The two most frequently cited issues with grading students’ practice are feedback and lack of time. Compliance with feedback in medical education has already been identified as an issue and discussed (Hiller, et al., 2016; Lawson, et al., 2016). Similarly, the quality of feedback in nursing, especially good quality constructive negative feedback enabled students to evaluate their practice more accurately than positive feedback (Plakht, et al., 2013).
Heaslip and Scammell (2012), in the introduction to phase three of their three-year service evaluation, argued that binary competence assessments (pass/fail) provided limited feedback to students on their performance, thus implying grading practice is superior. Their convenience sample of 107 students and 112 mentors were accessed through tutor groups and a mentor conference respectively. The higher response rate (86%) for mentors may indicate an expectation to participate, especially as only 51% of the final-year students participated. However, as this was the third of three phases there may have been an element of research fatigue if the same students were sampled previously, which may have happened (Scammell, et al., 2007). The
students and mentors in the Heaslip and Scammell (2012) study had divergent views on feedback from practice; 92% of mentors thought they delivered this effectively throughout the placement yet 56% of students said they only received it at the end of the placement. Three formal meetings were scheduled during each placement
between the student and mentor, yet 12.5% of students said that they did not receive any feedback at all (Heaslip and Scammell, 2012). When asked whether the
feedback matched the grade awarded, 89% of mentors agreed it did, while only 60% of students felt this way. A discrepancy between qualitative feedback and practice
grades were also noted in the national midwifery study (Fisher, et al., 2017a). The implication here could be that mentors have difficulty offering face-to-face feedback to students, especially if the feedback needed is constructive criticism.
Two national surveys in medicine cite reluctance to give negative or candid feedback to students (Briscoe, et al., 2006; Fazio, et al., 2013). Both studies had reasonable sample sizes and their recruitment strategy suggested they were likely to be representative, thus increasing the weight of evidence. Medical directors in Fazio, et al’s., (2013) survey admitted they avoided dealing with unhappy, upset or angry students in 27% of responses; it was the most common response and a potential source of grade inflation. Their discussion postulated that face-to-face feedback, especially negative feedback, contributed to grade inflation. Briscoe, et al’s., (2006) survey that demonstrated low confidence levels in doctors’ ability to discriminate between student performances ascribed some of this to the difficulty of giving candid feedback to students. One can postulate that the lack of negative feedback means that assessors feel a pressure to give high practice grades, as noted earlier, for fear of potential conflict from the students. This reinforces the notion that the
practice grades are imprecise, or at least imprecise for some students and some students may be able to influence the grade awarded.
1.4.1 LACK OF TIME FOR GRADING PRACTICE
Time was measured in two studies grading physiotherapy students’ practice (Dalton, et al., 2009; Murphy, et al., 2014). The findings of Dalton, et al’s., (2009) large- scale action research project undertaken over multiple university sites with numerous stakeholders to test a new assessment tool is supported by Murphy, et al”s., (2014) smaller, newer study. On average, Dalton, et al’s., (2009) grading tool took 17-28 minutes for mentors to administer. This was acceptable to the assessors and students alike. Murphy, et al’s., (2014) study which compared the change from one grading tool to another took 23 minutes (with a standard deviation of 13) to complete. This was reduced from the older tool which required 80 minutes (and wide standard deviation of 53 minutes). Most of the 80 students (82%) preferred the newer faster assessment, despite a slight reduction in practice grades (from 84% to 78%) (Murphy, et al., 2014). While both tools were positively evaluated, the authors
made no reference to the pressures of time in clinical practice to explain how this may have affected the participants’ views.
The qualitative studies tended to discuss the lack of time for education in clinical practice in the UK and USA which impacted university staff and clinicians’ ability to grade practice (Hanley and Higgins, 2005; Walsh and Seldomridge, 2005; Smith, 2007; Susmarini and Hayati, 2011). Susmarini and Hayati’s, (2011) qualitative study of six faculty who were expected to work with students three times per week
admitted spending only 15-20 minutes of time once per week with individual students. Anecdotal records reported in Walsh and Seldomridge’s (2005) study said faculty were unable to maintain accurate student records due to time constraints. Mentors in Smith’s (2007), small scale study said they were unable to devote as much time as they would like to supporting students due to the pressure of work. This is further corroborated by students in Hanley and Higgins (2005) qualitative study who suggested that assessors needed more time to observe the students’ practice. Collectively these studies suggest the time for observation, teaching and assessment in clinical practice is limited which is likely to have an effect on the quality of feedback and accuracy of the grade awarded.
1.5 PROBLEMATISING THE RESEARCH: PRACTICE ASSESSMENTS AS SOCIAL