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Practice Education Facilitators
April 2005
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Supporting the Underachieving Student
Aim of the session-
The mentor will have a clearer understanding of
the assessment process, including their
professional responsibility and accountability
Objectives-
The mentor will recognise how each step of the
assessment process is integral to providing a
fair and objective assessment. The mentor will
have an understanding of the professional and
personal implications regarding signing off of on
their assessment of their student.
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A little bit of reflection...Mentors are aware
that most of the students that they teach in the
placement will manage to achieve the expected
level of competency. Motivating them, assessing
and evaluating their performance is not a
problem.Many mentors will have had the
experience of working with a student who is
underachieving and it appears that they will not
achieve their competencies.If you haveDid you
feel you handled the situation well?Would you/
should you have done things differently?Would
more support, encouragement and the involvement
of others have helped the student to reach their
potential and meet their competenciesIf the
student didnt make the grade, did you bite the
bullet and give your student an assessment that
showed they had not reached the required level of
competency ...ordid you give them benefit
of the doubt and tick their boxes?
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Your student can be there for a few weeks or a
couple of months and like you they want to be
part of the team. The first few days, even hours
can make the difference as to how easily and
quickly a student can settle into your area.
Did You.?

• Welcome the student
• Orientate the student
• Allocate a mentor
• Discuss and agree goals
• Agree on a Learning Contract
• Carry out ongoing assessment
• Remember back to your time as a student a new
  area, especially a busy area can be an extremely
  daunting experience. How you welcome and help
  your student acclimatise can often set the tone
  for the rest of the placement.
• Being a mentor to a student is a two way street.
  Students have a responsibility to learn, ask
  questions and stretch both their own and their
  mentors skills, knowledge and professionalism.
• You as the mentor have a responsibility to
  support, encourage and push the student to
  achieve what they are capable of.
• And of course you are both responsible to provide
  objective and constructive feedback regarding
  performanceboth good and poor.
• Competencies based on the CAP Booklet

NOTE - You can find a template for a learning
contract and an orientation package on the CPPSU
site - http//www.cppsu.dundee.ac.uk/
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Competencies and the CAP Booklet- a shared
responsibility

• Use of the CAP Booklet as basis of identifying
  students Learning Needs
• Use of a Learning Contract to enable student to
  achieve required target level of competence
• CAP Booklet allows for comparison between
  performance and minimum standard required (the
  competencies)

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Your student is not performing as well as
expected They arent meeting the required
competencies as stated in the CAP BookletEven
with all the support, encouragement and hard work
on you and the teams behalf you find that your
student is struggling in one or more areasThere
are procedures and guidelines for mentors to
follow if they feel their student is not
achieving the required competencies for the
placement
EARLY INTERVENTION IS VITAL

• ALL the literature says to bring in help sooner
  rather than later. Duffy tells us to identify the
  problem and involve the school. (NMC study 2004)
• Our own CPPSU also tells us to call early, before
  a situation becomes more fraught or difficult,
  even if only for advice.

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You can get input from ALL involved with your
student
1. Mentor
2. Student
3. Practice Education Facilitator
4. The University
5. Team Members
6. Other Health Professionals

• The team is involved in the assessment process
• Listen to others who have worked with your
  student
• e.g. SN, EN, HCA, sometimes even medical staff
  etc.
• If you have any doubts or worries about a
  students performance and their ability to achieve
  the required competencies, then you must involve
  the university as early as possible.

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• Doubts over a students performance during their
  placement must be qualified in terms of outcomes
  and explanation. In general this will be based on
  the competencies as set out in the CAP book. By
  linking your assessment closely to the
  competencies you will be able to keep your
  assessment objective.
• Anything you do should be discussed with the
  student. The first thing you must do is let the
  student know that something is wrong
• Discussion with the student
• Discussion with personal and/or link tutors
• Exploration of opportunities that would enable
• evidence to be acquired towards the resolution
• of any uncertainties

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• Assessment can aid the student rather than just
  a measurement of performance Wallace (2003)
• The Learning Contract is a fluid document that
  can be adapted from the original contract
  developed as part of the initial interview.
• The Learning Contact offers self-direction for
  the learner.
• Action Plans should be agreed between the mentor
  and the student again these can be adjusted
  throughout the placement to suit the learning
  needs of the student. If there is a problem with
  the student bringing in others to assist ensures
  fairness and objectivity with its development.
• Is the student getting sufficient learning
  opportunities to achieve competencies?
• Always set a review date. Highlights the mentors
  view of the importance of continuous and onion
  assessment. Also ensures feedback as to progress
  being made.

