How Common is Remediation in Medical School, & How Can Tutoring Help

Remediation can be an anxiety-inducing term. The thought of failing a portion of your medical education and needing to formally address it may evoke a sense of dread. However, remediation is quite a useful concept. Rather than viewing it as a form of punishment, it is best to think of it as another approach to learning. Here we unpack what exactly remediation is in medical school. How common it is, how medical schools tend to approach it, and how tutoring is a valuable tool in both preventing remediation and addressing it effectively when it does occur.

What is Remediation in Medical School?

Remediation in medical school is distinct from remediation in residency and for attending physicians. We will focus on the process in medical school. Remediation during medical school relates to exams and coursework rather than clinical performance. We will also discuss academic remediation. Professional remediation due to lapses in professionalism standards is a different process and may involve disciplinary action.

In medical school, academic remediation occurs when a student does not meet the minimum competency criteria for a course. It is not meant as a punishment for failing. Instead, it is a process used to improve a student’s knowledge and performance. The goal is to help students progress to the next course or phase of their program. Medical schools vary substantially in how they define their minimal competency criteria. This is especially true since moving away from letter grades and towards more holistic and flexible criteria. Thus, exactly what level of performance results in remediation will be different depending on the program and the course.

Additionally, some schools implement formal remediation processes for students who fail USMLE Step 1 or Step 2 CK. The criteria for passing this exam are clear and uniform. That being said, schools take different approaches to a failed attempt (refer to the section below on how medical schools address remediation).

How Common Is Remediation?

Remediation occurs at virtually all medical schools, but the cumulative prevalence tends to be relatively low (though not unheard of). One study placed the rate at approximately 3% of students across a span of 6 years. This included all types of remediation, including academic and professional, as well as a variety of causes including mental well-being and time management issues. This study also found that remediation processes and resources together achieved a 90% success rate.

The takeaway is that remediation is not widespread. This means there are numerous ways to seek help throughout medical school (e.g., tutoring) to master challenging material. However, it is a universal occurrence at all medical schools. There are established procedures to help students achieve success after an initial failure. If you fail a course, know that you are not alone. There are many people and resources available solely to ensure your success. 

How do Medical Schools Address Remediation?

As described above, remediation looks different across schools and course/exam types. There are many variables to keep in mind, such as:

• Whether remediation is optional or mandatory
• Who you must reach out to following a failed course, or if you are automatically contacted
• Timing of the remediation/retake (immediate vs. delayed, e.g., over summer)
• Can you proceed in your program in the meantime
• Where information about remediation is available (often in the student handbook)
• Does remediation show up on your transcript

Remediation Following a USMLE Exam Failure

Remediation following a USMLE exam (Step 1 or 2) may also be unique. Because this is a standardized exam, schools may have more formal requirements about remediation prior to retaking the exam. In fact, many schools take steps to minimize failure rates on the first try to reduce the number of students requiring remediation. One of the most common procedures is to require (or encourage) students to take NBME practice exams. Afterward, students may confer with their dean or another representative about their likelihood of passing prior to scheduling their exam date. Many schools encourage delaying the exam rather than making a first attempt with a low chance of passing.

If a failure does occur, a school may recommend tutoring or other resources to help with studying prior to retaking the exam. More specific steps may also be invoked, for example:

1. Make an appointment with the dean for student affairs to determine possible reasons for failing
2. Create a specific remediation plan, perhaps involving one-on-one tutoring
3. Provide proof of a practice test score that is above a certain threshold above the minimum passing score (e.g., indicating at least a 95% chance of passing)
4. Apply to retake the exam after gaining approval from the dean

Remediation for Shelf Exams

Shelf exams during clinical rotations are another distinct set of exams where remediation may occur. Due to the fast-moving nature of clerkships, failing and needing to retake a shelf exam can risk falling far behind. Thus, some schools allow students to retake a shelf exam after all core clerkships have been completed, sometimes only as long as all other exams were passed. A retake opportunity in this circumstance can be very helpful. It allows a retry without having to redo the entire rotation.

Whether you fail a course, a USMLE exam, or a shelf exam, the most important step is to seek help. This may be by reaching out to the professor of the relevant course, your dean, or another representative to discuss school policies and next steps. And remember, their goal is always to help you learn and improve so you can become a good doctor, not to punish or shame you!

Does Remediation Affect Residency Match Success?

The general consensus among students who have remediated and surveys from program directors is that it does not impact match success or feature prominently during interviews. However, there are a few exceptions. Most students who remediate have to do so for only one or a couple of courses, due to unique challenges with the associated material.

