|Year : 2019 | Volume
| Issue : 2 | Page : 84-86
Charting a successful course: The academic and clinical success committee's impact on student success
Chris Diem, Angela Hairrell
Department of Student Affairs, Academic Support Services, Texas A and M University College of Medicine, Bryan, Texas, USA
|Date of Web Publication||18-Nov-2019|
Academic Support Services, Texas A and M University College of Medicine, Bryan, Texas
Source of Support: None, Conflict of Interest: None
Background: The road from prematriculation to graduation looks different for each student at each institution. To successfully complete the curriculum, students must often overcome difficulties, both academic and nonacademic. Up to 15% of 3rd-year medical students in the United States are still struggling on the major components of their clerkships and 11% in their 4th year. While there is an established need for medical school remediation, there is little evidence supporting what specifically works across the board. These deficiencies often do not go away on their own and with the need to educate all students, the guidance provided by multiple stakeholders (i.e., administration, staff, faculty, and clinicians) would be necessary to chart a course of success for these students. Methods: The Academic and Clinical Success Committee (ACSC) at the Texas A and M University College of Medicine provides a venue to review individual students and provide input, resources, and support on a timely basis. This is a necessary ingredient in guiding the students facing academic and clinical challenges toward successful completion of graduation requirements. Results: Since its incorporation, the work of the ACSC has contributed to a decrease in failures on consecutive block examinations, a decreased failure rate on Step 2 clinical skills (CS), and increased capacity to help students at risk of failing Step 1 to not do so. Discussion: In this brief report, we illustrate how we developed the ACSC, the impact and levels of success it has had on students, and challenges we have faced.
Keywords: Academic, clinical, preclinical, remediation
|How to cite this article:|
Diem C, Hairrell A. Charting a successful course: The academic and clinical success committee's impact on student success. Educ Health 2019;32:84-6
| Background|| |
Due to the intensity and rigor of medical schools, it is common to encounter students who have faced academic difficulties. Guerrasio found that 15% of 3rd-year and 11% of 4th-year students in the United States (US) struggle academically. Clearly, there is a need for support and remediation in the medical school curriculum, but there is little evidence of what works. These deficits do not go away on their own, and it takes the input of multiple school stakeholders to provide the needed guidance and support. The Academic and Clinical Success Committee (ACSC) at the Texas A and M College of Medicine was born out of a need to consistently provide this kind of support to students facing concerns ranging from poor class performance to professionalism issues. In addition, a system was needed to discuss the best ways to allocate resources on multiple campuses to best help students. Therefore, specific protocols were set in place to support students who may need additional help with academic or clinical skills. As such, this committee was established, and the implementation of prevention and remediation became a joint endeavor of students and multiple agents in the College of Medicine, providing a venue to review individual students and provide input, resources, and support on a timely basis. This is a necessary ingredient in guiding the students facing academic and clinical challenges toward successful completion of not just graduation requirements, but in becoming a successful practitioner following medical school.
| Methods|| |
The ACSC established areas in which academic support had been needed in the past or noted as deficient. Identification of students was critical in making sure that the resources available could be targeted to those in the most need of help. Students were identified by the Office of Academic Support Services or by faculty. To educate faculty on the function of the ACSC, members of the committee met with small groups of faculty, and one on one when needed, to discuss their roles and illustrate how the process will work over time. The scope of work also became crucial as this committee would need tangible goals to measure student success; as such, the charge of this committee was to (1) develop individualized student remediation plans utilizing available resources and (2) monitor student progress toward outcome goals. The target areas of remediation were medical knowledge, clinical skills, clinical reasoning and judgment, time management and organization, interpersonal skills, communication, and professionalism. Because remediation of these areas would require diverse expertise, the committee was compromised of faculty and staff from the offices of Academic Support Services, Student Affairs, and Academic Affairs, along with clinical and basic sciences faculty, and a physician specializing in burnout among practicing physicians. Being at a multicampus institution, representatives of all campuses were included. Faculty who recommended a student were invited to report on specific information needed to work with the student. Initially, a consistent monthly meeting time was set to assure consistency in service for the students. From there, the plan was individualized for each student to assure that their specific needs were met.
Building on Guerrasio, committee members and faculty were given a framework to help them recognize students struggling in both the pre-clinical and clinical environments. For preclerkship courses, students receiving 73% or below on examinations were brought to the attention of the committee. Should a student fail a block, the student stayed on the watch list and received a formal plan; however, once a plan was implemented and the student passed the course, he/she was removed from probation and moved back to a monitor status. For clerkships, students receiving a NBME shelf examination score at the 7th percentile or below, or failed a patient encounter (objective structured clinical examination), should be brought to the committee. These factors were all quantitative in nature (e.g., even communication skills with standardized patients had a scoring rubric) and proved to be a consistent means to determine the success of the student's remediation plan.
