Council on Medical Student Education in Pediatrics


Search This Site

Journal Club

We need a better exit strategy!

Failure to fail: The institutional perspective. Guerrasio, J et al. Medical Teacher 2014;36(9);799-803. 

Reviewed by Chris Foster

What was the study question?
What are the institutional barriers to carrying out probation or dismissal of underperforming students in medical training?

How was the study done?
This was a qualitative study using grounded theory coding of open text responses to an online survey sent to 48 randomly selected Student Affairs Deans or their “equivalent” at MD, DO, PA, and NP programs across the United States. The survey focused on probation and dismissal of medical trainees and elicited definitions, barriers to implementation, and beliefs about enforcement.

What were the results?
Nineteen programs (40%) responded with a broad mix of program type and geographic location. 12 barriers were identified; legal concerns (85%) followed by lack of remediation options (35%) topped the list. Alarmingly, 79% of respondents felt either their program or a program like their own had graduated unqualified students. Three programs acknowledged having no remediation “system” of their own and two programs had no formal dismissal “system.” Cognitive defects, as opposed to behavioral/professionalism deficits, were seen as more straightforward criteria for remediation or dismissal.

What are the Implications of these findings?
This study highlights another encumbering layer to the already restrictive process of failing students. Failing to fail students at the individual faculty level has previously been well described, and here Dr. Guerrasio and her colleagues shed light on the institutional hurdles that further constrain removal of poorly performing students even in the event faculty members have identified and reported a failing student. Her team does leave us with hope and reasonable mitigating strategies such as educating faculty and administrators about legal precedence in effort to allay ungrounded fears of legal repercussions, establishing local evidence based remediation models, and advocating for national support from accrediting bodies to provide defined criteria for remediation/dismissal upon which to stand firm in institutional decisions.

Editor’s note: This is an important paper because it examines the “failure to fail” problem from a different perspective – that of the institutions. Having just lost an appeal of unprofessional behavior in a student because we notified the parties in the “wrong” order, I read this with interest (SB).

Return to Journal Club