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When a student needs work...

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Hi all,

I take students pretty regularly and most of them are very, very good. I try to do a mix of bedside teaching, whiteboard talks and letting them see patients on their own. By the end of the rotation they are well-versed in EM/ICU and able to see sick patients fairly autonomously (with supervision). Recently I had a student near graduation who was..not so good (didn't know how to give a basic presentation, didn't understand basic physiology, couldn't formulate a broad differential, wasn't great at interviewing patients, among other things). Maybe it was just stress. I found that all of my teaching points were falling flat because the baseline knowledge wasn't really there - even when concepts were aggressively simplified.


I'm not a huge fan of just letting students just shadow, but outside of saying "go home and read more," or flat out starting from the basics, I didn't really have a great strategy for handling this and a full rotation with this student is going to be challenging. I've already reached out to the program since their students are usually pretty good; I wanted to see if anyone else has encountered this and what your strategies are..

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Fail him on the rotation or make sure his rotation review correctly identifies his strengths and weaknesses. It is very unpleasant to have to do that with a student but it has to be done. I have only had to do it a couple of times over all the years I took students but I feel we owe it to the student, the program, the profession, and the patients to insist on good performance. 

He may get an opportunity to rehabilitate himself or the program may show him the door. That is their policy and responsibility. Mine was to teach and then give a true evaluation.

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I am glad to hear you have notified the program. It sounds like some remediation may be in order. Specific examples are very helpful so as educators we know exactly where the student is struggling. If you genuinely don't believe the student meets even baseline expectations (after discussions with the program and presuming some remediation occurs) then absolutely the student should be failed. Student who keep getting passed along despite consistently poor performance reviews are a real problem.

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Is this the student's first, fifth or ninth rotation?

If a newbie, 1st rotation, I might be a bit more swayed by stage fright, lack of preparation, etc.

However, most students have some background in healthcare and have heard numerous presentations and somehow passed didactic classes.

Is this your first student from this particular program or a regular program that you precept for?

If new, I would question the preparation the student receives. If not new, then I would call the program and talk to that student's advisor and inquire about previous experiences, grades and observations in group or other environments.

The student obviously does not pass. I would be super honest with the student and give specific instances of deficiency and perhaps have another student (meh, maybe not) or a seasoned colleague act like a student and give you a presentation and differential and see if this student takes note.

Some folks can do the didactic but just cannot do the interpersonal which is so basic to our profession.

Let us know what happens.

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