Dr. Neely makes an excellent point in his letter to the editor in response to our report. Remediation is very difficult, and some students have problems we cannot remediate. However, if we do not identify students as having difficulty, then we cannot even attempt remediation. While egregious performance or behavior might be grounds for dismissal without discussing remediation, our experience is that most students are given a chance to change their behavior or improve their performance before discussing dismissal, an approach we agree with. To offer students the opportunity to learn from their mistakes, and because students make a significant financial and time investment in their education, we recommend giving students the benefit of all available resources. These resources may include counseling in studying and test-taking skills, medical or psychiatric evaluation, and psychological counseling, in addition to content- or behavior-specific learning modules. In our experience, some students are able to fill in gaps in learning and to change their behavior. Dr. Neely is correct that some students’ problems are not fixable. But in most cases, we need to try to fix them in order to be sure that we cannot. Identifying struggling students is the first step, and communicating about them is critical in both identification and remediation.
Sandra L. Frellsen, MD
Assistant professor of medicine and co-clerkship director, Rush Medical College, and attending physician, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; (email@example.com).
Elizabeth A. Baker, MD, MHPE
Associate professor of medicine and internal medicine clerkship director, Rush Medical College, Chicago, Illinois.
Klara K. Papp, PhD
Senior research associate, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Steven J. Durning, MD
Associate professor of medicine and course director, Introduction to Clinical Reasoning, Uniformed Services University of the Health Sciences, Bethesda, Maryland.