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Academic Medicine:
doi: 10.1097/ACM.0b013e31819398b4
Letters to the Editor

More About Struggling Students

Neely, David MD

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Director of undergraduate education, Department of Medicine, Northwestern University, The Feinberg School of Medicine, Chicago, Illinois; (dneely@nmh.org).

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To the Editor:

Regarding the article and essays on struggling students in last September’s issue, I think the crucial question is not “Should we share information with other clerkship directors about struggling students?” Rather, the question is a more fundamental one: “Do we clerkship directors have special, effective methods to help those students?” After 20 years as a clerkship director and 10 years of attending national clerkship directors’ meetings, I am much less confident that we can significantly help struggling students, whom I define as those in the bottom 5% of the class.

More specifically, better assessment, remediation, teaching, or “forward feeding”—the solutions often proposed—won’t usually work because struggling students’ problems tend to be ones of professionalism and humanism and/or clinical reasoning and prioritizing. Problems with the former mean that students cannot step outside of themselves to see themselves as they are perceived by others. Therefore, while they can respond to specific concrete feedback, they cannot self-correct. Problems with the latter boil down to weak processing skills. All these problems are largely innate and not easily remedied.

I worry that we spend a lot of our finite time and energy ineffectively trying to help struggling students at the expense of our two most important tasks: (1) to inspire and teach all our students, and (2) to figure out whether a struggling student can become a doctor. Many can; some cannot. We should spend more time and effort on these tasks and less on trying to fix innate problems that we don’t know how to fix.

David Neely, MD

Director of undergraduate education, Department of Medicine, Northwestern University, The Feinberg School of Medicine, Chicago, Illinois; (dneely@nmh.org).

© 2009 Association of American Medical Colleges

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