A Longitudinal, Structured Clinical Remediation Program for Medical Students.

Purpose: Clinical competency in undergraduate medical education (UME) is not obtained uniformly across all learners.1 Remediation efforts are needed when students are not progressing as expected. Though academic remediation to improve test taking is common, there is no agreed-upon structure for identification, remediation, and postremediation assessment of clinical performance struggles across UME programs.2,3 Best practices include early assessment to identify the primary deficit followed by targeted coaching.4 We describe a longitudinal, structured clinical remediation program (CRP) designed to support medical students across all 4 years of their training. Approach: The CRP functions within the framework of learning communities that include medical students, faculty coaches, and student affairs deans. Students identified as struggling with clinical reasoning (including history taking, physical examination, and diagnostic reasoning), organization, or efficiency/time management at any point in their education can be referred. After referral, a comprehensive assessment of the student’s performance is completed by a trained remediation specialist with context provided by student affairs dean and faculty coach. Specialty coaches then perform a focused assessment of the student within their coaching domain. Depending on the severity of performance struggle, students participate in supplemental small group sessions or engage in one-on-one coaching. For those requiring the most support, an extra remedial clinical rotation is available. Following these interventions, specialty coaches communicate observations, effective strategies, and proposed next steps back to the student’s learning community for ongoing monitoring and support. An online tracking system is used to document student deficit, severity, and progress. We provide descriptive statistics on the CRP, including source of referral, domain of struggle, and level of intervention. We then describe associations with other measures of clinical performance using Pearson chi-square test (asymptotic significance 2-sided). Outcomes: From 2021 to 2022, 79 students were referred to the CRP. Referrals differed by source: self-referral (52%), faculty coach (28%), clerkship director (19%), and student affairs dean (1%) (P < .001). Clinical reasoning (82%) was the most commonly identified domain of struggle. Sixty-nine students (87%) were referred to supplemental small group sessions and 10 (13%) to one-on-one coaching. Eight students (10%) in the CRP failed their objective structured clinical examination (OSCE) at the end of preclinical training while only 2 students (2.5%) failed the OSCE at the end of their core clerkship year. Students who failed the preclinical OSCE were significantly more likely to be referred directly to one-on-one coaching (P = .026). All students referred to the CRP graduate medical school on time or are on track to do so. Significance: We describe a structured CRP available to students across all 4 years of medical training, providing assessment and targeted coaching to the primary deficit as part of supportive learning communities. The high number of student self-referrals, subsequent improvement in OSCE performance, and on-time completion of medical training suggest program effectiveness. Program strengths include identification by a broad group of stakeholders, student access, assessment to identify the primary deficit as supported by the remediation literature,4 dedicated coaching by domain specialists, and ongoing tracking. This novel CRP provides an effective structure to longitudinally support students struggling with clinical performance as part of a learning community composed of stakeholders common to UME programs. While some capabilities will differ between institutions, the key aspects of our program should translate to most institutions. Acknowledgments: The authors wish to thank the college deans, longitudinal faculty coaches, and specialty remediation coaches who support our students.