However, in some rare cases, a student may fail several courses or need to repeat an entire year. This indicates a broader struggle with the material, and some PDs may wonder about the underlying issues. If a series of failed exams or courses led to taking a year off, that might merit a dedicated discussion during interviews. It can, however, be a good opportunity. If this comes up, be honest and open about the challenges you’ve faced. Demonstrate maturity or resilience in your response to those challenges. Program directors know that you will experience hardship during residency. Being able to show a positive response in stressful situations reflects well. In other words, if you are careful and precise in your communication, you can turn your experience with remediation into a favorable aspect of your application.

Remediation during medical school is generally not a substantial barrier unless you are applying to top programs in the most competitive specialties, such as Combined Dermatology at Harvard. Such programs receive far more applications from exceptional students than they can accept. They can afford to screen out those who have remediated because there are plenty of equally impressive candidates whom they can interview or admit instead. In summary, unless you are vying for the very best programs in the country, remediation is not a major concern and is easily overshadowed by desirable qualities and good performance elsewhere. This is especially true if it happened early (M1/M2) and was not a recurrent issue.

Common Reasons for Needing Remediation

There are a multitude of reasons for failing an exam, or a course, and subsequently require remediation. These can range from personal issues (health, finances, family) to academic problems (trouble focusing, inefficient study skills, poor time management) to others. For many, the COVID-19 pandemic revealed just how strong of an impact external circumstances can have on performance during medical school. Social isolation, loss, and chronic stress are just a few examples of how extreme life events can make it hard to study and learn at your full potential and capability.

Other causes may be less circumstantial. In order to get into medical school, a majority of students will have developed effective time management and study skills during college. However, medical school is vastly different from college. You are responsible for learning substantially more information in a shorter amount of time. There is typically a higher expectation of independence. Resources will be provided, but there may not be specific graded assignments or ample weekly feedback. You are responsible for tracking your own progress. Professors are unlikely to approach you if you appear to be struggling. You must take this initiative yourself.

Be Honest With Yourself and Seek Help Early

All of these features of medical school make it paramount to take full responsibility for your education. Identify sources of difficulty or discomfort, and reach out to seek help as needed. The fact is virtually everyone struggles at one point or another during medical school. For some people, they are the most challenging out of all their years spent in school and in training.

Often the determining factor of whether a student ends up needing to remediate is whether they sought help early. This applies not just to study or time management concerns, but also to personal issues that are impacting performance. Most faculty members and administrators are highly receptive to the impact of personal issues. The key is to communicate whatever is happening in a timely and professional manner. Take the appropriate steps to prioritize personal issues as needed while keeping your medical education on track. Faculty and administrators can only help you if they know what is going on with you.

Remediation during medical school does not necessarily imply that a student is struggling personally or deficient in a particular study skill. It could reflect a set of strengths and weaknesses that are not, at least currently, completely aligned with those required to be a successful physician. For example, most medical schools now have prominent communication and clinical reasoning courses within the preclinical years. These emphasize “soft skills” in tandem with basic scientific knowledge. Some students may have an exceptional scientific background but received fewer opportunities during college to develop their written and oral communication skills. Conversely, others may have received a humanities-focused liberal arts education and have exceptional communication skills but may need additional help mastering difficult basic science concepts, such as fluid dynamics in the cardiovascular system.

How Tutoring Throughout Medical School Can Help

Tutoring plays a crucial role for many students in medical school, regardless of prior background or current degree of comfort versus struggling. There may be opportunities for group tutoring or supplemental services through school, but due to the immense amount of knowledge accumulated throughout medical school and the remarkably fast pace of the courses, personalized one-on-one tutoring is the best approach for many students. Starting tutoring early and maintaining a consistent schedule throughout the preclinical years is a fantastic way of minimizing one’s chances of failing a course or exam. In general, material in medical school tends to be far more numerous than it is complex. Much of it builds on the knowledge gained in college. Thus, simply falling behind on material is a common root cause of remediation. Tutoring is a straightforward solution to this because scheduling a regular meeting encourages consistent studying and practice.

However, there may be cases where consistent tutoring isn’t possible or it’s too late to start “preventive” tutoring. That is okay! At Elite Medical Prep we offer specialized remediation services, designed to develop comprehensive retake plans for exams or courses. We build into these plans an understanding of your school’s remediation policies, so that the plan is both tailored to your program’s requirements and personalized to your specific needs. For more information on a 1-on-1 Elite Medical Prep tutor can help you succeed, schedule a complimentary consultation today!

Conclusion

In summary, remediation in medical school is a universal experience. Schools have refined their processes to de-emphasize punishment and consequences and instead focus on improvement and a better path forward. The most important things to keep in mind when you experience remediation are to communicate with your school, understand their policies, and seek out help.