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Tabitha grounds her lessons in stories about her own life, career, faith, and family in this funny, down-to-earth book, built around the catchphrases that her fans know and love, including: Hello There! Reese's monthly picks Read with the club. Weather: A Novel. A lively and ambitious family novel. His wife, Keila, desperate for a life with a little more intimacy and a little less Weather Channel, feels she has no choice but to end their marriage. Their three daughters—Claudia, a television chef with a hard-hearted attitude; Olivia, a successful architect who suffers from gentrification guilt; and Patricia, a social media wizard who has an uncanny knack for connecting with audiences but not with her lovers—are blindsided and left questioning everything they know.

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Hardin has nothing to lose Life will never be the same. After a tumultuous beginning to their relationship, Tessa and Hardin were on the path to making things work. Hardin will always be But is he really the deep, thoughtful guy Tessa fell madly in love with despite his angry exterior, or has he been a stranger all along? She wishes she could walk away. Not with the memory of passionate nights spent in his arms. His electric touch. His hungry kisses. She put so much on hold for Hardin—school, friends, her mom, a relationship with a guy who really loved her, and now possibly even a promising new career. She needs to move forward with her life. Hardin knows he made a mistake, possibly the biggest one of his life.

But can he change? Will he change Tasty, BuzzFeed 's popular cooking brand, delivers both comforting and healthy weeknight dinners for meat-lovers, vegetarians, and vegans alike, plus treats like ice cream, chocolate desserts, and rainbow recipes galore. Now you can deliver on the promise of a great dish whenever the urge strikes. Get ready—your cooking is about to go viral. Fear of termination of the their course was a barrier to open communication with staff. The experience of remediation is influenced by the way in which students make sense of failing. Generic remediation programmes may fail to meet the needs of students for whom personal, social and mental health issues are a part of the picture. Failure at medical school has significant consequences for the students who fail, the faculty that provides support, and the institution that is responsible for delivering education.

Students who struggle at medical school may be at risk of struggling as doctors [ 2 , 3 ], therefore the problem also has implications for patients. Successful remediation for these struggling students is important. The traditional method for academic remediation involves a 3-step process: identification of students who fail at assessment; a remediation period, usually repeating part of the course; and re-testing [ 4 — 6 ].

This approach is now under scrutiny since there is evidence that this merely perpetuates the problem and students continue to fail further along the course [ 6 — 9 ]. Although students present with academic problems, these are often a proxy for other issues. These may be personal, professional or health-related, and consume substantial academic and pastoral care resources. Academic staff are beginning to recognize the importance of tailoring remediation approaches to the needs of the students with different types of problems. There have been efforts to develop profiles of struggling students such as the work of Hayes , which identified problems arising from immaturity, learning skills, organizational skills, health or personal issues and poor insight.

Such profiles can inform recommendations about appropriate interventions. There is a risk, however, that pigeon-holing medical students into boxes atomizes the complexity of problems and may not lead to more accurate prognostication [ 10 ]. There are few quantitative tools to help faculty fully understand the nature of problems among failing students, so a qualitative approach to the process of identifying the aetiology of failure may be helpful. It follows that the management of remediation may be more effectively planned for the student.

Given the high admissions standards and competitive demand for medical school entry, successful students are typically high achievers. That can make encountering difficulty during medical training particularly challenging because it is at odds with their prior experience and developing sense of self. The value of qualitative methods in medical education and evidence-based medicine is clear [ 11 , 12 ]; this paper demonstrates the added benefit of taking a case study approach by using the idiographic method, Interpretative Phenomenological Analysis IPA [ 13 ].

The conceptual framework of IPA is hermeneutic phenomenology [ 14 ]: hermeneutics is a theory of interpretation which puts meaning at the centre of the pursuit to understand human experience; phenomenology adopts an open-ended approach to describing phenomena in the world as they are experienced by individuals. A dialogic relationship between person and world is assumed which means that we cannot understand people in isolation and so must always take into account the context in which they live. In short, IPA research focuses on the person within their world in order to understand the phenomenon of interest from their perspective.

