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AUSTRALIAN MEDICAL ASSOCIATION (WA)
The struggling student stands out like a sore thumb. You can tell from their unkempt hair, unwashed clothes, and tired eyes that they are behind. They’ll be late to placement, obstructive, and refuse help when you offer it. Correct assumptions, no?
We’ve just had our final exams, and with sadness a large proportion of the year discovered they did not clear the first OSCE. For a cohort that is tightknit and unanimously hard-working, it has been a difficult few weeks for all of us. It has been particularly difficult for those who will need to sit the second exam.
There are many reasons why students may not pass their clinical assessments. Some of these are trivial, such as misreading a question, or poor time management. Some people have test anxiety, which limits their performance. And sometimes, the cause is an ongoing issue which has been building over a long period of time, but has never been addressed by the supervisors and teachers they make contact with every day.
Although institutions may feel well-equipped to identify at-risk learners, the statistics say otherwise. Amongst medical students, between 10-15 per cent will experience significant difficulties during their training, with up to 60 per cent of struggling medical resident learners only being identified after they make a critical error in patient care. Despite this, barely any one receives additional academic or pastoral support over and above what is offered as part of the standard core curriculum. With the number of troubled learners so high, why do so few receive the help they need?
Part of the problem lies in the inherent difficulty in identifying students who are behind. For instance, the objective in-semester mini-CEX assessments that are used here and interstate are known to be poor at measuring extremes of performance, and are prone to missing weaknesses in core competencies.
Additionally, supervisor ratings of clinical progression are likely to be coloured by non-academic factors, such as professionalism and communication skills. The prompt, polite and attentive student can still need a helping hand.
How can we better identify struggling learners, and how can we intervene? While multiple models exist, I propose an efficient, cost-effective and evidence-based solution – communication.
During my own four-year degree, there have been times when I have felt pleased with my progress, and there are times when I have felt less sure. These feelings are acceptable, and a normal part of medical education. What is less acceptable is that I have never once been asked how I feel about my own progress. I believe that students have more insight into our progress than supervisors give us credit for, and we will happily tell you what our strengths and weaknesses are if you allow us to.
What stops supervisors from checking in with their students? Elisabeth Boileau, in a 2017 research paper, states that the most commonly cited reason is the “discomfort of not knowing which steps should be followed and how to achieve them”.
Put simply, supervisors believe that they do not know how to help a trainee if they need it, so they don’t ask in the first place.
I argue that supervisors are able to offer more to students than they realise. Whether this be advice about formal remediation, or simply a kind ear, listening to student experiences can be cathartic for all involved.
Helping students through medical school should be the responsibility of us all. Considering the fees, time and emotional energy that medical students invest in their degree, it is an injustice to them and their future patients to deny them the support they deserve.