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Practical Implications of Compassionate Off-Ramps for Medical Students

Aagaard, Eva M., MD; Moscoso, Lisa, MD, PhD

doi: 10.1097/ACM.0000000000002569
Invited Commentary: PDF Only

Attrition from medical school remains uncommon even when a medical student performs poorly, has a change in interests, or experiences an unexpected life event that may alter his/her ability to succeed as a physician. In this issue, Bellini and colleagues describe the scope of this problem and make recommendations to support the implementation of compassionate off-ramps for students. These recommendations include enabling ongoing assessment of commitment to career path via a professional identity formation curriculum; implementing competency-based education and training to identify struggling learners; using career advisors and coaches who understand alternative career pathways; providing credit or credentials for competencies already achieved; requiring financial counseling and supporting debt forgiveness; and requiring schools to report on their remediation programs and handling of debt. In this Invited Commentary, the authors describe a representative student—a composite of several students they have counseled whose medical school paths have been impacted by poor performance, unanticipated life events and stressors, changing career interests, and/or physical and mental health issues—who may have benefitted from these recommendations. The authors elaborate on Bellini and colleagues’ recommendations and describe what they think would be necessary to ensure the recommendations effectively meet the goal of providing compassionate off-ramps for students who need them. The authors describe the potential impact of the recommendations on the representative and similar students. Although this impacts a small proportion of students, the recommendations would help schools achieve the moral imperatives of humanistic care for students, while honoring the social contract of the medical profession.

E.M. Aagaard is Carol B. and Jerome T. Professor of Medical Education and senior associate dean for education, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ORCID:

L. Moscoso is associate professor of pediatrics and associate dean for student affairs, Washington University School of Medicine in St. Louis, St. Louis, Missouri.

Editor’s Note: This is an Invited Commentary on Bellini LM, Kalet A, Englander R. Providing compassionate off-ramps for medical students is a moral imperative. Acad Med. 201X;XX:XX–XX.

Acknowledgments: E.M. Aagaard thanks Drs. Jeannette Guerrasio, Maureen Garrity, and Terri Blevins for their indispensable contributions to her understanding of remediation and student counseling.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Eva M. Aagaard, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., Campus Box 8073, St Louis, MO 63110; telephone: (314) 362-7874; e-mail:; Twitter: @AagaardEva.

© 2019 by the Association of American Medical Colleges