Council on Medical Student Education in Pediatrics


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Cleland JA, Knight LV, Rees CE, Tracey S, Bond CM. Is it Me or is it Them? Factors That Influence the Passing of Underperforming Students. Medical Education 2008; 42:800-809.

Reviewed by: Susan Bannister, MD, University of Calgary, Calgary, AB

What was the study question? Why do preceptors "fail to fail" underperforming students?

How was the study done? Focus groups were carried out at two different medical schools in the UK.

What are the results? The authors analyzed the qualitative data and identified six main themes relevant to understanding the behavior of preceptors failing to fail underperforming students. These are faculty attitudes towards an individual student, tutor attitudes towards failing a student, normative beliefs and motivation to comply, efficacy beliefs, skills and knowledge, and environmental constraints.

What are the implications of these findings? The authors describe the tensions the faculty face as they complete student assessments - the need to report competence and protect the public vs. the faculty's need to be fair - and the resulting dissonance the faculty experience. Many faculty feel that is they who have failed in their role as a teacher when they fail a student.

Editor's Note:
Even though this study is several years old, it offers some important insights into this topic. And - we were heard last year at COMSEP when Maxine Papadakis spoke about her research - concerning issues in professionalism that are identified in medical school are indicative of future lapses in professional behavior. This study highlights the need to support faculty as they make the difficult decision to fail an underperforming student.

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