N OT RECEIVING A FIRST FOR PRACTICE

For the students who did not get a first though, their grade had the potential to impact upon their self-esteem.

Yeah you don’t want to give yourself a 4 and then they give you a 3 and then you feel like you’re really stupid. I think it depends whether you are on the higher side or the lower side, because I didn’t get the best mark on mine and everybody else got like 80 or 90 percent and I got like I don’t know 69 or 68 or

something and I came out feeling like the biggest pile of crap in the world, so when you get higher marks, it’s easy (S17/T1/G5).

If you got that in an essay you’d be over the moon (S19/T3/G5).

Yes, but in practice because everybody else gets great marks if you get a bad mark you feel really bad whereas if you get a bad mark in an essay it’s not so bad (S17/T1/G5).

Conceivably, the small cohorts at Sanderling University facilitated most students sharing their grades, whether these were theory or practice grades. Knowing and voicing that a practice grade was not as high as other students had detrimental effects on students, as S17 and others also confirmed. One student declined to be in the group interview, explaining she was not happy with her grade and would be upset if she talked about it for the research. Others were more able to share their experiences even if they were negative.

I came out of there really disappointed. Areas where I know that I was really good at, I felt was lowered and between the certain person and my mentor, it was suggested that we shouldn’t be sort of 70 – 80%, that we should we be for our level just coming in to it. That we should be looking at 50 and 60’s, that had a massive impact on the marking (S51/T1/G11S).

This mature, qualified nurse cried during the interview, possibly due to the

frustration and impact of her lower practice grade. Accordingly, for students there was a tangible sense of emotion built into their practice grades. For some the emotion was positive and reassuring as it was associated with a high practice grade yet for others it was demoralising and felt unfair.

With different opinions in the lecturing team and in practice, grading was problematic. This concurs with the literature (Scammell, et al., 2007; Gray and Donaldson, 2009a). Scammell, et al’s (2007) qualitative study of students, mentors and lecturers’ experiences of a newly implemented grading tool found confusion and misunderstanding and different interpretations of the assessment document despite their attempts at mentor preparation. Inadequate knowledge about the grading tool impacted upon its use. Students said mentors were unable to award the high practice grades they wanted (Scammell, et al., 2007). While it was not clear where the

perception originated, there were reports that university based staff wanted students to produce more evidence for the higher grades. This had the potential to undermine the mentors’ confidence and authority in grading (Scammell, et al., 2007). It also undermines students confidence in the process.

The aim of the systematic literature review undertaken by Gray and Donaldson, (2009a) was to explore the issues with grading practice including reliability and validity. Validity was considered in terms of the grading tool and process of grading. Both the tool and the process were criticised by Sanderling students. Inter-rater reliability was also documented as problematic with inconsistent interpretation of the criteria (Gray and Donaldson, 2009a). Consequently, Gray and Donaldson (2009a) determined the usefulness, reliability, validity and effectiveness of grading of practice was still to be proven.

5.3IMPRESSION MANAGEMENT

To make a favourable impression on mentors, students often had to suppress their feelings regarding the uncertainty of their practice grade. Much of the anxiety about grading came from the need to self-assess.

On mine I put two stroke three (S23/T2/G6). Oh, do you? (S25/T1/G6).

Because I’m not really sure where I fall, and obviously, I fall in the middle but when I’m doing my tripartite you know a decision needs to be made which one you’re going to be…. I find that really, really hard…. I feel in the middle…I think that’s where the five box just needs to come into play (S23/T2/G6).

Students across different groups were fearful of being overly confident with their grades.

Yes, I don’t want to, not that I’m big headed anyway but I just feel like even if I feel oh I can do this but I don’t want them to feel that I’m putting myself

high when I’m not, I just don’t want them to look at me and like yeah

whatever….If you give yourself a 3 and you’re like I’m sure I can do that even with supervision but you still sometimes feel maybe I should put myself as a 2 so they can look at that and it’s their mark at the end of the day, isn’t it. ……. I think if your mentor thinks that you’re big headed then they’ll probably mark you down anyway, I think (S18/T3/G5).

S18 shows how difficult it was to self-assess her grade and defers to the authority of her mentor ‘it’s their mark’. A reoccurring theme across the student interviews was how students projected their identity in the grading process, if this was above or below what their mentor considered appropriate there could be repercussions.

And you read them and think well I think I’m this but if I put that, am I going to get marked down because they’ll think, I think I’m great (S34/T1/G8). Like big headed (S37/T1/G8).

Or if I put, so if I put the next one down, they’re not going to mark me up from that because I put that. So, you feel like it’s a bit of a game (S34/T1/G8). You don’t want to go too low because then they’ll think you’ve got a lot of don’t know what word I’m looking for (S37/T1/G8).

Not a lot of confidence (S33/T1/G8).

Yeah confidence and stuff and then they’ll ask a million more questions (S37/T1/G8).

It’s a little bit of a mind game as to what to put (S34/T1/G8).

This impression management was very important in grading themselves (Goffman, 1959). When an individual is in the immediate presence of other people, he or she will seek to control the impression that others form of him or her to achieve their goal (Hivid Jacobson and Kristiansen, 2015). The other participant in the encounter will attempt to form an impression of who and what the individual is. The student’s performance or ‘front’ is the attitude, presence and expressions used to construct a certain image of who he or she is. These students thought a mentor would reduce

their grade for being over confident and be subject to further scrutiny if not confident enough. This was a valid thought reiterated by mentors.