IPA has been used to understand subjective responses to illness [ 15 ], identity formation [ 16 ], psychological distress [ 17 ], and well-being [ 18 ]. The significance of case studies for making sense of the unique elements of experience is understood in clinical practice [ 19 ]. These demonstrate the incongruence of the experience of failure for these otherwise high achievers, and helped delineate the constituents of failure which students did not anticipate. These students had all failed their final-year examinations and requested to repeat the year in remediation. The students were invited to participate in the study at the start of their repeat year. Students were informed that involvement was voluntary and not a formal requirement by their medical school as a consequence of the failure.

A formal consent procedure was undertaken after students had been given background information sheets about the study and assured of confidentiality. Using semi-structured narrative interviews see Appendix 1 , participants were encouraged to describe their experiences of any failure on the course and how they made sense of these experiences. Both SB and CT have a background in psychology and are lecturers in medical education.

RP is a lecturer in medical education and provided informal teaching during the remediation period, however sessions were voluntary and not a formal part of the remediation programme for students at either medical school. Interviewers allowed participants to discuss topics and issues most relevant to them. Interviews lasted 60—90 min and were recorded on a digital recorder with the consent of participants and subsequently transcribed verbatim.

The idiographic nature of IPA required transcripts to be analysed case-by-case within a 3-stage process that included an initial exploration of the data, a review of emergent themes and a final drawing together of themes across cases [ 23 ]. RS has a background in psychology and is not a faculty member at either medical school in this study. Initially, phenomenological coding involved a detailed examination of meaning units small units of transcript. This was achieved by highlighting across sections of text and annotating the transcript with descriptive summaries of content, e.

During this stage, notes were made of language, metaphor or imagery used by participants and the tone of their account [ 23 ]. The second stage involved interpretative coding: looking at the transcript as a whole to identify patterns or inconsistencies within the account. This included looking for repeated use of particular language, and asking questions about what this language told us about how the participant had made sense of the phenomena or how they presented themselves in relation to it. Emergent themes were noted on each of the three individual transcripts. Finally, a cross-case analysis was conducted to generate a table of themes that represented the aspects of the phenomenon of failing which were shared between participants but also those aspects which were unique.

Pseudonyms were used throughout data collection and analysis stages to preserve the anonymity of the participants. Researchers are called upon to reflect on and make themselves aware of their own assumptions. This is to ensure their presuppositions biases do not impact unknowingly on the process of analysis and interpretation. The interviewers discussed findings among each other to challenge the trustworthiness of their own findings [ 25 , 26 ]. RS provided an external perspective since she had no involvement with the participants or medical education. Two participants were female Sarah and Alice and one was male Raj. Two of the three were graduate entrants Sarah and Raj and one was an undergraduate Alice.

We identified three themes: emotional trauma of struggling and failing; personal problems as inseparable from academic life; and social isolation. Other themes such as a lack of insight, poor self-regulated learning and external attributions for failure are described elsewhere [ 22 ]. Both Sarah and Alice struggled academically during their medical degree and failed a number of high stakes exams prior to failing finals. They both recognised limitations in their approaches to studying. Alice had dyslexia, and described how it took her a long time to read and assimilate information; she also felt that she tried to go into too much depth in her revision.

Sarah also recognised that her revision was not sufficiently focused. The most notable feature of their accounts of struggling and failing, however, was their description of the anxiety and emotional trauma they experienced. Sarah had successfully completed a previous degree in a different subject, and was shocked to find that she struggled at medical school. Clinical exams in particular challenged her ability to protect her self-esteem in front of others, since her low ability was there for all to see.

She felt that success just required her to work harder, but the pressure eventually took its toll and she developed depression. She failed the high-stakes mid-course exam and had to repeat the year. Her ability to think rationally was affected, she lost motivation for learning and felt she had sabotaged her potential because of her low mood and lack of motivation. I'd self-sabotaged with my 'What's the point? Alice also had high expectations of herself, having been a successful student prior to medical school. She described very similar anxieties to Sarah about the risk to her self-esteem from performing poorly in exams, particularly clinical exams.

