Answer to "In what situations do students experience difficulties?"
There is a complex range of factors that are associated with students who experience difficulties. Many of these factors are inter-related and a combination is usual at times of transition, such as examinations. Students are more likely to present for support as students in difficulty at these times of transition, especially after examinations.
A review of students who experience difficulties noted several and interrelated contributory factors (Boileau , St-Onge, Audetat):
Cognitive causes (a) Insufficient knowledge, including insufficient investment in studies, learning disorders and organization related difficulties, (b) Clinical reasoning, including insufficient knowledge, difficulty organizing information and clinical reasoning difficulties
Non-cognitive causes (a) Attitude problems, including lack of awareness of professional responsibilities, different values and beliefs, poor insight, poor social skills, insufficient motivation, and conflicts in the workplace (b) Affective problems, including anxiety and depressive mood disorders, other mental health issues, substance abuse and stress (family, personal, relational)
An appreciation of the times and factors that provoke students in difficulty can lead to pro-active support, such as modification of the medical school and clinical environment, increased student awareness of opportunities for support and promotion of self-help approaches, and increased awareness by teachers.
All teachers have an opportunity for early identification. Research on teachersʼ informal judgments of in-class behavior has noted the validity and importance of recognizing lack of participation, lack of commitment, poor academic performance, poor social interactions and general signs of distress as early signs of the student in difficulty.
It is important to identify and support students with academic difficulties at an early stage since 10-15% students have persistent difficulties with their academic performance over their time in medical school.
An important factor to consider when students who experience difficulties with academic performance is dyslexia and early identification is essential to ensure that appropriate services are provided.
An appreciation of the times and factors that provoke students in difficulty can lead to pro-active support, such as modification of the medical school and clinical environment, increased awareness of opportunities for support and promotion of self-help approaches.
Effective support of students in difficulty requires a holistic approach to the identification of the inter-related factors.
Boileau E, St-Onge C, Audetat MC (2017) Is there a way for clinical teachers to assist struggling learners? A synthetic review of the literature. Advances in Medical Education and Practice. 8n89-97
Neill LD, Morcke AM, Eika B (2016) . The validity of student tutorsʼ judgments in early detection of struggling in medical school. A prospective cohort study. Advances in Health Sciences Education. 21(5):1061-79
Shaw SC, Anderson JL. (2017) Twelve tips for teaching medical students with dyslexia. Medical Teacher. 39(7):686-90
Steinert Y (2013) The “problem” learner: whose problem is it? AMEE Guide No. 76. Medical Teacher. 2013 35(4):e1035-45
Vogan CL, McKimm J, Da Silva AL, Grant A (2014) . Twelve tips for providing effective student support in undergraduate medical education. Medical Teacher. 36(6):480-5.
Yates J, James D (2006) . Predicting the “strugglers”: a case control study of students at Nottingham University Medical School. BMJ.;332(7548):1009–1013