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Learner Deficits and Academic Outcomes of Medical Students, Residents, Fellows, and Attending Physicians Referred to a Remediation Program, 2006–2012

Guerrasio, Jeannette MD; Garrity, Maureen J. PhD; Aagaard, Eva M. MD

doi: 10.1097/ACM.0000000000000122
Research Reports

Purpose To identify deficit types and predictors of poor academic outcomes among students, residents, fellows, and physicians referred to the University of Colorado School of Medicine’s remediation program.

Method During 2006–2012, 151 learners were referred. After a standardized assessment process, program faculty developed individualized learning plans that incorporated deliberate practice, feedback, and reflection, followed by independent reassessment. The authors collected data on training levels, identified deficits, remediation plan details, outcomes, and faculty time invested. They examined relationships between gender, training level, and specific deficits. They analyzed faculty time by deficit and explored predictors of negative outcomes.

Results Most learners had more than one deficit; medical knowledge, clinical reasoning, and professionalism were most common. Medical students were more likely than others to have mental well-being issues (P = .03), whereas the prevalence of professionalism deficits increased steadily as training level increased. Men struggled more than women with communication (P = .01) and mental well-being. Poor professionalism was the only predictor of probationary status (P < .001), and probation was a predictor of other negative outcomes (P < .0001). Remediation of clinical reasoning and mental well-being deficits required significantly more faculty time (P < .001 and P = .03, respectively). Per hour, faculty face time reduced the odds of probation by 3.1% (95% CI, 0.09–0.63) and all negative outcomes by 2.6% (95% CI, 0.96–0.99).

Conclusions Remediation required substantial resources but was successful for 90% of learners. Future studies should compare remediation strategies and assess how to optimize faculty time.

Supplemental Digital Content is available in the text.

Dr. Guerrasio is associate professor, Department of Internal Medicine, remediation consultant, and remediation program director, University of Colorado School of Medicine, Aurora, Colorado.

Dr. Garrity is associate dean of medical student affairs, University of Colorado School of Medicine, Aurora, Colorado.

Dr. Aagaard is associate professor, Department of Internal Medicine, and assistant dean of lifelong learning, University of Colorado School of Medicine, Aurora, Colorado.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Approval was granted from the Colorado Multiple Institutional Review Board.

Previous presentations: Partial pilot data were presented for Michigan State University Grand Rounds in December 2012.

Supplemental digital content for this article is available at

Correspondence should be addressed to Dr. Guerrasio, 12401 East 17th Ave., Mail Code F782, Aurora, CO 80045; telephone: (720) 848-4289; e-mail:

© 2014 by the Association of American Medical Colleges