Year Three Resources

Students failing to attend a required examination, without either prior excusal (in the case of a planned absence) or notification of the appropriate faculty (in the case of an emergency) will receive a "0" for that portion of the course/clerkship that is missed.  This may result in a failing grade in the course/clerkship if appropriate prior excusal or notification is not made.

Background: Medical students are evaluated in the general categories of Clinical Performance, Professionalism and Non-Cognitive Behaviors. Student performance in these domains is commonly measured in several ways including computer based simulations, peer assessments and direct observation of students with patients in clinic and on rounds. These guidelines are provided to assist SIUSOM clerkship directors in the process of developing a remediation plan for students who have failed in a category of performance. 

1. Remediation in Year Three is determined on a student-by-student basis and depends on the particular deficiency exhibited. The clerkship director, in conjunction with other clerkship faculty, makes a recommendation to the Student Progress Committee regarding the activities, length, and content felt to be necessary for that particular student to complete clerkship requirements. Core Clerkship time is considered inviolate: that is, all work or remediation for a given Core Clerkship should be completed during year three whenever possible. Limited exceptions to this rule may be negotiated, with the full agreement of the clerkship directors involved. Remediation recommendations should describe a separate curriculum and evaluation process. A specific period of time for the remediation should be included in the recommendation. 
2. In order to generate the recommendation, the clerkship director is advised to meet with the medical student to gain an understanding of the student’s past academic performance. The student’s perceptions of his/her current failure and other academic difficulties may be valuable in planning the remediation. The clerkship director may also seek input from other faculty members as to the reasons for student failure. 
3. The performance of concern is then analyzed to the degree to which it is a skill, knowledge, and/or a behavior. 

     a. Skills - The opportunity for practice1 and the availability of a coach2,3 are the major factors that allow for the successful mastery of a skill. The coach should be competent in the skill of interest and should be able to identify problems in the performance and provide feedback that allows the student to correct deficiencies. The skill is best assessed using direct observation in a real or simulated environment. Someone other than the coach should provide this summative assessment. 

     b. Clinical Reasoning - Students with difficulties applying knowledge should be placed in a program where they are observed interacting with either real or standardized patients. Questioning and feedback is important during these encounters to guide the student to practice analyzing the patient problem and applying knowledge to generate an appropriate diagnosis and management plan. Evaluation of this type of knowledge could include direct observation of a patient encounter or an oral examination where reasoning could be explored.  In addition to a description of the period of time required for the remediation, the clerkship director should identify the faculty member(s) responsible for the remediation. 18 

     c. Behaviors - During the meeting with the student, the clerkship director should be sensitive to signs of correctable causes for the student’s unacceptable behaviors. These causes might include psychiatric problems (e.g., depression or substance abuse)7 or social stressors (e.g., inadequate child care). Consultation with the Associate Dean for Student Affairs may allow for a remedy for correctable causes of behavioral problems that do not require a formal remediation. Attitudinal problems as the cause of unacceptable behaviors represent a challenge as it is unclear that attitudes can be taught or assessed8. It may possible to correct the behaviors9 even if the underlying attitudes remain the same. Correcting behaviors will likely require a longer period of time than is necessary for remediation of deficiencies in knowledge or skills. Further, assessment of the success of remediation of problematic behaviors will require longer than is necessary for the assessment of the remediation of skills or knowledge. Thus, the clerkship director may play a role in educating the medical student about the consequences of their behaviors in the profession of medicine but the remediation of behaviors should be coordinated with the Associate Dean for Students Affairs. 

References 

1. Ericsson KA, Lehmann AC. Expert and exceptional performance: evidence of maximal adaptation to task constraints. Ann Rev Psychol 1993;100:363-406. 
2. Issenburg SB, McGaghie WC. Clinical skills training- Practice makes perfect. Med Educ 2002;36:210-211. 
3. Rogers DA, Regehr G, Howdieshell TR, Yeh KA, Palm E. The impact of external feedback on computer-assisted learning for surgical technical skill training. Am J Surg 2000;179:341-3. 
4. Hemmer PA, Pangaro LN. Natural history of knowledge deficiencies following clerkships. Acad Med 2002;77:350-353. 
5. Magarian GJ, Campell SM. A tutorial for students demonstrating adequate skills but inadequate knowledge after completing a medicine clerkship at the Oregon Health Sciences University. Acad Med 1992;67:277-278. 
6. 6. Constance E, Dawson B, Steward D, Schrage J, Schermerhorn G. Coaching students who fail and identifying students at risk for failing the National Board of Medical Examiners Medicine Subject Test. Acad Med 1994;69:S69. 
7. Fontaine S, Wilkinson TJ. Monitoring medical students’ professional attributes: Development of an instrument and process. Adv Health Sci Educ 2003; 8:127-137. 
8. Martin J, Lloyd M, Singh S. Professional attitudes: Can they be taught and assessed in medical education? Clin Med JRCPL 2002;2:217-23.
9. Papadakis MA, Loeser H, Healy K. Early detection and evaluation of professionalism deficiencies in medical students: One school’s approach. Acad Med 2001:76;1100-1106. 

Approved by Year Three Curriculum Committee 

03.22.2004  Revised  07.01.2016

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