Problems of objectivity in assessment and failure to fail

In relation to the challenges of combining the three aspects of the PT role, one theme that dominated discussions within my own study is objectivity in assessment. After working with a student for over ten months, mentoring them in developing clinical expertise and facilitating their learning of the wider issues, the PT then has to make an objective assessment of the student’s progress and the extent to which their portfolio reflects that personal development. In essence, the PT has to make a decision as to whether to pass or fail the SP student.

As examined earlier in this chapter, the strength of the relationship between PT and student is an important factor in student development and progression in practice. A poor relationship or a lack of understanding has the potential to create dissonance between the two regarding evidence for, and construction of, the portfolio of practice.

Canham (2001), in a study referred to earlier in this chapter and in chapter two, examined the introduction of a marking tool to

previously formative assessment of SP students and suggests that the intense relationship formed between PTs and SP students does impact on marks awarded. Canham (2001) deduces from the study that the supportive role of the PT towards the student is reflected in a higher mark being awarded than would perhaps be appropriate. The Canham (2001) study implies that objectivity is compromised by the close relationship developed between student and PT. Chilton (2009) states that a professional manner of communicating is fundamental in maintaining an objective relationship, however given the intense nature of the learning experience, both the interviews with PTs and focus group discussions with academics indicate that objectivity and professional boundaries are important yet difficult for PTs to maintain.

One PT related the issue to the importance of maintaining professionalism in the relationship:

“…Because I know you do question yourself – is this a personality thing, are we gelling as well as…at the end of the day, you’ve not got to be best buddies; it’s a professional working relationship. You’ve got to be conscious that you don’t overstep that professional relationship…”

1st interview

The reluctance to raise issues with a student regarding not meeting expectations appears to be as a direct result of the close relationship that has developed. The PT is acting as the student’s advocate; an admirable stance, yet one which could limit objectivity and honesty in assessment. Watson et al (2002) in a systematic literature review of the assessment of clinical competence in nursing, refers to circumstances which impede objectivity in assessment. Examples include the application of personal judgement in the absence of assessment criteria; further supporting the development of assessment criteria detailed in my own recommendations, and bias created by development of a close relationship with the student and

the natural socialisation process which takes place in practice.

One PT raised the issue of her expectations of a student not being met and the difficulty in addressing this directly with the student. This example relates to a PT with a limited degree of experience in assessment at specialist level:

“You may get on really well with your student

and have no concerns, but then there might be issues and that’s an opportunity to address it [at placement visit from University tutor], because it’s difficult if you are working with a student who is not living up to your expectations or you think needs some more support, that they’re not accepting. We’ve talked quite a lot about failing students, haven’t we? And that is a hard thing to address. You want your student to do well and to be good, and it’s difficult to be able to address that”.

3rd interview

As also suggested by a focus group member:

“…it’s quite a subjective relationship…, but I think the level of training and the level of experience – I know that changed as they’ve [PTs] got more students coming out to them and their knowledge base and how they actually dealt with students after a couple of years, it’s different”.

Focus group 1

This comment implies that as the PT’s confidence grows in their role as assessor, so their ability to objectively appraise practice is enhanced. One practitioner in interview 9, who had four years experience in the PT role and considerably more in the specialist role, stressed the need to clearly explain her requirements to the student, and later in the interview referred to the importance of honesty in the PT-student relationship. This quote can be found on page 129, and

communication channels between her and the student. This enabled the student to also develop greater insight into the SP role and be honest subsequently in self-assessment; reappraising her stage of development.

This approach is supported by the NMC Standards to support learning and assessment in practice (NMC, 2008b), which state that PTs should:

Set effective professional boundaries whilst creating a dynamic, constructive teacher- student relationship.

NMC, 2008b, p 23

The first focus group also raised maintaining professionalism as a problem and suggested clear parameters were needed to avoid subjectivity in assessment:

“…you have to as a PT lay down ground rules with your student about your expectations, but then stick to those…in some relationships… sometimes it oversteps the mark – that they’re meeting up at weekends and doing all sorts of strange things, and then you’re expected to objectively mark this student at the end”.

Focus group 1

However, although focus group members could appreciate the extent of the pastoral role of the PT in their relationship with the student in light of the pressures of the programme of preparation, all adhered to the above NMC standard (NMC, 2008b). Both of the academics quoted below had previously had experience as SP students and in PT roles, as had the academic in the above quote.

“…sometimes, just because of the nature of being so close to somebody for a year, you would be completely heartless if you didn’t forge a relationship with somebody, wouldn’t

Focus group 1

In relation to the pressure placed upon the PT by the closeness of the relationship, another academic with a background in practice teaching identified the potential impact of this on portfolio assessment:

“I worry that they’re [portfolios] not very objectively assessed sometimes and PTs are under a lot of pressure to pass things they know they’re not actually as good as they should be. So it’s a good form of assessment but I think it’s unfair that the PT that’s got so close to that person – a lot of us who’ve been students and had PTs that we’ve had for a year with us and they’ve become our best friends and it’s very difficult to fail work if you have that relationship”.

Focus group 1

It appears therefore, that a balance has to be made between support, socialisation and pastoral care and maintaining professionalism, role modelling and objectivity in assessment.

