Managing poor performance

Poor performance in clinical placements: issues and challenges

  • how much of an issue is poor performance?
  • identifying poorly performing students.
  • managing the placement process
  • failure to fail and borderline assessments.

Why is poor performance on placement an issue?

  • placements are a key part of the programme
  • discrepancy between theory and practice outcomes
  • potential consequences:
    patients
    students
    colleagues
    profession
  • assessment is a shared responsibility between higher education establishment and service.

What constitutes ‘Poor Performance’?

  • Agree/disagree – would you fail a student for issues with:
    safety
    lack of knowledge
    clinical reasoning
    unprofessional behaviour
    poor risk awareness
    poor attitude
    personality issues
    trustworthiness
    poor skills
    lack of insight
  • Which aspects are most challenging to assess?
    clinical reasoning
    unprofessional behaviour
    poor risk awareness
    poor attitude
    personality issues
    trustworthiness
    lack of insight.
These are less tangible but all need addressing.

Some behaviours that can alert you to the need to take action such as:

  • inconsistency in clinical performance
  • not responding appropriately to constructive feedback
  • appears unable to make changes in response to constructive
  • has limited interactions or poor communication skills
  • experience continual poor health; feels depressed, angry, uncommitted, withdrawn; is emotionally unstable, tired or listless.

Can you identify other behaviours you have encountered that indicated a need to offer further support/involve others?

Challenges of dealing with poor performance:

  • accurate and timely identification of issues
  • managing the process
  • dealing with the ‘fall out’
  • what happens next?

Identifying poor performance

Scanlan et al study: mentors took an average of two-three weeks to recognise a failing student.

Scanlan, J.M., Care, W.D., Gessler, S. (2001) Dealing with the unsafe student in clinical practice. Nurse Educator. Vol. 26 (1), pp.23-27.

Identified issues early on but:

  • gave ‘settling in’ time
  • hoped students would ‘pick up the signals’
  • lack of a ‘concrete’ issue.

If the difficulty is related to a disability or learning impairment

You need to need to consider where to get additional support relating to the ‘Disability Discrimination Act’ (2005), and consider what reasonable adjustments are required.

However, many individuals are unaware that they have difficulties that may impact on healthcare practice. Mentors/PPE need to be aware that some traits, such as the following, could indicate dyslexia:

  • erratic spelling
  • misreading
  • poor handwriting
  • poor memory retention
  • difficulty in organising work
  • poor time management
  • short concentration span
  • confusion between right and left.

Source RCN Tool Kit

Managing the process

  • support
  • communication
  • documentation
  • action planning.

Support

  • access early support
  • use of Placement Development Team and/or programme team
  • involve your team members in assessment process
  • gain or use advice from experienced educators.

Communication and documentation

  • clarity is key
  • use specific examples
  • be objective – constructively criticise the behaviour not the individual
  • use of safety/professional behaviour warnings
  • include copies of all documentation with final assessment
  • signatures of all involved.

Action planning

  • often useful to have tripartite meeting with student personal tutor/PDT and mentor/PPE
  • set SMART goals and review dates
  • may need to facilitate student’s action planning and reflection
  • regular (but not incessant!) feedback.

Writing the formal assessment – issues:

  • mismatch between text and marks (if grading required)
  • need to give overall picture of progression: mid-way assessment to final assessment.

Failing to fail

Consider what would be the key challenges for you in failing a student?

Failing to fail – reasons:

  • leaving it too late
  • awareness of the consequences
  • personal challenges
  • experience and confidence.

Borderline assessments:

  • make sure the result matches the overall performance
  • be clear in your feedback - issues and development needs
  • document concerns in the assessment (and highlight to PDT/programme link that they are there).

Dealing with the fall-out and what happens next?

  • will need extra support to manage a poor performing student on placement
  • de-briefing is crucial
  • action planning-developmental needs, learning from process, official processes, student progression etc.
  • planning for future placements.

"Katie" is a second year student undertaking her practice placement under your supervision and direction. You are due to undertake her halfway assessment and consider her performance so far.

Watch "Katie" video clip on YouTube

Considerations:

What are the issues Fiona has addressed with Katie? Why is it important to address them? How difficult would you find tackling professional issues with a student if they weren’t so amenable?

Katie has asked for more guidance and direction: could you formulate a learning contract for her?

What criteria could you use and when would you review her performance?

If she continues to demonstrate this behaviour what can you do?

Mentoring in Practice mini course