What [not] to do about failing medical students

I teach in a large, team-taught, exhausting first year med student course. There is a lab. We all do the lab. It is a lot of work. We have to rewrite the lectures every year to keep up with the literature, and what gets taught on the boards. Do we teach to the boards? Yes, but that’s not the point of this post.

Every year, the first exam is tough on the students. They haven’t figured out medical school yet, and they are shocked at how much and how quickly the material comes at them. Most get it, and pass, and move on. They are so used to be the smartest and the bestest that it’s hard to be surrounded by a lot smarter and a lot better. Every year a couple of students leave the program.

But the encroachment of administrators (kinda like ants crawling over logs and leaf litter in the jungle) on the curriculum has brought forth a number of edicts, including:

Faculty will hold a review or question & answer session for all at-risk students at a frequency no less than once per module. Faculty intervention … include additional assignments for at-risk students … including completion of cases, questions, diagrams/tables, etc. Homework can be used as session agenda, or it can direct student questions for faculty during office hours or for tutors.


Tutors [non-faculty, non-academic] will work with at-risk students individually or in small groups on a weekly basis throughout the course.

My first reply was “no fucking way”, which the course director indicated he would forward to the Dean of Studentés anonymously. I adore my course director.

However, my sage and thoughtful colleagues had more intelligent things to say about this effort in futility.  Daily review sessions are not efficient, and amount to an additional, but less structured, lecture.  Team-taught courses will demand multiple faculty involvement as expertise is often lecture specific.  One important concern is that Academic Support often attempts to provide content material to aid studying which in the end is a waste of student time and costs faculty more for correcting the errors that tutors make.

But to me and to my colleagues, the most important idea is something that is not such a problem in PhD programs (which is not to say that there are not lots of other problems). Student success cannot be mandated from above.  At-risk students have to take a proactive stance toward their own learning.   As the old proverb says, “you can lead a horse to water, but sometimes you have to drown it to get water inside”.  The ideas spelled out in the intervention proposal are what I would expect at an undergraduate university.  This week, in response to the request for specific page numbers associated with each lecture, I told the students that patients don’t come with page numbers stenciled on the forehead. Nor do they come with a kindly mentor or a calming manatee to explain what they need to know to be able to function as a professional. I think help in learning how to study is useful. But a class to reteach the material, in my eyes means that, beyond making children of our adult students, we will either pass students on who will fail later, or we end up promoting people who should not be physicians.

Going to Medical School is hard work. Being a physician is hard work. Our job is to guide them through that work, not do it for them.

For the equivalent PhD students – they get flunked out.


One thought on “What [not] to do about failing medical students

  1. Couldn’t agree more with this: “But a class to reteach the material, in my eyes means that, beyond making children of our adult students, we will either pass students on who will fail later, or we end up promoting people who should not be physicians.”

    On the last medical student exam we graded, I gave one student no credits at all, because none of us (we were 6) could read the writing. When the student came to complain about our unfairness, I asked them to think about their daily life as a doctor, how their patient would like to have the wrong arm amputated because their assistant couldn’t read their notes… They will get a second chance, ultimately a third and if they didn’t manage to pass the exam by then, they are kicked out too. I fully agree that we should not promote the wrong people.

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