A Silent Dilemma
The concept of ‘failure to fail’ is not new but is a contemporary yet largely silent dilemma across the plethora of learning and development contexts, traversing the whole learning journey from entry to practice to lifelong learning. It is a predicament that affects both learners and educators unevenly, in the same way that ‘failure to pass’ would, too. However, ‘failure to pass’ is not commonly used, possibly because the default paradigm is one where ‘passing’ or ‘being competent’ is considered as the ‘norm’.
Shades of Grey
How wide is this ‘grey area’ in reality? The healthcare environment is very much focused on the value of science, so how can it be that passing or failing is not simply black and white? Indeed, if we had wholly evidence-based and objective assessment tools, learned and experienced assessors with dedicated time, and less knowledgeable and less experienced learners, would verification of competence be easy? Another point to consider is whether the ‘greyness’ has increased over time and that having 50 shades is a non-linear spread and merely the tip of the iceberg.
Theatrical Protagonists
So, who are the protagonists involved in this production? It is essential to assess the interplay between assessors and learners as this may make it easier to understand why this has become an inexact science. The overarching point is that we are dealing with humans – busy and emotional individuals. On an emotional scale, deeming a learner competent is less draining and less of a workload than failing a learner. Can experienced and learned assessors become competent in the process of failing learners when this is not a skill they will use every day? What grey areas exist in the ‘act’ of verifying competence in others?
Do we expect or assume good performance and then deduct marks in certain areas, or do we presume poor performance and add extra marks?
Career-ruining Decisions
The burden of proof seems to be required when failing someone – contemporary society seems to need evidence compelling enough to satisfy not only the learner but potentially their lawyers. The consequences of failing someone and potentially ‘ruining a career’ are omnipresent – second and third chances, appeals, tribunals, court proceedings – all of these consequences seem to conspire against an isolated assessor(s) who may feel that the risk of their decisions being undermined through appeal processes outweigh the gains of protecting the public when faced by learners who are not yet competent.
Theory vs Practice
Is the paradigm different when we consider theoretical assessments compared with clinical placements? A theory assessment may have a well-defined rubric that guides a learner through the production of work that matches with assessor's expectations. It is a fairly linear process whereby the better the rubric match is, the better the outcome may be for the learner. Marker ‘moderation’ seeks to ensure the objectivity of this process, and a failure to accomplish a pass mark usually results in further opportunities. University assessments are often faceless. Sometimes de-identified writing is deemed satisfactory or otherwise, regardless of the student's circumstances. However, failing a clinical placement opportunity is not easily remedied. It may necessitate a repeat of a whole placement, whole subject, or whole academic year – an added stressor for learners. We now see the advent of placement poverty, whereby mitigating the ‘cost’ of being on placement has become a government policy lever important enough to win votes.
Gatekeepers to Success
So – who holds the key to success – is it the learner or the assessor? If the learner has not learnt the required skills, who is to blame – the learner, the assessor, the teacher, or the institution? In healthcare, we prepare people to work in a dynamic team environment. Still, we often assess individual performance – this may suggest the keyholder of success sits at least 50% with the learner. Still, an experienced, considerate and encouraging preceptor, mentor, supervisor, teacher or educator can make a world of difference between pass and failure and pass and excellence.
Who’s Got the Monkey?
A significant expectation sits on the shoulders of preceptors and supervisors regarding the clinical placement context. Sharing their workload with a learner whilst remaining accountable for appropriate supervision requires not just an appropriate clinical skillset but a sound knowledge of human factors and the importance of soft, professional skills. Many have completed short preceptor programs to equip them with the theories of adult learning, how to use various assessment tools and the giving of crucial feedback. However, no ‘extra’ time or other tangible rewards are offered. Sometimes, supporting learners can be seen as the necessary impetus for promotion to different roles. Yet, at other times, the extra support given to learners is seen as part of the ‘everyday’ role of the health professional and related to professional standards of practice.
Assessment on a ‘Dis’continuum
There is no linear relationship between quality teaching, supervision and assessment, and learner success, as we need to consider the intrinsic motivation in the possession of the learner. The tertiary sector presents several challenges for learners, particularly opportunities to fail or pass, with multiple assessments and clinical placements to complete. Assessment ‘on a continuum’ is impossible as teachers are forever changing, although student employment models offer more natural learning and assessment opportunities. The advantage of continuous assessment is that the learner may be viewed more holistically – with their own experiences and skills, cultural background and narratives, rather than a student number alone.
Work-readiness
The salient point is that, despite multiple successful assessment transactions over time, a student may often remain ‘work-unready’ and require another clinically-based support period to transition to day-to-day work. How can it be that multiple verifications of competence are not enough – surely everyone needs a period of transition into any new role regardless of maturity or experience – do they need 12 months of work-readiness support as they are often offered in some disciplines? Suppose a learner is not work-ready irrespective of whether they have successfully passed all elements of their studies the first time or have struggled on multiple occasions over a 3-4-year period. Does that nullify the whole notion of pass or assessment anyway?
In summary, being human makes us fallible, and these imperfections allow us to consider emotions and consequences that lead us down the grey path.
It also makes us aware of society's litigious nature and the relative risks of failing another human being compared with supporting learners to ‘get across the line’.
Author
Tony McGillion
Tony McGillion is the Divisional Director of Education & Training at Northern Health and a Registered Nurse with over three decades of experience across various roles. He began his career in the UK, also working in Saudi Arabia, before transitioning to leadership and educational roles in Australia, including positions at Epworth Hospital, Cabrini Health, Austin Health, and as a policy advisor to the Victorian government.
He later joined La Trobe University as an Associate Professor and held multiple directorships. Tony holds a Bachelor of Education, a Master of Health Administration, and adjunct positions at the University of Melbourne and La Trobe University. He currently focuses on leadership development in nursing, serves as Chair for the Australian College of Nursing in Victoria and Melbourne, and mentors mid-career nurse leaders.
