Medical School Policies Regarding Struggling Medical Students During the Internal Medicine Clerkships: Results of a National Survey

PURPOSE: To characterize policies of medical schools regarding struggling medical students: those at risk of receiving a grade of less than pass because of problems with knowledge, clinical skills, professionalism, or a combination of these items. METHOD: The annual 2006 Clerkship Directors in Internal Medicine (CDIM) survey included a section about how clerkship directors handle struggling third- and fourth-year medical students. The section contained 14 structured questions and five items requiring free-text responses. The items explored both core and fourth-year clerkship perspectives. Data were analyzed using descriptive statistics. RESULTS: Eighty-three of the 110 (76%) institutional members responded. Respondents identified 0% to 15% of students as struggling each year during the required core internal medicine clerkship and 0% to 11% of fourth-year students. Two thirds of respondents present struggling students to a medical school promotion committee. More than half (64%) of respondents feel they should share information about struggling students with other clerkship directors, and 51% of respondents do share information. Clerkship directors are divided about whether it is in students' best interests to disclose information about them with current teachers or other clerkship directors. Only 14% of institutions have written policies about sharing information, and 57% of clerkship directors design remediation plans for struggling students. CONCLUSIONS: Internal medicine clerkship directors handle struggling students in widely varying ways. Many clerkship directors share information about struggling students; opinions are divided about whether this is appropriate. Future research is needed to determine the effectiveness of identifying and remediating struggling students and to determine effective remediation plans.