Managing the struggling ophthalmology learner: a review

Medical trainees frequently experience challenges in clinical education requiring educators to be prepared with possible informal remediation strategies. Educators can apply familiar clinical problem-solving techniques to address the struggling learner. This article will apply and expand upon the subjective, objective, assessment, and plan (i.e., “SOAP”) format, commonly used in medicine, to create a guide for addressing the struggling ophthalmology learner. The SOAP format provides for “S” subjective self-reflection by the learner; “O” objective institutional metrics for improvement over time; an accurate “A” assessment of the root causes for any deficiencies; and a structured, measurable, and timed “P” plan for performance improvement that ensures due diligence and, if necessary, due process. The root cause of a learner’s deficiency is often multifactorial, with cognitive elements (difficulty with organization, incomplete knowledge base, etc.) and non-cognitive personal elements (personal responsibilities, mental health challenges, etc.). Additionally, there are steps that can be added to the SOAP format to create a more comprehensive approach. Learner difficulties may be prevented by providing an orientation at the beginning of rotations to outline learner expectations. To recognize learner deficits rapidly, learners can be screened for challenges using frequent assessments. After remediation has been completed, the learner should be reassessed to determine if competence was achieved. This process can assist learners and educators across specialties, but tools and resources specific to ophthalmology education will be included in this article.