Ilott and Murphy (1999), when considering the perspectives of assessors regarding assigning fail grades to occupational therapy students, revealed a high incidence of assessors allowing students inappropriately to ‘just pass’ (p13), based on a number of quite complex issues and conditions. A seminal text for the nursing disciplines by Duffy (2003) outlining her research into the reasons why underachieving pre-registration nursing students in practice rarely fail their placement assessments also seems relevant here. As Duffy (2003) recognises, the jargon incorporated in practice assessment documents and the recognition of a minimum standard as sufficient to pass considerably hinders the assessment process. As with the pre-registration nursing programmes, the SP programmes at my academic institution have applied a pass-fail outcome to practice

standard achieved. The close working relationship between PT and student and the emotional impact of failing the SP student seem at least as relevant in this situation. This was also recognised by Sharp (2000), in an examination of practice assessment for social work students, who highlighted another pressure imposed upon the practice assessor: the considerable impact of a threat by the student of an appeal to a fail outcome on the PT’s decision to pass or fail the student’s practice. The impact of a fail outcome on the assessor therefore also has to be considered.

These different perspectives appear to be encapsulated by a PT in her evaluation of the practice assessment process and the impact of the close relationship on this:

“…it’s weighing up your responsibility against your compassion”.

3rd interview

Ilott and Murphy (1999) concur with the suggestion that failing a student can become more difficult, both for supervisor and tutor, as the relationship develops and is compounded by the effects of the pastoral role.

The introduction of a third party to assist in addressing issues and support the PT and student in the assessment process appears to be pertinent, and it is suggested by Boran (2009) that a tripartite approach between PT, lecturer and manager is important in addressing the implications of a fail outcome by providing mutual support and guidance in the decision-making process. The aforementioned study by Jenkins et al (2009) also recommends a tripartite approach, with open dialogue in this case between tutor, PT and student to identify and manage dissonance in order to inform decision making. This currently occurs to some extent within the programmes, however the interview and focus group data analysis

suggest that enhancement of this approach would provide greater support for the PT and student in practice assessment.

In a study by Manias and Aitken (2005) examining clinical teachers’ perceptions of their roles supporting students within postgraduate nursing programmes, the authors found that although the clinical teachers felt confident in their clinical expertise to act as role models and facilitate SP student nurse education in practice, they felt less comfortable evaluating the student’s clinical decision making and progress. Although this was an Australian study relating to postgraduate programmes in acute care disciplines, it does highlight the potential problems and conflicts raised by the combination of practice assessment and mentor roles. The quantitative analysis of the resulting data from questionnaires completed for the Manias and Aitken study (2005) limits a deeper insight into the nature of the concerns raised regarding practice assessment. Although perceptions by the clinical teachers of their roles are included in the paper via descriptive statistics, these were limited to generalised statements. The authors recommend further investigation of a wider range of specialties across HEIs, as this study, similarly to my own, focussed on experiences of clinical teachers from one university into a limited range of disciplines.

An experienced PT who had mentored many SP students recognised in the quote below the difficulty of failing a student, whilst acknowledging the responsibility that the PT role engendered and the requirement to adhere to professional body standards, particularly for the ongoing protection of patients and clients (NMC, 2008a):

“…because when you get used to your student, the temptation is, oh, she’s really lovely, and I want to give her a… [laughs].… And they’re fledglings, and you don’t want to fail anybody. And at the end of the day, we don’t want people to pass and practice at an

abysmal level because children will not get protected, will they?”

7th interview

Practice Teachers often felt or were attributed a considerable level of responsibility for the student’s level of achievement. This generally had a positive connotation, as in the following quote:

“And [tutor name] and [name] came to see me and said, - we just have to say, we think you’ve done a marvellous job, because they had worries about her at the beginning too”.

8th interview

This comment clearly refers to the PT’s mentorship role, particularly the understanding of the impact of personal issues on student study and the pastoral support provided. The PT also clearly valued academic recognition of the effectiveness of their role and its impact on student outcomes. In a separate interview, a PT considered their responsibility in role modelling and facilitating development when observing the student taking the lead:

“Obviously, she has learnt from the previous prompts…I don’t have to remind her to do that; she had done it off her own back,…you have not ignored what I have said to you… you are telling others – sort of directing them as well… They’re getting on the right track. Because the person has accepted constructive criticism; looked at myself (sic) [themselves], thought about it laterally, objectively and if a similar situation happened again, a few months down the line, and she just did it. That was good, it is good...”

5th interview

The PT conveys pride in the student in this example and in the other interviews on several occasions, in their ability to accept advice and act upon it; a great achievement for PTs as role models (Chilton, 2009, Davies, 1993) and a source of satisfaction given their

investment in the learning process.

The quotes and discussion above clearly identify the complexities of the PT role and evidence the need for robust support mechanisms in achieving the requirements of the role. As recognised by Neary (2000b) in her previously cited studies, this multi-faceted role is additional to the mentor’s responsibilities to maintain their own CPD, deliver patient care and expand their leadership and management expertise. Heale et al (2009), in a Canadian cross-discipline internet survey of clinical mentors, also recognise the challenges faced by mentors in juggling responsibilities of the role alongside increasing workloads and competing demands on their time, which will inevitably impact on their ability to objectively assess student outcomes.

Problems of objectivity in assessment and failure to fail are widely recognised within the nursing profession. This study presents anecdotal evidence of the phenomenon, however it also recognises the immense pride felt by the PT in a job well done by the student, and emphasises that the reward of a successful student is a major factor in the PT’s continuation in the role, despite the lack of recognition discussed in the next section.

I will continue by discussing these issues in relation to the PT’s responsibilities and the impact that the student’s level of achievement has on them, both as individuals and as health professionals.