When students come seeking help

May 27 2017 Published by under Uncategorized

Yesterday a student from the medical class I teach came to me looking for advice. I think mine was the only open door on the hallway. She certainly had not sought me out before.

I knew her because she had failed first year Med School (M1), and squeaked by the in the class I teach 2nd year. As is true of many med school lab courses, its big (150 students, of which about 5 are PhDs, andthere are  7 or 8 people in lab, and a couple of us who lecture, etc), the grading is all computerized, pretty much, so there is almost no subjective assessment, and the bit of grading we do by hand, practical exams, is by IDnumber. So, its not like I have much say in pass or fail. And I don't sit on the committee that hears student appeals for grades. So there is nothing much I can do for a student with grade issues.

It seems this woman has failed her first year again. She had failed two basic science classes (Ithink it had been three the first time through). And she wanted advice. Except she really didn't. She wanted to complain. I kept my best sympathetic smile, plastered on my face, almost till the end.

Firstly, she said that she couldn't believe she failed because "she had really mastered the material. In my study group, you know, I always knew the answer". Secondly "this school is in the middle of nowhere and I had no support during the year, and there was nothing to do on the weekends". And, thirdly, "I was part of this program [one we have to help at risk students, in conjunction with a local college, because this university has no undergraduate programs at all] and it required me to drive to go to work there and I wasted time each week driving when I could have been studying".

Smile still plastered on my face. I didn't mention that two and three on her list seemed contradictory. I did say that failing the exams more than once suggested that perhaps she hadn't mastered the material. She insisted that she had, and that she "just couldn't take exams".

I don't want to debate, here, now, whether board exams for medicine are good or bad, whether we select the best people to be physicians, etc. Whether it is worth changing how we assess medical students, whether it is worth my time to work on changing that is another argument. Certainly this woman isn't going to be in a position to do anything about it.

I did ask her how she thought she could pass the boards (Step I, the exam med students take end year 2/ beginning year 3), if she couldn't pass class exams, no matter how much she had "mastered the material". She returned to point 2, "if I only had support I would have done better".

Then she said: I really believe that if someone wants something badly enough, and works at it hard enough, they can do it. I wanted to say: Then, not once, but twice, you either didn't want it enough, or you didn't work hard enough, since you didn't do it. I did say: You know, I was an athlete in high school and in college. But it was very clear to me, at the end of my 20s, early 30s, (and really much earlier) that no matter how hard I worked, I would never make it to the Olympics. (of course it was obvious much earlier than that).

She answered: Oh, that's different. I really want to be a physician. I know I can be a very good doctor. I am going to apply to go somewhere else.

Is it that different? I don't think so. I think part of what separates good amateurs from professional athletes is a kind of physical genius, which begs the whole question of the separation of physical and mental, since it is the brain that controls our motor systems (and I am perpetually irritated by the words "muscle memory". Muscles have no memory. They are stupid mechanical engines following signals from the nervous system). But its hard to acknowledge that your brain may not work in the right kind of way to pass medical school.

After about 20 minutes of this, I said (still trying to be gentle), is there anything I can do for you?

There was not.

20 responses so far

  • Karen Phillippi says:

    I don't understand why she come back to "if only I had support". You do do the work or you don't. You pass or you fail. Maybe it's not inthe cards for her.

    I had a friend who believed if she did what she loved, the money would follow. She quoteD all sorts of spiritual sources. She wanted to be full time artist, quit her job, and sold her paintings online. But no matter how much she painted, it still was a matter of disposable income for people who could purchase, economic conditions for that, and her own income vs expenses. Yet every conversation came back to since she did what she loved, money should roll in. It was a false arguement. But she wouldn't let it go. And se wouldn't sully her pure love of art by getting any kind of job, since it took time away from painting.

    Some people just don't understand that wanting something doesn't mean you have the gifts, talents or skills for that specific job. But there are other avenues for her if she wants to be a healer.

    • A Salty Scientist says:

      I don't understand why she come back to "if only I had support".

      Because people often equate failure to achieve one's goals as a moral failing. You can achieve all of your dreams if you only work hard enough...you can be anything you want to be... This has pervaded our culture. We hero worship those with exceptional talents and then find ourselves disappointed when we find out they have feet of clay. Athletic contests are not won by those who are most talented, but are instead displays of fortitude, grit, and determination (yak).