While parameters for identification of academic difficulties were clear cut, the qualitative nature of professionalism referrals proved to be a more difficult task, with the remediation of professionalism issues a challenge as unique as the individual themselves. Upward of 10% of all residents may be classified as “problem residents” and attending physicians are often quick to react by thinking “how could they have gotten this far” with communication and professionalism concerns. While not yet residents, the professionalism issues seen in 3rd- and 4th-year medical students often elicited a similar response, and thus a difficult time in establishing how to remediate. The inclusion of a professional who deals with physician burnout and professionalism, along with an emphasis on student self-reflection, helped provide an end means to address professionalism issues. The success of professionalism remediation, like academic remediation, can take time, so the success may not also be immediately quantifiable.
Once students were identified, procedures were established to assure follow-through from the students. First, students meet with the Office Academic Support Services to develop an initial plan. A formal Academic and Clinical Success Plan included agreed-upon goals, strategies, and protocols to support the students academically. The students were notified of additional tutoring or one-on-one consultations depending on the needs demonstrated by/of the student. Then/second/subsequently, the plans were presented to the ACSC by the Office of Academic Support Services and revised, if necessary. Third, the revised plans were shared with the students and implemented. The students are required to meet regularly with the Office of Academic Support Services and with any additional faculty as required by the plan. Fourth/finally, the Office of Academic Support Services presented progress reports to the committee monthly. This report allows for the whole committee of experts to be involved in the process and ensures follow-through. This process continued until established goals for the student were met.
| Results|| |
The first meeting of the ACSC took place in March 2015 and since that time, it has evaluated well over 300 students [Table 1]. The evaluations include every student who has failed a block, was at risk of failing a block, or was at risk for a board examination failure since 2015. Our ability to identify students prior to the actual block failure has allowed us to target, intervene, and remedy the situation for many students through the use of specific feedback, skill building, and goal setting to prevent failures. For example, students failing the first introductory course dropped from 24 students after the second examination to only 11 when the course concluded. Between those two points, each student was discussed in the ACSC and met with the Office of Academic Support Services. These meetings included work on study and test-taking skills and analysis of test performance. That success has also been demonstrated on national knowledge and clinical based examinations. For US Medical Licensing Examination Step 1, students deemed at risk were recommended to the ACSC and a required dedicated study time plan was created. For the Class of 2018, nearly 40% of the class was identified at risk (according to the set parameters), but the school passing was nearly 98%. The ACSC allowed for multiple professionals to analyze student progress, give feedback, and allowed the Office of Academic Support Services to execute an individualized plan to get students to a passing score. Intensive work on behalf of the Clinical Learning and Resource Center (CLRC) resulted in Step 2 CS failures dropping from 8 to 2 in 1 year, a 75% drop. Any students showing clinical deficiencies in standardized patient encounters are required to meet with the members of the ACSC (CLRC and/or Academic Support Services) for intensive video and written note review to remediate deficiencies early.
These results were encouraging to the college, though not all students proved to be successful. Often times, outside stress factors related to family and finances prevented a student from being successful. The ACSC was often able to mitigate these issues by working on time management skills related to when and how to study. In other cases, the situations proved so burdensome that outside counseling was recommended (the school provides access to these professionals) to help work through the situation in that environment.
| Discussion|| |
There is much discussion of whether remediation is worth the time and effort necessary. Time is a valuable commodity, and the composition of the committee includes individuals whose time is valuable and needed in multiple places. As a result of the ACSC, the college has been able to identify faculty whose time and skillset can best serve a student in need of additional academic support and guidance. The diversity of skilled experts with experience in working with struggling learners has provided the ACSC a comprehensive group of educators who can look at our students, chart a plan for remediation, and execute the plan. The goal of the ACSC is to identify and remedy student performance issues before they reach the level of a failure or worse, possible dismissal. Indeed, by constantly tracking data and reaching out and meeting with students individually regularly, the ACSC is situated to react to formative student data and quantitative feedback, not just summative information. Updated information can be communicated in real time and ultimately, the student can be provided with resources that give them the best chance possible to remediate their deficiencies in a timely manner and continue on in medical school with a better chance of ultimately being successful.
We would like to acknowledge several committee members who have been instrumental in their support for this committee, including Gary McCord MD, Ruth Bush MD, Kathleen Fallon, MD, Laura Ferguson, MD, Laura Livingston, MA, Jerry Livingston, PhD, Danielle Dickey, M.ED, Robert Steele, MD, and Daniel Hootman.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guerrasio J. Remediation of the Struggling Medical Learner. Irwin, PA: Association for Hospital Medical Education; 2013.
Kalet A, Chou C. Remediation in Medical Education. New York: Springer; 2014.
Ellaway RH, Chou CL, Kalet AL. Situating remediation: Accommodating success and failure in medical education systems. Acad Med 2018;93:391-8.