . Direct observation of students during clerkship rotations: A multi-year descriptive study . Acad Med . 2004 ; 79 : 276 - 280 .
4. Hauer KE , Ciccone A , Henzel TR , Katsufrakis P , Miller SH , Norcross WA , Papadakis MA , Irby DM . Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature . Acad Med . 2009 ; 84 : 1822 - 1832 . (...truncated)