Support for Practice Educators using the “Cause for Concern “process.

1. Support for Practice Educators using the “Cause for Concern “process. Amanda Stears QMU 25/10/2013

2. Why ? Identified within QMU PT team that there was a need to strengthen our support for practice educators to help them identify students that were giving “cause for concern” and to give them a process to help support and manage the student whilst on placement. Scoping exercise internally and externally across NMAHP professions. Main source Kathleen Duffy (2003,2007) and Stuart (2007) Note incidence is low 6 in last 2 years !

3. Identification of behaviours Duffy identifies patterns of behaviour that should raise “cause for Concern” Educators can also have own hidden patterns of behaviour ie benchmarking students against previous students and not assessment criteria. Stuart (2007) and Rowntree (1987) describe feedback as the “lifeblood of learning” as it allows the student to engage in reflecting on their strengths and weaknesses. Contributes directly to the learning process and students self esteem. Must be a two way process between PE and student.

4. Intuition or fact? Duffy (2003) identifies that PE’s often have that “gut feeling” or concern that is difficult to objectively explain. Duffy (2003) Gainsborough (2010) and Stuart (2007) tell us PE’s are hesitant to fail students. One major inhibitor is that they may be over ruled on appeal. Placement planning , support and guidance can reduce the likelihood of this occurring. Duffy states PE’s “fail to fail because of the lack of knowledge about the assessment process. Regardless of profession all PE’s have a duty to ensure that patients will be is safe hands with students *Duffy 2007, Hunt 2011)

5. Management of CFC student Time consuming ! Emotionally draining for the team not just PE. Needs to be a clear and auditable process available to PE’s to support students not performing as expected. The CFC ensures that the student is given every opportunity to improve their performance whilst at the same time recording any identifiable early pattern of behaviour. The decision to pass or fail is made on sufficient evidence to reach a defensible conclusion. Protecting both student and PE.

6. Purpose • Helps PE to recognise “early warning signs” • Supports PE in re-affirming their duty to themselves and their profession to recognise and deal with students who are struggling, and if despite extended support fail, these students must be failed to protect the public and the profession. • Recognise that assessment regulations give students the right to receive timely feedback about their performance, before the mid way assessment if necessary, and have the opportunity and support to correct the behaviours/practices that are considered unsatisfactory. • Be made aware that students must be told when their performance is not meeting the criteria set for satisfactory performance before being failed, giving the benefit of the doubt, or passing the buck to the next placement is not satisfactory (Stuart 2007). • Setting out good practice for meetings, allowing the student to bring another member with them for support. • Allowing students the opportunity to self assess and engage in reflection rather than being told what is wrong. Students should be asked to reflect on their performance during their initial meeting with their PE but there is formal recording before the mid way assessment . Although we recognise that PE’s may use informal feedback throughout the week or day, this risks not being seen by the student as such and in cases of an appeal, a lack of hard evidence does not support the PE . • It is as wrong to fail to fail , as it is to fail unjustly (Ilott and Murphy 1999)

7. Early Warning behaviours.

8. CFC Process Complete Page 1 detailing concerns. contact QMU Complete page 2 and 3 at meeting and decide whether further review is required. If so detail clear action plan and timescales p3 &4 . It may be that a one off meeting is all that is required. The action plan on page 4 can be carried forward and use with review meeting log on page 5. Return form to PBL at QMU

9. Worked examples P1,2 and 3

11. Action Plan p.4

12. Good Practice for Meetings and Action Plans • Meetings should be held in a quiet area where you will be free from interruptions. • If issues are identified early do not wait until the midway assessment, early intervention can be the key. • Open by allowing the student the opportunity to self reflect on their progress. e.g. “what do you understand happened here?” Use open ended questions. • Listen to the student’s feelings, they may be afraid of failure or angry, give honest detailed feedback with clear examples that support your concerns and document these on the cause for concern form, do not use expressions such as “I have heard…. I think”. Use the feedback sandwich (this helps build self esteem). • Develop an action plan with the student and set a review date. A five day review is suggested as appropriate. Students appreciate honest feedback on areas where they can improve their performance (Duffy 2007). • Use SMART goals to achieve specific objectives, discuss how they might achieve them and inform them of the consequences should improvement not occur. • Negotiate further learning opportunities if necessary.

13. Failing the student • Do not avoid the issues of failing students, failing a student can pave the way for greater achievement in future clinical placements. (Duffy 2007) • Do however be prepared for the students reaction which may include: • Shock and disbelief- There may be a genuine lack of insight into their own abilities, or previous mentors passing the buck or giving them the benefit of the doubt. This is neither in the interest of the student or the profession (Duffy 2003) • Shock their “friend” has failed them; students can mistake the warm, nurturing environment on placement as friendship. Practice educators need to become skilled at maintaining a professional and supportive role. • Students may become emotional, crying, angry, aggressive, be in denial, become verbally abusive, they may cite a personality clash or victimisation. If there is a hint of this a 3rd person may be useful from either the team or QMU. • They may blame previous practice educators or QMU. • Some may be relieved and willing to fail the placement. It can be a positive outcome. It is a common assumption that students will always take it badly. Zuzelo (2000) observed that students often recognise their clinical weakness and shortcomings and are relieved when Mentors give advice on how that can be improved. (Duffy 2007

14. Support for Practice Educators • Mentors should have the opportunity to discuss issues with a supervising practice educator (PEF’S, HEI) • Note not all situations with students can be resolved; you must sometimes seek advice from colleagues or your PEF. • Follow local policy. • Liaise with the QMU’s PBL team, the students PAT or the programme leader. • Acknowledge your own feelings. • Don’t give benefit of the doubt. • Don’t ignore alarm bells. • Seek support early from QMU. • Avoid bias and making assumptions. • Consider using supervision for anonymous discussion or utilise a second observer , this can help bring objectivity and prove to the student there is fairness in assessment .

15. Questions