When Jeannette Guerrasio, MD, arrived at the University of Colorado Department of Medicine eight years ago, she discovered that residents who were struggling with the curriculum had nowhere to turn for help.
“They would just get passed along without ever being given the skills they needed to be competent physicians,” said Dr. Guerrasio, Associate Professor of Medicine and Director of Remediation and Individualized Learning Plans.
When she discovered there was no literature that addressed the issue, she created individualized learning plans for the bottom 10 to 15 percent of residents and students based on how they learn. That approach was in sharp contrast to the thinking at the time: encourage students to simply read more or give them a deadline to be able to demonstrate certain skills, for example.
She initially started with internal medicine residents but eventually expanded the program to include medical students and eventually all of graduate medical education.
She called program directors across the country to find out what they were doing and discovered they had no curriculum or programs of any kind. “I realized I had to build something from scratch,” she said.
The result of her work is detailed in her book “Remediation of the Struggling Medical Learner.”
She currently presents at several national conferences – she has seven on tap this spring alone.
“There are so many places that feel the need for this type of program,” she said.
And she has recently been selected to receive the 2014 Society of General Internal Medicine Award for Scholarship in Medical Education recognizing her leadership at the national level in developing programs and curriculum for struggling medical learners.
Starting from scratch is no small feat, and Dr. Guerrasio is quick to credit others who worked with her: Kirsti Broadfoot, PhD, Carol Lay, EED, Eva Aagaard, MD; Maureen Garrity, PhD, and Carol Rumack, MD.
“They all gave me ideas to try and helped guide me.”
The Department of Medicine’s remediation program includes about 40 residents and 40 students a year.
It takes about 22 hours of one-on-one time to successfully remediate a student. Every hour of dedicated faculty time giving feedback and methods to practice reduces negative career outcomes by 3 percent per hour, Dr. Guerrasio said.
“It’s not a quick process, but we know it works,” she said.
The program has a 90 percent success rate, that is, students have successfully passed an assessment after going through a remediation program and have gone on to graduate and practice. Of the remaining 10 percent, some end up on probation, some switch to nonclinical careers and some go into other specialties better suited to their skills. About 1 to 2 percent are not able to complete the program and find alternate careers.
She acknowledges that the work can be time-consuming and tedious, and she’s always looking for people to help.
She says her own personality lends itself to such work and likely led her to develop the program in the first place. “I’m approachable,” she said. “Part of my strategy is to help with how students learn.”
Dr. Guerrasio’s second book is currently with the publisher. She also is working on a research study to help residency programs set policies around remediation. She notes that there are no national guidelines on how to work with people who are struggling and hopes the study will help.
In her free time, such as it is, she plays the oboe and writes. She and her partner also keep busy with their two dogs and two cats.