      So, when we perhaps lack the talent to achieve our goals, the instinct is to assign moral blame. If we cannot or will not blame ourselves, then the result is defensiveness and deflection. This must be someone's fault, so if not mine, it was the system being unfair. The corollary is that some students feel entitled to good grades if they put in exceptional effort.

      It makes it a challenge to give our students the advice they need. Yes, sometimes they really do need to work harder, but often they struggle due to lack of ability. This is not a moral failing, but they often treat it as such, and will not hear what they need to hear.

      • potnia theron says:

        I think both you and Karen are making good points. It is about the ability to look at oneself and see the reality of what one can and cannot, not will and will not, do.

        But in this case, I do not think the issue is moral failing. I think it is just the idea of failing. I saw a tweet that said something like: I don't praise my child for specific achievements, but for attempts, because that promotes flexibility. I wanted to reply, it is also promotes self-induglence, and entitlement.

    • Dave Dell says:

      Karin - Back when the IRS used to provide real taxpayer service I was often drafted to "work the taxpayer service counter" when the regular people had the day off, or were in training.

      Often, someone would come in with a start up a business question, or talk about how to go about making a living off something they loved doing. Fishing, bicycling, following the Grateful Dead and selling tshirts, whatever...

      I would always advise them that if there's something you really loved doing there was a way to have that love provide you a living. "Not necessarily a great living.", I would caution. "You might have to be a member on a pro bike racing team for little more than minimum wage, but you'll be close to doing what you love. Closer than most people, anyway."

  • xykademiqz says:

    This is a real issue in the US culture. Nobody has a problem stating that an athlete is not talented enough to make it to the big leagues, and it is universally accepted that you have to be talented AND want it badly/have mental toughness AND work really hard in order to make it. The same is more-or-less accepted in the arts. But for some reason, when it comes to intellectual pursuits, it seems like it's forbidden to assume that talent (or if you don't like the word talent, then natural aptitude) plays a big role and that it's not true that all you need to do is want something hard enough or work on something hard enough. You have to have all three (talent, hard work, and mental toughness) to have a real chance at a big success... And even so, you might be thwarted by poor luck.

    I see these students who get Bs in my undergraduate courses and they complain that they are killing themselves with how much they work, and they wonder why can't they get an A. I cannot tell them, as it's really frowned upon, the real reason; the real reason is, as I see through their work, that their aptitude is average at best. And I know it seems unfair when they see the classmates who put in 1/5 of the work but just get things so much more easily...

    The problem is, telling kids earlier in their schooling that they do or don't have an aptitude for something seems to be tailor-made for abuse by misogynist or racist educators who would quickly tell girls that they can't do math or tell poor black kids that college is not in their cards.

    I don't praise my child for specific achievements, but for attempts, because that promotes flexibility. I wanted to reply, it is also promotes self-indulgence, and entitlement.

    I agree. I heard talk recently on fixed mindset versus growth mindset, where the speaker didn't do a very good job. Indeed, we want the kids to develop a growth mindset, i.e., recognize that doing anything even remotely well requires effort and most people can't do things well the first time they try. But people take it too far, substituting hard work for everything else that matters. Sometimes a little hard work goes a long way, but sometimes even a lot of hard work doesn't get far. We need to teach kids to pick their efforts wisely.

  • I agree with Xyk 100%. The people who fail my class either don't do the work, can't do the work, or both. I've had a few rare students who seem like they have the intellectual capability, but are psychologically unable to stop using study/learning strategies that don't work for my course (usually these are people who insist on trying to memorize the material for a problem solving based course).

    It unfortunately does weak students no favor to pretend they will somehow succeed in my subject. They are much better off finding something else that they both enjoy and have aptitude for than to try to compete with people who are better at my field for jobs/advanced training. I've seen hard working B students eventually figure something out and start getting A's in their last years (rarely), but I've never seen this happen for hard working C students. If students aren't working, and low grades don't motivate them to change this, they are also better off changing fields.

    • potnia theron says:

      to both PA and XYK: This is part of the problem. I think one of the reasons that it exists is because "ability", as is true of "collegiality" has been used as a code to keep others out of academia. And of course, there are still people who believe that race, gender, even religion, determine one's abilities.