A good student who in my eyes that wants to learn, has set objectives, is keen to work, works well within the team, doesn’t you know, works effectively independently but also knows when to not [to] independently but with guidance but not someone whose quite cocky, we get the odd one that comes through that you think, ‘Well you keep saying things like that, you’re going to really annoy people’ but they are sort of my good students, all round

(M3/T3/H)

Similarly, at another Trust:

You hear your colleagues don’t you. If they are too loud they are too cocky, if they are too quiet, they’re too shy. You’ve got a have a happy medium and it’s very difficult to get like that (M10/T1/H).

You get a student come in, in the first year and you’re like ‘I don’t like her, she’s a bit cocky.’ I think she knows it all (M11/T1/H).

Acceptable student behaviour throughout their time in practice needed careful consideration of impression management, which many students were aware of. The following vignettes show the strength of student feeling and how they tried to manage a more favourable impression of themselves in practice. ‘In the first year I absolutely hated it, I didn’t know what to say, I didn’t know what to do, the mentor didn’t know what to do……. I found it really uncomfortable saying well I have been really proactive and I’ve been really enthusiastic I think I deserve’ (S4/T1/G1). S4’s words, show how her feelings were suppressed to enact the role of the student, or the role she assumed she needed to project, one of enthusiasm. Enthusiasm, as with effort earlier, is not one of the explicit grading criteria; however, it probably contributes to an overall positive mentor evaluation of the student.

A student who visibly lacked confidence in their self-assessed grade the first time and tried to show more confidence in their self-assessed grade the next time explained her experience.

We went into it not really understanding the process, was asked to complete a form that I didn’t understand very well and it kind of leant itself to

underestimating yourself because you didn’t want to look as though you knew everything…...people were urging me to have more confidence and to put better grades. By the second year I was thinking of, using that information and the next time I would, I would say I think I am doing better, only to be told well actually you’re not there quite yet. It was the same people but different times (S26/T1/G6).

Even though the same people were involved in the grading process and encouraged S26 to be more confident, her self-assessed grade was apparently too high at the end of the second year. However, this was one of the first students to say her personal tutor influenced the grading process.

Mentors thought students tended to offer a lower grade than they deserved, perhaps this was part of the game. The students left room for the mentor to raise their grade, as they were the authority.

Yes, they [students] probably underestimated their abilities a bit. But I think everybody does that anyway. Because you don’t want to look like the bees’ knees when even though you are, you don’t put it on paper do you, so. But I did for her (M3/T3/H).

I interpret the reason some mentors raise the students’ grades as a feature of their relationship with the student, it reassures the student that they have been accepted and can increase their confidence in practice.

Say you got 85 in an essay then you’d be like wow, that’s crazy, publishable, whatever. Whereas if you got 85 in a tripartite then you’d obviously come out with better marks than I think I would have got from theory side of things and it gives you more confidence but at the same time it feels a bit like, well it’s easier to get higher marks in some of those in the tripartite (S19/T3/G5). Even knowing it is easier to achieve a high practice grade this student expresses how her confidence is increased by a high grade. Another student found the tripartite meeting offered more feedback on her performance than the previous qualitative

mid and end-point meetings. The presence of the lecturer appears to have influenced the mentor’s performance.

I like the tripartite, I like clarification that I’m doing things right and that I’m OK and so I find that in the tripartite you get that, I get that. Whereas

sometimes some people will be like in practice so you know that was really good or that wasn’t so good or whatever but in the tripartite the mentor actually really goes into more detail which is what I like about it (S1/T2/G1). This student was clearly articulating the need for more in depth feedback from the mentor and the tripartite grading process offered that. She altered her language from ‘you’ get that to ‘I get that’, to show how other students might not agree but for her it was positive. Many of the other student group discussions corroborated this student’s experience, that they lacked detailed feedback on their performance in practice. However, this comment also suggests some sort of objectivity in the grading process, with the opinion that practice can be ‘right’ as opposed to a subjective enacted encounter.

For some students, the grading process was of great value.

The only thing that I would say that up until that point [the tripartite] about how she was going to go, I hadn’t had an awful lot of feedback up until that point, so I was really worried and nervous about what she was going to say and then it turned out that it was fine, so I always assuming that things were OK but she might have said before now if it wasn’t going to be good but I still didn’t know because up until that point she hadn’t really said what she thought. On the first year that was a very first time that they [say] how good you were doing or how bad you were doing (S26/T1/G6).

This student was unsure about her practice performance. She assumed she was demonstrating the appropriate skills but the lack of feedback caused her uncertainty. For her, as with S1, the tripartite grading discussion was in more depth than their previous experiences of feedback.

I’d have been very disappointed if I hadn’t got a first, over 70% on that

[practice]. Because I felt from the feedback that I’d had and the interviews that I’d had and from everything that happened in the three years nothing had even been pulled up that I needed to improve or change apart from developing my skills and knowledge (S44/T1/G10).

I think I would have been [disappointed], I did find it hard; it got easier but the self-grading thing. I found I probably lacked confidence compared to you [talking to S44] and I did under mark myself but gradually over the years that improved (S45/T1/G10).

When students receive positive feedback from practice a logical conclusion is that their performance warrants a high grade. S44 repeated the notion that she under graded her performance, and attributed this to a lack of confidence. The reason students and mentors’ grades are higher at the end of their training could be attributed to the increased confidence that comes with time enacting a role,

professional enculturation. However, it could be due to the weak boundary between the student and mentor at the end of the course. In occupational therapy education student grades had a statistically significant increase in the second and third years (Roden, 2016). 593 student grades were analysed with a rise of 1% in each year. Reasons for the increase included students modelling their behaviour to fit the criteria and they become more skilled at this each year. In addition, students respond to constructive criticism to improve their performance (Roden, 2016). However, as already noted not all midwifery students thought they received much feedback, and few discussed constructive criticism, so this element of learning may be missing from practice.