Acad Med. 2024 Nov 1;99(11):1254-1259. doi: 10.1097/ACM.0000000000005845. Epub 2024 Aug 8.
Medical training institutions worldwide must be prepared to remediate struggling learners, but there is little empirical evidence around learners' perspectives on remediation efforts. Research shows that emotion has a significant effect on learning, but it has not been well studied in remediation in medical education. Given the high stakes of remediation, understanding more about learners' emotional experience could lead to improvements in remediation programs. This study aimed to explore medical students' emotional experience of failure and remediation to offer opportunities to improve remediation.
This study is a thematic analysis of data collected from July to September 2022 from one-to-one interviews with students from 4 institutions (2 in the United States and 2 in the Netherlands) who had not met expectations on 1 or more medical school assessment(s). Interview questions explored students' experiences with learning of and responding to a performance that was below expected standards, with probes around any mentions of emotions.
Fourteen students participated: 9 from schools in the United States and 5 from schools in the Netherlands. The students perceived the failure and remediation event to be highly significant, reflecting negatively on their suitability for a career as a physician. We identified 5 themes: (1) shame was pervasive and only retrospectively perceived as unwarranted; (2) self-doubt was common and weighty; (3) resentment, blame, and other external-facing emotions were present but softened over time; (4) worry and stress related to perceived career effect differed across countries; and (5) students had mixed emotional reactions to the remediation process.
Medical students have strong emotional responses to failure and remediation. Expecting and considering emotions such as shame, self-doubt, and anger could help educators design better remediation programs. Differences across countries may be at least partially explained by different degrees of time variability and flexibility within the curricula.
全球医学培训机构必须做好补救学习困难者的准备，但关于学习者对补救措施的看法，几乎没有实证证据。研究表明，情绪对学习有重大影响，但在医学教育的补救中，这一问题并未得到很好的研究。鉴于补救的高风险，更多地了解学习者的情绪体验可能会导致补救计划的改进。本研究旨在探讨医学生在失败和补救中的情绪体验，为改进补救措施提供机会。
本研究是对 2022 年 7 月至 9 月期间，来自 4 所机构（美国 2 所，荷兰 2 所）的学生进行的一对一访谈数据进行的主题分析，这些学生在 1 次或多次医学院评估中未达到预期。访谈问题探讨了学生对低于预期标准的学习和应对表现的经历，包括对任何情绪提及的探究。
14 名学生参与了研究：美国学校 9 名，荷兰学校 5 名。学生们认为失败和补救事件非常重要，这反映了他们不适合从事医生职业。我们确定了 5 个主题：（1）羞耻感普遍存在，只是事后才被认为是不合理的；（2）自我怀疑很常见，而且很沉重；（3）怨恨、责备和其他面向外部的情绪存在，但随着时间的推移而软化；（4）对职业影响的担忧和压力因国家而异；（5）学生对补救过程有混合的情绪反应。
医学生对失败和补救有强烈的情绪反应。期望和考虑羞耻、自我怀疑和愤怒等情绪可能有助于教育者设计更好的补救计划。国家之间的差异至少部分可以解释为课程内时间可变性和灵活性程度不同。