      What made the case I describe easier is that the grading was anonymous, and as objective as possible. The question of preparation, support, etc still needs to be addressed. But I see that as a different basket than having failed multiple courses twice.

      • JL says:

        Anonymous grading might make it less subjective, but it does not take the cultural biases off.
        As a foreigner in the US I have noticed that exam taking is different in this country. It is not just a matter of being better or worse.
        Of course, it can be argued that someone who wants to be a physician in the US has to be good at taking US exams.
        Let's not fall in the trap of thinking that we are truly being objective by grading technique. It will always favor some at the expense of others.

        • potnia theron says:

          I appreciate that such biases exist, having seen them. This issue and this student was not about biases, however. She was, in my view, looking for excuses. For medical school, our exams are based on the medical board exams, with questions in the same format, and the same kinds of q's. If a student cannot pass these classes, they have little chance of passing the boards. This is a different question than whether the boards are "fair" or even "appropriate" for training.

  • --bill says:

    I teach at a non-selective regional university; we get lots of borderline students. We've found two things: 1, many of our students don't have good academic skills, and 2, "academic skills" is a thing that can be learned.
    Study groups, for example. When I teach introductory math, I tell them that study groups work best when everyone has tried all the homework problems on their own, and then the study group goes over the ones people have problems with. Our students come in believing that an effective study group is one that starts the homework together. But that approach doesn't work well.
    Our university provides support to borderline students to help learn academic skills, and works with faculty to provide such support in classes.

    • potnia theron says:

      One of the issues with the level of support you provide is to determine what is possible with a class of 100-150 medical students. We have extensive student services, tutors, etc. All of the faculty in this course have an open door policy, and an "email me and I will see you within 48 hours" policy. This woman never came to see me once in the two years she took this class. And, I always get a few course review comments that say: Dr. Theron spends too much time teaching us how to learn and not enough time telling us what we need to know".

  • Microscientist says:

    I work at a compass point state university, in a state that does not give much funding to education as a whole. I've encountered many of these students. Her blaming of the lack of support is the only way she can blame someone other than herself.
    But I do think there is one way now that you and the med school can help this student. She was "smart enough" to get into med school, but now has failed. I'm sure at this point that she is totally at a loss as to what to do with her life. The med school could help her to explore other options. Maybe she would be good as med lab technician, or as a PA, or going into research or clinical trials, or teaching science at a middle or high school. My guess is that some of what she was looking for was direction of where to go, beyond admitting failure and returning home to work at a startbucks for the rest of her life. Many of my students say they want to me MDs because its the only science related job that they know of. We try very hard here to educate students (and their parents!) about other options.

    • potnia theron says:

      Some of this happened, but perhaps not enough. One of the assumptions is that medical students are grownups, and that they should be able to do this. I truly think that some of these classes are not conceptually difficult, but require massive ingestion of information (not just memorization, but a linked-map-of-ideas). You cannot learn this material the day before the exam. Or even the week before the exam. Lots of students get a wakeup call with the first exam, and in fact, we've started giving a "mini-exam" 2 weeks into the course, a little sooner than half way to the first exam. Doing that helped the scores on the first exam tremendously.

      However, this still begs the question of how much is appropriate to help students, and at what point are they adults who need to figure it out for themselves.

  • becca says:

    This one is tough for me, since I encountered several people in grad school who told me I didn't have the aptitude to continue in science. Truth be told, I *don't* have the aptitude I originally hoped for, and I'll never be a gifted experimentalist.
    That said, it was awfully hard down to pin down what people meant when they said "aptitude". When people could articulate what skills I lacked, I really appreciated it, even if I felt grumpy about it at the time. In some cases those weaknesses were later identified as strengths by other people, precisely because once I knew it was a weakness I could work on it.
    But often, people couldn't pin it to skills, it was instead a nebulous all-encompassing type of thing. Unfortunately, in many cases they were engaging in pattern matching rather than analysis of capacity. They knew X, Y or Z type of person who had succeeded in science, and I was a Q type of person, ergo I didn't belong (see: susceptibility to various -isms, but also just personality type factors). I am not opposed to the idea there is an innate immutable aptitude necessary to become a scientist, or a physician. I remain agnostic on that count. But I have a root distrust (not to mention dislike) of anyone who uses "lack of aptitude" as a reason someone hasn't succeeded without being able to explain how they assess it and why that assessment is valid.
    I suspect the truth is we haven't a clue what aptitude *is*, how much is necessary, or how it is shaped by internal and external factors (including desire and luck and and the educational environment).

