The Student Guidance Program: A Road Map to Success

Danit Ariel, MD, MS

The professional life of clinical assistant professor of endocrinology Danit Ariel, MD, MS, took a pivotal turn one day in 2016. She had completed medical school, residency, fellowship, and an enriching postdoctoral year with professor of endocrinology emeritus Gerald Reaven, MD, during which time she was supported by a career development (K) award from the National Institutes of Health and an American Diabetes Association Mentor-Based Postdoctoral Fellowship Award, and she completed a master’s degree. She also had two children and was about to give birth to a third.

At that point, Ariel was deciding how to curate the next steps of her professional career. So she did a deep self-inventory, she says, to refresh and remind herself of what brought her the most meaning and what she was passionate about. “I’ve always loved to teach. I find it to be incredibly gratifying and fulfilling to be able to impact medical students at the early stages of their medical training, to excite them, and to ignite their passion for problem-solving and compassionate patient care. I realized I wanted to be formally involved with the medical school at the level of the medical student.”

She applied for and was granted the Rathmann Family Foundation Educators-4-CARE Medical Education Fellowship in Patient-Centered Care and spent a year immersed in medical education research, teaching, and curricular development. “My goal,” she says, “was to bridge my background in clinical research and epidemiology with my passion for medical education. It was during that year that I knew without a doubt that I wanted to find my niche within medical education.” Quite soon thereafter, on that pivotal day in 2016, she was recruited to be the designer and founding director of the Student Guidance Program (SGP), an innovative individualized mentoring/coaching program.

Identifying the Students

At a few critical times in the course of medical school, students have comprehensive exams to evaluate how they perform. Those are key junctures where it is possible to identify medical students who need additional clinical skills training, and then they are referred into the program.

In Ariel’s words, here is the backstory:

“Stanford School of Medicine has always held the belief that each student is here for a purpose and will make a unique contribution to medicine, science, society, tech, public health, etc., and we want to be able to support them as much as possible. The support was always there, with various faculty members contributing to individual students, but it was not centralized. Two visionaries pushed to get a program into existence: professor of primary care and population health Lars Osterberg, MD, MPH, and professor of surgery James Lau, MD, MHPE. They were the ones who brought this program into existence and supported its ability to flourish. And now we have a centralized program with a clear structure, created to support medical students who have increased clinical skills training needs.”

“I point out that every single one of us, including me, comes across road bumps at different points of life. This program is an opportunity for us to use all of the resources we have to support them through this"

Ariel explains to those students that “each medical student brings something unique to the table. Our approach is designed to be holistic and comprehensive—meaning to think of the entire person before us, including wellness, mental health, diversity, equity, all those things that can impact a person in their ability to grow and expand in their clinical training, and to address all the growth areas of the students’ needs with respect to developing their clinical skills—and it’s done in a supportive and affirming environment, with positive coaching.

“I point out that every single one of us, including me, comes across road bumps at different points of life. This program is an opportunity for us to use all of the resources we have to support them through this. I describe to them that the Student Guidance Program is akin to the coaching that executives in Fortune 500 companies receive.”

Root Causes

A key component of the program is thinking about possible contributors to each student’s particular current challenge. These can range, for example, from being a first-generation student with a lot of family responsibilities and thus lacking crucial time, to having some kind of learning challenge, or even to the difficulty of balancing their medical education with a board of directors position at the start-up they left for medical school.

Ariel sometimes finds initial resistance among students. “We’re working with students who up until now have been incredibly successful, so this can be a really unsettling experience. Some express reticence to meet me. For me, it’s a lot of active listening, trying to understand who they are as a person, and supporting them in their individual needs. I tell them that we want to help them become the best doctor that they can be. I want my guidance to land effectively.”

She works collaboratively one-on-one, supporting six to eight students per year, homing in on the weaknesses in their clinical skills and guiding them to improvement. She has also assembled an SGP advisory committee of faculty volunteers who are educational leaders to provide expertise and advice on next steps in student remediation.

Student Feedback

One measure of the success of the SGP is the letters that Ariel receives from participants.

Here are a few excerpts:

“I wanted to express my gratitude again for all the guidance and support the SGP has provided me over the last few years. It was instrumental in helping me navigate clerkships, professional relationships, and my own self-improvement, and helped me better prepare my application to residency.”

"From your individualized mentorship, I have gained not only tremendous clinical skills but also insight about how to best learn and grow.”

"This experience has not only taught me the valuable clinical skills to succeed as a physician and surgeon but also helped me learn the approach to tackling setbacks and become a more resilient individual.”

“The SGP has been a truly transformative experience for me. It has placed me on the right path to becoming a good clinician and is a reservoir of strength and wisdom from which I will draw to tackle any future challenges.”

A Yardstick for Success

By any measure, the Student Guidance Program is enormously successful. And there are several distinct measurements. First, students receive an exit evaluation to capture their feedback, and these have been overwhelmingly positive. Second, at the end of one year of clinical training, all students have to complete a final clinical skills performance exam. Those in the SGP do very well, with every student passing the exam since 2018. Third, students in the program are successful at matching in competitive specialties and subspecialties for residency training. Fourth, stakeholders are advocating to expand the program to include an additional entry point: students on clinical rotations who are identified as needing additional support.

To help Ariel with the SGP, there is a clinical skills development coordinator who tracks the students and schedules meetings, the volunteer faculty members who are clinical teaching coaches in patient-centered environments, and the advisory committee.

Ariel sums up her philosophy about the Student Guidance Program in this way: “The foundational idea is that every medical student has a tremendous amount to contribute to society. Our responsibility is to support them to be able to advance themselves in their career and their goals. There’s another important piece that drives us at Stanford: our obligation not just to our students but to society as a whole. We have a contract with society to ensure that everyone who is coming out of our School of Medicine is trained to the highest standard.”