Why Educators Fail to Fail Underperforming Students? What are the Remediations? | Medical Education
Why are educators not willing to fail to fail an underperforming students? What are the reasons behind this fact? How can health professions educators (nursing, dentistry, medical) solve the issue of failure to fail trainees?
A systematic review presents six barriers and three enablers. Enablers are possible remediations in medical education, nursing education, and dentistry education.
Hi and hola para amigos!
In the health professions education literature, it is well-documented that clinical teachers who evaluate or assess students feel unwilling to report a student’s failing performance. But why? Why the clinical nursing, dental or medical educators feel that way? Why they are not willing to give the failing grades even if they are incompetent?
Many articles revealed this fact and present what there are behind it. Today, we gonna look into a systematic review of these articles. Some researchers have conducted a systematic review and analyzed a decade of knowledge from medical, dental and nursing literature to reveal barriers in front of reporting failure of a student. They also provide a few enablers to overcome these problems.
These pretty flamingos are getting ready to present all of them. So, stick around until the end.
The authors identified six barriers to failing an underperforming student.
The first barrier is “assessor’s professional considerations”.
It consists of several reasons.
When you fail a student, you have to provide proof of failure. Collecting proof adds time cost into clinical teachers’ high amount of responsibilities. The burden of proof is one of the professional considerations of avoidance. As a parallel reason to this, fear of litigation, fear of legal consequences is another one.
As an addition to the reasons above, failing a student means that failing the teacher. They do not want to deal with the failure of themselves that can be cost their job.
A clinical teacher is saying that: “We feel that the “burden of proof” rests squarely with the program. . . .[We] are very hesitant to consider dismissal for fear that we will be dragged into court.”
In short, it is simply easier and safer to pass underperforming students than to fail them.
The second barrier the authors identified is “assessor’s personal considerations”.
As I said before, the assessors see failing a student as failing themselves. They feel personal guilt. Apart from that, some assessors have close relationship with students. While failing someone who you don’t know well is unpleasant and emotionally fraught experience, failing someone who is personally close to you is more difficult.
A clinical teacher saying that: “You go home and go over it time and time again. It is the right decision? Have I missed something? Is it a personality clash? It gives you sleepless nights! I’m not exaggerating!”
Another saying that: “The students cry, are upset and telling you X, Y, Z. It is like emotional blackmail. They put pressure on mentors…”
The third barrier is “student related considerations”.
Thinking from the students’ perspective is another barrier. Clinical teachers consider the impact of a failing grade on the student’s career goals and financial security.
A nursing teacher saying that: “For a student, failing a placement can be a significant loss experience: loss of self-esteem, time, education, money, certification, and career. “I don’t think any of us want to see somebody throw four years of their life out the window.”
The thinking related to the timing of the failure judgement reveal an interesting inconsistency as well. Assessors are reluctant to give failing grades for the students who are in the early years of their training, since they think “the students have enough time to make progress”. They are reluctant to fail students as well who are in the last years of their training. An assessor saying that: “There is reluctance because it is a third year and they have come that far.”
The fourth barrier… “unsatisfactory assessor development and/or evaluation tools”.
Assessors report feeling unprepared, lacking experience and lacking confidence in their evaluation role. They report also having little formal training in evaluating students. The doubt coming from lack of ability and confidence leads to reluctance to give failing grades. Apart from that, another obstacle is the fact that educational evaluation is not something like black and white. The uncertainty is hard to cope with for some assessors. One of them saying that: “Professional behavior occurs along a spectrum and the point at which a student is no longer competent is not clearly defined.”
The fifth barrier… “institutional culture”.
The first four considerations were at individual level. The current one is at institutional level. A quote saying that “There was also perceived pressure from the university to pass students at one of the schools; this was associated with issues of finance and reputation, accompanied by the belief that faculty with high failure rates would deter potential students.”
As a result of it, it’s possible to be witnessed some detrimental acts for the assessors such as rejecting the assessor’s fail decision using the power of higher levels of university. Let’s hear an assessor describing it: “It’s frustrating. You think “I’m not taking another student. . . You know my opinion is not valued. I’m telling you this person is unsafe to be out there.” And it’s just not listened to.”
The last, sixth, barrier… “consideration of available remediation for the trainee”
Sometimes assessors are reluctant to fail a student since there are not available remediation options for the students. An article saying that: “Many participants felt that they could not fail a trainee if remediation was not available to them. They felt it was their responsibility to provide remediation and, if unable to do so, they might not fail that person.”
Yes, we talked about barriers until this point. Now, it’s time to talk about how to climb over these barriers. We will mention three enablers.
Enabler 1: “duty to patients, to society, and to the profession”
Assessors have a responsibility to patients, to society, to profession. If you don’t fail an underperforming student, you cannot protect the patients, you cannot protect society, even you cannot protect reputation of your profession. Incompetent doctors, nurses, dentists don’t uphold their profession. This is the reality and it should be reminded.
Enabler 2: “support from the institution, from colleagues, and assessor development”
The barriers are not easily passable without support from institution or colleagues. This is not a kind of problem that can be coped with just by yourself. Institution should support the fair judgement, there should be a strong assessment system with established criteria and clear procedures. Also colleagues should discuss about failing students. Failing a student should not be an isolated incident. Failure should be seen as a usual fact in the way of being doctor.
Enabler 3: “opportunities for trainees after failing”
If there are solid remedies targeting to improve students after failure, the assessors could be more open to fail an underperforming student. All they need is guidance.
We talked about six barriers and three enablers. These are so important since the authors found that “these barriers and enablers are universally reported across health professions and trainee levels, and have been consistently reported over the past decade”.
If you want to read the article, I left the source description below.
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