    • xykademiqz says:

      I think it's a matter of thresholds really. For instance, the natural aptitude in math needed to be a professional mathematician is much higher than what is needed to be a mechanical engineer, even though the aptitude threshold needed to be a mechanical engineer is still well above average.

      In experimental sciences the concept of aptitude does become more nebulous, as it combines things like thinking logically, manual dexterity, and some level of creativity... But I definitely knew people with "golden hands" who could make equipment sing and who could come up with new and improved techniques or very creative ways to test hypotheses, in contrast with a majority of people who could learn to use the equipment competently but that was about it.

      I would say that natural aptitude means the ability to quickly improve at something, a high first derivative if you will, combined with some innate enjoyment of the activity. For instance, I believe I have a fairly high aptitude for math and the physical sciences -- it always found it easy and enjoyable and I was always hungry for more. In contrast, I have always considered history to be deathly boring and it was a chore to study it, so I wouldn't consider myself to have an aptitude for history even though I could always get an A.

    • It is easier to see lack of aptitude in a class setting, because a class is designed to teach some specific concepts and or/skills that students master (or don't) to some degree. I've worked with struggling students who have no study skills, students who study hard but don't study effectively, and students who study hard but just can't master the material, even though they are trying every trick I know. I give my students many suggestions on how to learn more effectively, but I can't make them follow my suggestions. Some do, some don't. I don't take it personally if they don't, but I also don't have much sympathy if they are then upset about their grades.

      It is much more nebulous (and subjective!) to say someone lacks aptitude as a scientist. It is definitely true that someone who is not a natural at something can succeed through hard work, but only if they have ability at least above some minimum level--for example, someone who cannot do math cannot succeed in my field, regardless of desire. Aptitude is in some way self-reinforcing. People often enjoy doing things they are good at, and doing more of those things makes them better at it. I agree with Potnia and Becca that aptitude has/is often used as a way to keep certain people out, but that doesn't mean it doesn't exist. I've certainly encountered students I didn't think would be successful as scientists in my field. That said, I don't give unsolicited advice to students unless I am in a supervisory role (PI or member of their committee).

    • potnia theron says:

      No we don't know what "aptitude" is, and the class /admin/promotion of students committee try not to use that word. But, if a student can't pass the exams, they are not going to pass the boards. As I have said elsewhere, ability to pass the exams is not the same thing as whether the exams are fair, appropriate or accurate assessments. What is on medical boards (Step I, Step II, Step III) is determined by a group of people, most of whom care passionately about the subject.

      This is also a different question from who gets to be a physician in the US. I'm not arguing about those. I recognize that there are problems in that. But differentiating amongst being smart enough, or working hard enough, or being clever enough to figure out the system, is not the issue. She had one chance, and couldn't do it. She failed the same things, again, and could not see that the problem was hers.

  • becca says:

    xykademiqz- I don't see it as a matter of thresholds. A lack of rigorous background can be partially compensated for by a larger amount of aptitude, and I'm not sure much can compensate for active dislike of a subject. It is true that some arenas are more tightly competitive, so you need more factors working in your favor overall. It is possible that e.g. top mathematicians all have the background and the passion, so at that point it might seem like "Fields medal recipients" go to pure aptitude. Yet at least in the natural sciences, there is a high degree of serendipity and (to be blunt) popularity of topic that go into e.g. a Nobel. At the end of the day, I doubt anyone can accurately assess the specific aptitude component, but there comes a time when you have had something of a fair shot in an arena when you can conclude that one doesn't have enough of those combination of factors going for you. It's unfortunate for areas of study where the field in school doesn't look much like the day to day reality of the profession (though if anything, I'd imagine that's more of an issue for medicine than academic science).

    ProdigalAcademic- I can see how a class setting can give (ideally a relatively objective) measure of *achievement*. But nobody who has ever encouraged a blisteringly bright student to repeat a class after they had to withdraw because they had too many chemo treatments (or equivalent edge case) would argue that they measure *only* aptitude.