The drive to maintain her well-being prevented her from developing the resilience required for performing at assessment and learning how to think clearly under pressure. And then she just looked at me, gave me this stupidest, weirdest look. It was really horrible [Alice]. Alice was devastated by her exam failures, which severely undermined her sense of self-worth. In describing her experiences, she used language suggestive of trauma and post-traumatic stress.

I dreamt about [the exam]. I had nightmares. I stopped using the perfume […] it was awful [Alice]. She described feelings of guilt at letting her family down, and became increasingly fearful of failure. Her experience of repeated failures, and associated fear and trauma resulted in a downward slide into severe depression, making it difficult for her to engage with the course, or to face sitting an exam. He described how it had taken him some time to come to terms with the emotional fall-out of failing, but, because he could attribute this failure to breakdowns in his personal life rather than his academic ability, he was better able to make sense of the failure and move forward.

I was gutted. Completely gutted […] It was a surprise in some sense and not in others. Personal problems affected all of the participants and all of them failed to cope with them whilst trying to prepare for assessment. Sarah struggled academically throughout the course and experienced ill health and depression. These problems were compounded by relationship breakdowns at the time of a mid-course high-stakes exam, and again around finals, which impacted negatively on her ability to study and her mental health.

She also experienced financial hardship and worried more about making ends meet. One consequence of this was she did not take her depression medication regularly. I was on treatment [for depression] on and off. It was entirely the cost [Sarah]. Sarah felt that she had to keep these problems to herself rather than sharing them with, or seeking help via, the Medical School. She made a stark contrast between what she believed was the position of the medical school — that students should keep their personal problems separate to their academic life — and her own belief that the emotional consequences of personal problems inevitably impacted on her ability to succeed. Interestingly her account demonstrates a belief that health problems, but not personal problems, would be judged to be legitimate reasons for failure.

I know medical school isn't interested in relationships so in my appeal had to emphasise some of the other problems I had going on, but really it was the relationship that caused me such problems. I think if it had been just a few health problems, I don't think I would have descended into depression again. For Alice, personal problems were not the most prominent feature of her account, but her experiences of struggling academically were set in context of a bereavement.

It was a good start to Phase 2, but then unfortunately my best friend from back home died in a car accident […]. While Alice suffered serious mental health problems as a result of her experiences of failure, as described in the previous section, her account suggested that the loss of her friend acted as a tipping point, resulting in the development of severe depression. Alice approached the Medical School about her depression, and accessed counselling. She found this helpful in coping with her feelings, but found counselling sessions exhausting, leaving her unable to study while she recovered from each session.

I wanted the counselling and it really helped, but it took a lot out of me. I was so tired emotionally and drained [Alice]. Having been a successful student throughout his medical degree, he experienced a relationship breakdown before his final exams, resulting in a downward spiral of emotional and financial problems. He found this period of time extremely traumatic and distressing, and described how things fell apart for him. I was about three thousand pounds in debt [and I] suddenly owed the landlord [that money]. All three students recognised in hindsight that the ability to draw on the support of other students and engage in group study was critical for success.

The students felt that they had been relatively socially isolated for a variety of reasons, and that this had disadvantaged them. Sarah believed making friends was difficult for her since she was older than her peers. Sarah acknowledged that she had missed opportunities to benefit from social learning, and she reflected on this in considering what advice she would give herself if she was starting her course now. Alice had support from her boyfriend who was also studying medicine, but struggled with finding enough time to make friends, in the context of the amount of time and effort she felt she had to put into study. I never studied with anyone.

She felt that the culture at Medical School was such that it was difficult to discuss failing with other students, meaning that she ended up working for resits alone. Raj felt that he had had a good social network during his studies, but that this network had dispersed by the time he discovered he had failed his finals, leaving him to face this alone. Sarah failed both the written and clinical elements of the final exams. At the time of interview Sarah had not started remediation, but her relationship with the Medical School had been damaged by her perceptions of the response to her failure; she did not believe that the Medical School was motivated to act in her best interests. At finals, Alice passed the written papers, but failed the clinical exams.

