1. Learners in Difficulty: The “Problem” Student Joseph O. Lopreiato MD, MPH Associate Dean for Simulation Education Professor of Pediatrics

2. Acknowledgment

3. Outline

4. Definition

5. 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)

6. USUHS Pre-clinical: Magnitude

7. USUHS clinical: Magnitude

8. Approach to evaluation

9. Symptoms: Potential Problem Noted

10. Symptoms: in Clinical Arena Yao and Wright, 2000

11. HPI/PMHx

12. Differential Diagnoses

13. Lucey Reference ########

16. Depression and Anxiety Liselotte N. Academic Med 2006;81:354-373

17. Dependence

18. Disorders

19. Disease

21. Self-Efficacy Artino & Bandura ◦Choice of activities; effort; persistence *

22. Motivation Rhoads, J of Med Ed 1974

23. Approach to evaluation

24. References 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.

25. Learners in Difficulty: Therapeutic Considerations CAPT Barbara Knollmann-Ritschel Fundamentals Module Co-Directors Associate Professor for Pathology and Emerging Infectious Diseases

26. Objectives 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.

27. 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

28. 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

29. 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

30. 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

31. REMEDIATION OF SCIENCE KNOWLEDGE VS. CLINICAL SKILLS VS. PROFESSIONALISM Are they the same?

33. Creating a Remediation Plan

34. 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.

35. 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

36. Remediation of Professionalism: Five-Step Approach Major concern from AAMC

37. Tiered Approach: 5 Step Process

38. Cost Student 2

39. Acknowledgements