    Also, with all due respect, if I were working with a student who could not master the material despite trying every trick *I* know, my first thought wouldn't be their lack of aptitude so much as my lack of knowledge of tricks. Granted, you may know a *lot* more ways of acquiring knowledge than I do, and you may have tested them against many more students.

    potnia theron- barring edge cases, I'll grant that a student who can't pass classes probably can't pass boards. I don't think boards are so spectacularly well designed there are no "false negatives" in using them as a screen, but that doesn't matter much for the student. In this way board exams are a real blessing to med school profs- as they depersonalize some of the gatekeeping of students paying an arm and a leg in tuition.
    At the end of the day, the degree to which we use an internal locus of control in assessing failure is something that's highly personal and not at all easy to optimize. I'm not at all sure it's *healthy* to see the problem as yours when you fail, if that makes you less likely to try the next thing with all you've got. To the degree the student came off whingey, or you were expected to do emotional labor that you are not implicitly socially contracted to (as your statements about not having any particular way to help her imply), that is not an adaptive habit for her. But seeing a failure as a lack of systemic support rather than a lack of innate aptitude? That might well be correct, or even mostly incorrect but still a more useful focus.

    • xykademiqz says:

      A lack of rigorous background can be partially compensated for by a larger amount of aptitude

      becca, I am not sure what you are saying in the comment above. Are you saying there is no such thing as aptitude? Or that aptitude and background can compensate for each other? Because I don't think that's true in both directions past high school.

      Aptitude can indeed somewhat compensate for a lack of rigorous background (where background = hard work plus good schooling) but converse stops being true somewhere in college. You start seeing attrition (as Prodigal does), because some students put in a ton of work and spend extraordinary amounts of instructor time and effort, as we try to help them every way we can, and they still cannot get the concepts well enough to be able to use them to effectively solve problems. It's not that the instructor doesn't know enough tricks; an experienced instructor like Prodigal knows plenty of tricks, and certainly enough to help the vast majority of students, provided they are willing to use said tricks. It's that these people who require extraordinary investment of time by themselves and the instructor, and still do not improve much in response to such focused coaching, simply should not be pursuing that discipline. Their aptitude is below the threshold needed for pursuing that discipline. Not everyone can major in everything.

      I mean, we see that all the time with sports, I don't know why it's such a taboo in intellectual pursuits. No one has a problem telling kids at age 10 that they didn't make the cut for a higher-tier soccer or basketball team because they don't have enough talent, and the kids are encouraged to pursue another sport. Yet somehow it's okay to waste everyone's time and energy by requiring instructors to bring to competence every student who fancies themselves in a certain major, regardless of the student's aptitude or background, even though these students are young adults who should have considerably more self-awareness than a 10-year-old.

      top mathematicians all have the background and the passion

      Do you know some creme de la creme mathematicians? I do, and their colleagues -- who all have superb math abilities-- regard them as gods. They have a preternatural ability to solve long-standing, difficult problems that others can't. That's a gift and you cannot teach it.

    • I agree 100% with Xyk. Not every student can major in every subject, and it does a disservice to students to pretend otherwise. I don't think grades always correlate with aptitude--there are loads of reasons why someone might not do well in a class. That said, if a student is working hard, taking advice on how to improve their study skills, doing all the assignments, coming to class, reading the appropriate material, and in general spending hours and hours in class, in my office, and at home, and they still can't master the material, then they have no aptitude for it. They may enjoy it, they may WANT to master it, but they can't do so without levels of effort not required by the vast majority of the students in my classes.

      I never meant to imply that I am the best educator ever, but if someone is spending so much time (theirs, mine and sometimes others) for so little result, they should perhaps consider that the subject isn't for them. Whether they do so is up to them--I've certainly persisted in things I wasn't particularly good at that I enjoy anyway, but I didn't attempt to base a career in them.

      By now I've seen quite a few fourth or fifth year students, desperate to pass a required class (or several classes) after one or more previous attempts, who are trying to just finish up and graduate so they can move on to something else in a different field while salvaging something from their time and money spent. These students would definitely have been better off if an academic adviser had suggested exploring other options earlier in their student career. Same for a medical student who cannot jump through the required hoops. It doesn't actually matter if the hoops actually can determine who will be a good doctor--right now, they are required to become one regardless of their predictive value. Best to cut losses now before they have 4 years of medical school debt to pay off rather than just 2.

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