Diagnosing the Learner in Difficulty

Abstract

Teaching undergraduate and postgraduate learners is often a joy. What to do with a student who is not meeting expectations, however, is challenging. Clinical attending physicians must identify, and remediate, students who struggle. This article presents a practical approach to identifying, diagnosing, and managing the learner in difficulty. A learner in difficulty is a student at risk for receiving less than “pass” because of concerns regarding his or her knowledge base, clinical skills, or professionalism.1 Learners in difficulty rarely self-identify for a variety of reasons, including lack of self-awareness or concern that if they acknowledge they are in difficulty, they will be stigmatized.2 However, early identification of such individuals, with appropriate intervention, seems to lead to better outcomes for these learners.3 The responsibility of identifying learners who are not meeting expectations largely rests with their clinical teachers. Many teachers hesitate to identify and report learners experiencing difficulties for a number of reasons, including inexperience handling such situations, concern they are misjudging the circumstances, lack of documentation, fear of retribution by the student, and the time required to resolve issues.4–6 The current nature of training further compounds this problem. Oversaturated placements, shorter duty hours and academic half days, and concurrent exposure to multiple supervisors reduce student contact with clinical teachers. Problems often go unidentified until a critical incident has occurred.6 Just as we all have an approach to a child who presents with a cough, it is helpful to have a basic approach to a learner who is not meeting expectations. Teachers are good at recognizing a … Address correspondence to Stacey Bernstein, MD, FRCPC, Department of Pediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8. E-mail: stacey.bernstein{at}sickkids.ca