Failure to Fail ‑ Why or Why Not?

In the middle of difficulty lies opportunity.
Albert Einstein    

There are many reasons some students cannot or should not pass, but most eventually do succeed.

From entry to exit at DMNB, many individuals will contribute to the success of our medical learners. Your role as Tutor indeed contributes to learner success!

Failing or remediating a learner – Why or why not?

  • DUTY to the public – DUTY to the learner
  • Patient safety
  • Reputation of the profession
  • Learners who have difficulty in medical school are more likely to have formal complaints against them as practitioners
  • Increased level of professionalism issues during and post medical training (in practice)
  • Credibility of educational standards and institutional integrity
  • Time
  • How will this impact the learners future career?
  • Second guessing what you are observing (is it just me, are they just having a bad day?)
  • Unsure how to begin the process or conversation with a learner
  • What does this mean for me as teacher?
  • Will I be supported as teacher?

Where to start?

Reasons a student may have academic problems:

Reamy and Harmon 2006

Caution! Signs that there may be trouble ahead for a learner

Caution! Signs that there may be trouble ahead for a learner

  • Can’t focus or prioritize
  • Poor fundamental of knowledge
  • Overeager or excessive shyness
  • Poor knowledge integration and consolidation
  • Lack of professionalism
  • Deficits in communication skills
  • Failure to improve with feedback


A learner is in difficulty – What is my role as Teacher?

Five Remedial Roles:

  • Facilitator - enthusiastic, motivation
  • Nurturing mentor - approachable
  • Disciplinarian - honest, enforcing
  • Diagnostician - observation and thought
  • Role model - accountable, professional
Initial observations and actions:
  • Observe your learner
  • Has the behaviour or action(s) of concern been repetitive?
  • Attempt to engage the learner if they appear disengaged or unfocused
  • Suggest a private conversation and gauge their interest in feedback:
    • Learner may be able to provide insight and explain recent actions
    • Learner may not be receptive to your feedback and observations
    • Learner may be relieved to receive feedback and seek assistance


If it is not documented, it NEVER HAPPENED!

Feedback opportunities

Non-solicited feedback:
  • Ask to meet with the student at an agreeable time and private meeting space
  • Sensitive and timely feedback is sometimes sufficient
  • Don’t sugar-coat the problem
  • Establish and reassure the goal is learner success
  • State plainly “I am giving you feedback” (this provides context and confirms feedback is occurring)
  • Provide the student opportunity to share their perception of the issue
  • Ensure there is documentation of your observations and conversations with the learner
Assessment feedback:
  • Set the tone – Allow a few minutes and open-ended questions as to how they see them selves and their progress
  • Review assessment document with your learner (and co tutor for Professional Competency units)
  • Refer to notes you took at weekly tutorial sessions related to learner’s performance


  • Learners’ perception of participation may be different than yours as Teacher:
    • Encourage the quieter, reassure them their knowledge is wanted
    • Remind the strong in leadership learner to allow opportunity for all voices
  • Cleary state areas where learner has met or exceeded learning outcomes
  • Clearly state issue(s) of concern
  • Confirm learner has understood and heard your feedback
  • Re visit how they see them selves and provide opportunity for learner to share thoughts

Learner success!


Self-reflective action (2 minutes): Promotes transfer of learning


Review and reflect upon a learner you have encountered that you were concerned about meeting learning outcomes and expectations.

Think about:

  • Your duty as teacher.
  • How might this impact the learner’s future medical education?
  • Will patient safety be of concern?
  • What steps did you / could you have taken to identify areas of concern with this learner?

Learner in difficulty: Change in practice

Upon review of some best practices and why or why not to fail a learner:

  1. Think about what practices you will continue doing should you be required to offer feedback to a learner in difficulty?
  2. Consider what change(s) in practice you will implement to help provide better prepare for a conversation with a learner in difficulty. (Hint… document, document, document)

Module summary: Failure to fail – Why or why not?

  • DUTY to the public – DUTY to the learner
  • During each tutorial capture brief point form notes on each learner
  • Remain vigilant about warning signs of learner in difficulty
  • Be specific about the identified issue