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04-06-2019 | Failures/Surprises | Uitgave 3/2019 Open Access

Perspectives on Medical Education 3/2019

Training wheels needed: Lessons in professionalism from a liberal deferral policy

Perspectives on Medical Education > Uitgave 3/2019
Michelle Daniel, Tamara Gay, Rajesh Mangrulkar, Paula Ross, Sara Weir, Emily Hogikyan, Owen Thompson, Sally Santen
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s40037-019-0520-7) contains supplementary material, which is available to authorized users.
“It was an interesting experiment and an epic failure” Rajesh Mangrulkar, MD, Associate Dean for Medical Student Education, University of Michigan Medical School


The results presented herein were determined by the University of Michigan Institutional Review Board to be not-regulated status (HUM00111390).


Learning to self-regulate is an important aspect of professionalism. Thus, in 2015–16, the University of Michigan implemented a learner-centred ‘deferral’ policy called ‘trust and track’ in the preclinical phase. This gave students the autonomy to decide whether to attend required experiences, take quizzes and exams on schedule, or submit assignments on time. Surprisingly, quiz and exam deferrals remained relatively stable, but required experience deferrals more than doubled. While late assignments were not specifically tracked, there were multiple reports of assignments being months overdue. Some reasons for deferrals exhibited questionable judgement. Behavioural patterns carried forward, with an unusual spike in deferrals of licensure exams and requests for time off in the clinical phase. Wellness indices did not improve, despite learners having more autonomy and flexibility. It became clear to us that novice learners need clear professional expectations with limits to assist in developing professional behaviours. In 2016–17, we implemented a stricter policy that set clear expectations, established limits, and provided guidance on acceptable reasons to defer. We simultaneously implemented other measures to promote wellness. The moral of the story is that ‘training wheels’ are needed to help early learners develop the professional behaviours expected of practising physicians.
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