Section 4: Giving a Remedial Grade
A remedial grade, while initially uncomfortable for all involved, is a helpful process when a student needs to understand the extent of the issues keeping them from a successful clinical performance. While it is tempting to give a grade that is passing so that a preceptor can avoid awkward moments, this merely passes the buck and can cause the student to waste thousands of dollars before they potentially are dismissed from the program without a degree. Below are examples of a poorly-delivered verbal conversation about a remedial grade and a professionally and warmly given remedial grade.
Poorly Delivered, Unhelpful Script (What Not to Do)
Preceptor:
“Hey, we need to talk. You’re getting a remedial grade.”
No pause, abrupt tone
Preceptor:
“You’re just too slow in clinic. You’re not finishing your charts, and honestly, your thought process isn’t where it needs to be. I shouldn’t have to chase you on this stuff.”
Student is visibly uncomfortable
Preceptor:
“I don’t know why these things aren’t clicking for you. Other students don’t have this problem. You need to figure it out because we really don’t have time to keep reviewing the basics.”
Preceptor:
“I’m giving you a remedial grade because you’re behind. That’s just how it is. You’ll need to improve somehow. Maybe try practicing or something.”
Dismissive tone
Preceptor:
“Anyway, that’s what’s happening. I hope this doesn’t come as too much of a shock. Let’s get back to clinic; we’re already behind.”
Well-Delivered, Professional, Supportive Script
Preceptor:
“Thanks for meeting with me today. Before we talk about your midterm performance, I want you to know my goal is to help you grow into a confident and capable clinician. You are absolutely capable of succeeding, and I want to work with you to get there. How do you think you have been doing in clinic?” [Here, the student either confirms they are struggling or thinks that they are doing well. Respond with open posture and nonjudgmental tone. “I agree” or “I see. I wanted to spend some time with you because I’m seeing things differently”]
Pause, warm tone
Preceptor:
“Based on your performance so far, I do need to let you know that you’re receiving a remedial grade at this point in the rotation. I know that may feel disappointing, so I want to explain clearly what this means and why.”
Preceptor:
“One area is exam efficiency. You are improving, but you’re consistently requiring significantly more time than is reasonable for your level. This affects both the flow of clinic and the number of patients you’re able to see. The good news is that efficiency can absolutely be improved with deliberate practice.”
Preceptor:
“Another concern is chart documentation. We’ve discussed the importance of completing charts on time and ensuring they are complete. There have been multiple sessions where charts were not fully finished, or important components—including medications, allergies, and key findings—were missing. Thorough and timely charting is an essential professional responsibility, and we need to see consistent improvement there.”
Preceptor:
“The last area involves analytical thinking. You often have the right information, but you struggle to connect the findings into a coherent assessment and plan without significant prompting. This is a very common developmental hurdle, but we need to see you taking more initiative in reasoning through your cases.”
Pause, supportive tone
Preceptor:
“This remedial grade is not a punishment—it’s a signal that you need more structured support. And I want to provide that. Here is a plan I think will help:”
- “We’ll schedule one-on-one skill-building sessions for efficiency and exam flow.”
- “I’d like you to complete your charts within 24 hours, and I’ll review them with you for the next few weeks.”
- “We’ll practice writing assessments and plans together using sample cases.”
- “I recommend dedicating time outside of clinic to review your cases and look up related learning issues with a clinical tutor.”
Preceptor:
“I want to be clear: you can pass this rotation. You have strengths, including your professionalism, rapport with patients, and willingness to learn. If you commit to the improvement plan and stay engaged, I am confident we can help you reach the expected level.”
Preceptor:
“How are you feeling about this? I’d like to hear your thoughts and answer any questions you have. My goal is for you to feel supported while understanding the seriousness of where you stand.”