By the time of resits she was suffering from insomnia, anxiety and panic attacks. Alice felt that the generic support provided during remediation, which focused on approaches to learning, was not appropriate for her. It was about how we study, how we can improve, there was some exercises. She appreciated the attention and support that she received from her personal tutor during the remediation period, but her account had an underlying tone of bitterness and regret that the Medical School had not given her the same level of support and care during her degree, which may have helped her to get through without failing. How about before that? It could have not ever happened if you cared or gave a bit more of attention [Alice].

Raj, having failed due to personal rather than academic difficulties, found the generic nature of remediation frustrating. He described how his own attempts to proactively seek support that met his needs during the remediation period had been met with a punitive response from the Medical School. This experience acted as a barrier to open dialogue about how remediation could be tailored to his needs. Is there anything we could do to make that better? This work has demonstrated the individualised journeys of failing students, within which there may be common themes.

We have been able to demonstrate how the interaction between internal and external factors may overwhelm students who fail, thus hindering or preventing their remediation. Students attributed their failure, and subsequent emotional experiences, to a range of internal and external factors, including their own abilities, and health and personal problems. The analysis identified that failing in itself can generate significant emotional trauma. This made it difficult for them to access support and suggests that students need to develop emotional intelligence and self-awareness to recognise the links between personal growth and struggles and their professional competence.

These students also experienced social isolation, which deprived them of opportunities for social learning. The study findings have implications for the ways in which medical schools seek to understand, support and remediate students. This study provides further evidence that personal problems [ 30 ], poor relationships with others and mental health problems [ 31 , 32 ] can arise from, and can complicate, academic difficulties. Despite this complexity, the majority of remediation still involves the provision of more teaching [ 33 ]. This study suggests providing yet more teaching to students with complex problems will not be effective for managing unresolved personal problems, developing interpersonal skills or improving psychological well-being.

There are systems in place for classifying and managing the students who fail at assessment based on whether individuals struggle for predominantly academic, personal or professional [ 1 , 36 ] reasons. Yates [ 36 ] recognised the value of recording adverse health, social and behavioural events encountered by students to better predict those at risk of failure and this study adds more support for that to happen. Whilst those studies used quantitative methods for better understanding the problem of failure prior to it happening, this study attempted to explore the nature of the problem after the event through the use of a qualitative approach.

Stress and vulnerability are recognised among medical students at the start the course [ 37 ], however the findings from this study suggest both may be present in significantly high levels among students susceptible to repeated failure. The use of an IPA approach is a particular strength of this study; this approach has generated an important perspective on the experience of failing students, and one that differs in depth and focus from that generated by using a thematic analysis approach. The idiographic nature of IPA enables the individual story to be preserved, giving vivid and cohesive pictures of the experiences of individual students.

There is potential for the essence of the IPA technique to be transported to an educational setting. A simple recommendation might be that education providers offer failing students a safe, one-to-one meeting with a personal tutor or equivalent to reflect upon their performance and their situation. The process of articulating this will evoke meaning-making, which if facilitated in a non-judgmental way will identify idiosyncratic issues and enable the development of individualised strategies for remediation. This study presents findings from a small sample of only three students.

This is consistent with recommendations for studies using IPA to gain a deeper understanding of a phenomenon [ 13 ]. This approach, while enabling a deep and rich understanding of the accounts of individual students, has some limitations. The students in this study had failed finals and the re-sits, and the experience of failure may be different for students who fail other high-stakes assessments but subsequently pass and graduate as doctors. The experience of failing is presented from a UK context in two Universities, and the phenomenon may be different within other institutions or from an international perspective.

The findings explain why generic remediation programmes may fail to meet the needs of students for whom personal, social and mental health issues are part of the picture. Yates J, James D. Article Google Scholar. Disciplinary action by medical boards and prior behavior in medical school. New Engl J Med.