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The Midway Assessment

• Reflect on issues previously discussed e.g.
  Learning Contract Action Plan
• Specific Learning Opportunities (CAP Booklet)
• Set Review Date
• Document the session

The Midway remains a formative assessment and is
another opportunity for mentor to discuss
progress made and develop new plans for remainder
of the placement. With a good student it maybe
about challenging them - provide the student with
added learning opportunities tied in with the
competencies in order to allow them to obtain
experience compatible with their abilities.
With the Underachieving student the Midway
assessment is about supporting them. By involving
the University and other clinical staff members
before the Midway Assessment the mentor will be
able to implement an Action Plan that has been
universally agreed. Continue process of
feedback, set date(s) You must record your plan
of action, support provided, input from others,
thoughts, attitude and response of the student.
Evidence of the work, effort and time you are
putting in is vitally important.
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Evidence

• Literature states that anecdotal notes are
  significant(Smith et al 2001)
• They provide day to day data about a students
  progress within the clinical placement
• In the case of an appeal the mentors
  responsibility is eased when there has been
  careful, deliberate and objective documentation
  of the students clinical performance.
• There have been cases where the importance of
  clinical anecdotal notes have been illustrated.
  (Davies v. Regis College 1991)
• Input from others involved with working and
  assessing the students performance allows a more
  objective opinion and decreases the possibility
  of student crying foul re personality clash. The
  decision to fail is not an individual one.
• Also protects the student against irresponsible
  decision to fail them.
• Security Locked drawer in Charge Nurses Office,
  or other suitable system to prevent unauthorised
  access. Time personal data held for any purpose
  or purposes shall not be kept longer than is
  necessary for that purpose or those purposes
  Data Protection Principles as per Central Legal
  Office. Safely disposed when no longer required.
  Trust Policy re disposal of sensitive data.
• Under the Data Protection Principle the student
  is entitled to be aware of reports on there
  progress (regular feedback).

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Failing a student can stir up a hornets
nest.(Lankshear 1990)

• her reaction was a combination of aggression and
  distress (Duffy 2004)

• unpleasant, messy, emotionally fraught
  experience (Milner OBryne 1986)

• Dont forget there is always support and help
  available

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Student still not achieving the required
competencies?You have no choice but to fail
your student
The Final Assessment

• Students should understand that the formative
  clinical evidence is an ongoing process
  throughout the clinical rotation compiled to
  determine the final grade. (Smith et al 2001)
• The evidence you have collected allows you to
  make your decision regarding the students
  performance throughout the placement. That
  decision is either to PASS or to FAIL the
  student.
• Failing a student in your placement does not
  necessarily mean they will be thrown off the
  course.
• The student must demonstrate 100 achievement of
  the clinical outcomes at the required level by
  the end of the CFP (1st year)
• Students at the discretion of the Board of
  Examiners, may be allowed to carry normally no
  more than 10 of unmet clinical competencies from
  year two to year three, with stated conditions
  for these unmet competencies being met by a
  specified date in the year of that programme
• (Programme Guide for Students Jan 2004)
• The final assessment should come as no surprise
  to any involved throughout the whole assessment
  process.
• You are training tomorrows nurses today
• You have a responsibility not only to your
  patients
• but to your profession ..and to yourself.

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NMC Code of Professional Conduct
Section 8- As a registered nurse or midwife,
you must act to identify and minimise the risk to
patients and clients.

• Please note Section 8.2 in particular
• The NMC Code of Professional Conduct 8.2 states
• ..you must act quickly to protect patients and
  clients from risk if you have good reason to
  believe that you or a colleague,.,may not be fit
  to practice for reasons of conduct, health or
  competence

• The Mentor Accountability
• You have a duty to facilitate students and
  develop their competencies
• You are personally accountable for your
  practice, for your actions and your omissions
• (Code of Professional Conduct, clauses 6.4 1.3)

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• It is inevitable that some students will not be
  able to meet the required level of practice and
  it is essential that mentors do not avoid the
  difficult issue of having to fail these students
• Duffy 2004