The Anesthesia Record

The Truth Regarding Academic Remediation and Dismissal

For students, the fear of dismissal is a constant concern that only adds to the stress of anesthesia school.  We breathe a small sigh of relief at the end of each semester but when a classmate’s desk remains vacant the following week that uneasiness can return with a vengeance.  No matter our performance record, at one point or another we’ve all asked ourselves, “Will I be next?”

At the AANA Assembly of School Faculty held in Orlando, Florida this past February I had the opportunity to listen to the Program Director of the Uniformed Services University, Commander Robert Hawkins, DNP, MBA, MS, CRNA, speak on the topic of student remediation and dismissal.  He provided those in attendance with statistics related to anesthesia school attrition and described a number of remediation plans available to assist struggling students.  By the end of the presentation I realized that much of our fear as students is driven by inaccurate information and misconceptions surrounding the dismissal process.  Learning more about the subject of attrition calmed my anxiety and improved my understanding of the many paths to academic and clinical success.

Research

In 2005, an attrition rate survey tool was distributed to all existing nurse anesthesia programs (n = 101) within the United States¹.  Of the 93 schools with graduating students, 67% (n = 62) responded.  The researchers reported that 9% (n = 135) of the 1,499 students enrolled failed to complete their respective nurse anesthesia programs.  Voluntary withdrawal accounted for 35.5% (n = 48) of the 135 non-graduates.  Factors leading to withdrawal included personal concerns, unsatisfactory academic or clinical performance, and lack of knowledge related to the time commitment or role of a CRNA.  Academic dismissal accounted for 30.4% (n = 41) of attrition and was most often caused by poor academic preparation.  Poor study habits, insufficient undergraduate preparation, and lack of motivation were cited as contributing factors of academic dismissal.  Lastly, 15.6% (n = 21) of the 135 enrolled students were removed due to inadequate performance in the clinical arena.  Poor clinical performance and theory transference were most often at fault, though lack of motivation or interest in the profession, class size, and family issues were also listed as reasons for dismissal.  The remaining 18.5% (n = 25) of students failed to graduate as a result of impairment, academic dishonesty, health problems, or other non-specified issues.  The authors noted that attrition rates tended to increase in programs of longer duration (p = 0.031) and these events most often occurred 12 to 18 months following enrollment.  They hypothesized that increased stress levels stemming from the initiation of clinical training or increased clinical demands may be, at least partially, at fault.

Attrition: A Lose-Lose Situation

Nurse anesthesia students and their families make incredible sacrifices for the opportunity to attend CRNA School.  The cost of our education goes beyond just tuition payments, clinical fees, and textbook purchases.  Expenditures such as forfeited income, increased time commitments, moving expenses, and stress on our marriages and families must all be accounted for.  Oh, and let’s not forget the added cost of hair dye needed to disguise all those new gray hairs framing our exhausted faces.   Clearly, nurses sacrifice much for the chance to become a CRNA and stand to pay dearly should they fail to achieve this goal.  

While students are well aware of the ramifications of dismissal, it may come as a surprise that our faculty members and universities also suffer as a result of SRNA attrition.  Educators become invested in the success of their students and faculty morale is greatly tested by each instance of SRNA withdrawal or dismissal.  In addition, remediating struggling students is a time consuming and exhaustive process for many educators.  Providing these additional resources for struggling students is also a costly endeavor for universities.  Should the remediation process fail, schools stand to suffer even greater financial losses since academic institutions rely on tuition fees for revenue.   Finally, because the attrition rates of each program are reviewed by the Council on Accreditation, a student’s failure to graduate can have lasting implications on an institution. Although student remediation and attrition negatively impacts a wide network of individuals, our profession has a responsibility to protect the public.  This task requires our educators graduate only the safest and most competent of providers.

Remediation

While the removal of a student may seem sudden to his or her classmates, the SRNA was likely offered numerous resources and opportunities to succeed.  All effective remediation strategies consist of common components and goals². First, students must identify and acknowledge their deficiencies.  Faculty members should partner with these individuals to clarify the emotional components of the problem.  Together they must then match remediation activities to the specific problem and establish objective criteria and timelines for completion.   The student is also encouraged to partner with a mentor who is able to provide academic and emotional support during this transition period.  The goal of these efforts is to restore the student’s performance to expected levels.  Consistent evaluation of and adjustments to the chosen remediation techniques should be performed until the goal of remediation is attained.

Although commonalities between remediation strategies exist, each plan must be tailored to the individual student’s needs.  SRNAs commonly struggle with either didactic or clinical demands, though personality conflicts, lack of professionalism, or behavior problems may also lead to dismissal on occasion.  Didactic remediation courses may benefit students with inadequate knowledge or preparation, test anxiety, or poor time management.  If, on the other hand, students fail to apply their didactic knowledge in the clinical setting or continually perform skills incorrectly, clinical remediation in the form of case studies and simulation lab experience may be more appropriate.  In either instance, students must have the desire and ability to modify their behavior if they are to improve their performance and continue their anesthesia training. 

The Student’s Role

Given the expectations and stress we carry as nurse anesthesia students, it is only normal to feel a certain degree of fear throughout the schooling process.  However, we must not allow that fear to paralyze our academic efforts.  Instead, we should refocus that energy towards practices that will ensure our scholastic success.  This includes continually assessing our performance, identifying deficiencies and, most importantly, seeking assistance before it’s too late.  Asking for help may prove difficult for some but it is an important skill that all safe and capable anesthesia providers must cultivate.  In order to aid this process, we should strive to support our classmates by offering our assistance and providing encouragement whenever possible.  After all, it takes a village to educate a CRNA. 

I would like to thank Commander Robert Hawkins for his willingness to share his knowledge of remediation with the AANA Assembly of School Faculty attendees and his support for this article.

References

1.      Dosch M, Jarvis S, Schlosser K. Attrition in nurse anesthesia educational programs as reported by program directors: the class of 2005. AANA Journal. August 2008;76(4):277-281.

2.      Kimatian S, Lloyd S. Remediation and due process for trainees: setting the stage for future success. International Anesthesiology Clinics. Fall 2008;46(4):113-125.