QMU Guidelines Supporting a failing student

Good practice for meetings and using action plans

Meetings should be held in a quiet area where you will be free from interruptions. If you identify issues with a student early on in the placement do not wait until the midway assessment as early intervention can be the key to turning around a failing student.

Open by allowing the student the opportunity to self-reflect on their progress. e.g. “what do you understand happened here?” Use open ended questions and listen to the student’s feelings, they may be afraid of failure or angry.

You should give honest detailed feedback with clear examples that support your concerns and document these on the relevant section of the assessment form. You should not use expressions such as “I have heard…. I think”. Consider using the feedback sandwich (this helps build self-esteem).

Develop an action plan with the student and set a review date. A five day review is suggested as appropriate. Students appreciate honest feedback on areas where they can improve their performance (Duffy 2007). Use SMART goals to achieve specific objectives, discuss how they might achieve them and inform them of the consequences should improvement not occur and negotiate further learning opportunities if necessary.

There may be times when you or the student feels there is a need for another student or staff member to be present at the discussion, either for support and or mentoring. Be aware this is often interpreted as being “formal”, however it can be useful but must be agreed by both sides and cause no undue stress.

Duffy(2003,2007) Stuart(2007)

Failing the Student

Sometimes despite the best efforts of the practice educator the wider team and QMU Staff it will be necessary to fail a student. In this situation the final assessment should come as no surprise to those involved. Do not take this personally, remember you have clear evidence that the student has failed to meet the competencies expected. The documentation completed can help establish if there is a pattern over placements and protects the student against irresponsible decisions. Remember as a Practice Educator you have a responsibility not only to your clients but to your profession and yourself.

Do not avoid the issues of failing students, as failing a student can pave the way for greater achievement in future clinical placements. (Duffy 2007)

Do however be prepared for the students reaction which may include:

Shock and disbelief- There may be a genuine lack of insight into their own abilities, or previous mentors passing the buck or giving them the benefit of the doubt. This is neither in the interest of the student or the profession (Duffy 2003)
Shock their “friend” has failed them; students can mistake the warm, nurturing environment on placement as friendship. Practice educators need to become skilled at maintaining a professional and supportive role.
Students may become emotional, crying, angry, aggressive, be in denial, become verbally abusive, they may cite a personality clash or victimisation. If there is a hint of this a 3rd person may be useful from either the team or QMU.
They may blame previous practice educators or QMU.
Some may be relieved and willing to fail the placement. It can be a positive outcome. It is a common assumption that students will always take it badly. Zuzelo (2000) observed that students often recognise their clinical weakness and shortcomings and are relieved when educators give advice on how that can be improved. (Duffy 2007)

Support for practice educators

Educators should have the opportunity to discuss issues with a supervising practice educator or your practice education facilitator (PEF). Note not all situations with students can be resolved; you must sometimes seek advice from colleagues or your PEF. Always liaise with the QMU’s practice based learning co-ordinators, the students PAT or the programme leader for ongoing support during a difficult placement.

It is important to:

Acknowledge your own feelings.
Don’t give benefit of the doubt.
Don’t ignore alarm bells.
Seek support early from QMU.
Avoid bias and making assumptions.
Use supervision for anonymous discussion/utilise a second observer, this can help bring objectivity and prove to the student there is fairness in assessment.

Resources and references
Anglia Ruskin University, Faculty of Health, Social care and education: Supporting the under achieving Learner: A guide for Mentors (2013)
Assessment of Students in Health and Social Care: Managing Failing Students in Practice. (A resource)
Bedford, H. Phillips, T. Robinson, J and Schostak, J. (1993) Assessment of Competencies in nursing and Midwifery Education and Training, London
Birmingham University: Policy for Securing, Monitoring, Allocating, Evaluating and Terminating Practice Learning Opportunities for Professionals regulated by the Health and Care Professionals Council. Oct 2012
Duffy, K. (2003) Failing Students: A qualitative study of factors that influence the decisions regarding assessment of student’s competence in practice. Glasgow Caledonian University. www. nmc.org
Duffy, K. et al (2007) Supporting Failing students in Practice 1: Assessment. Nursing times; 103:47, 28-29
Duffy, K. et al (2007) Supporting Failing students in Practice 2: Management. Nursing times; 103:48 , 2829
Hunt, K.A McGee, P. Gutteridge. R. Hughes, M. (2011) Assessment of student nurses in practice: A comparison of theoretical and practical assessment results in England, Nursing Education today (2011), doi;10.1016/j.nedt.2011.05.101
Ilott, I and Murphy, R (1999) Success and Failure in Professional Education: Assessing the evidence, London: Whurr Publishers
Marsh, S. et al (2004) Assessment of students in Health and Social care: Managing failing students in practice.
Mattheos, NMC, Nattestad, A. Falk-Nilsson, E and Attstrom, R (2004) The interactive examination assessing students’ self-assessment ability. Medical education, 378-389
NHS East of England Fitness to Practice: Guidelines for Mentors*In practice, East of England Health Strategic Authority
Price, B. (2005) Assessing a learners progress. Nursing Standard:19:48, 73-74
Smith. M et al (2001) Legal Issues related to dismissing students for clinical deficiencies. Nurse Education; 26:1, 33-38
Stuart, C.C (2007) Assessment, Supervision and Support in Clinical Practice, Churchill Livingstone