Failed assessments can lead to self-doubt and low confidence, which can, in turn, affect future attainment. Students who fail assessments are less likely to reach out for support and are at risk of underachieving in their professional lives.
We must identify these students and intervene early to prevent them from following this negative trajectory and to help them build professional skills. We piloted a remediation strategy – a workshop that is guided by reflective practice principles to increase competency in clinical skills such as patient-doctor communication and support the formation of a trainee’s professional identity. The results were promising: 86 per cent of students who attended this workshop passed their end-of-year objective structured clinical examination (OSCE), compared with a 61 per cent pass rate for students who were invited to attend the workshop but declined.
Here are some tips based on what we learned in the process.
Identify struggling students
One of our main aims was to identify students who were struggling with mid-year assessments to help improve their skills levels before the end-of-year assessments. We recommend working with your assessment team to understand the mid-year fail data. We looked at the pass mark for the consultation skills OSCE stations. If a student hadn’t met it, we invited them to attend the remediation workshop.
Diagnose the problem and develop a personalised plan
At the start of the workshop, we gave students a workbook to prompt self-review and reflection to help identify performance issues. The book asked for clear descriptive goals and actions that would be taken to achieve these, based on Gibbs’ reflective cycle – a prominent framework used for reflective practice in learning and professional development. The cycle contains six stages: description, feelings, evaluation, analysis, conclusion and action plan. Guiding individuals to work through the cycle helps them to think critically about their experience, learn from past mistakes and improve future practice.
For reflection to be effective, it needs to evoke feeling. The questions posed required students to approach the task with an analytical mind and be evaluative so they could pinpoint exactly what was going wrong for them. It helps if you ask students to bring their assessment reports so they can analyse areas that need improvement and draw conclusions for their next steps forward. Reflective questions such as “According to my OSCE personalised feedback, my main areas for improvement are…” helped them examine their goals and strengths and then asked specifically about their assessment results. Students had to explore what went well, what could be improved upon and what they would do differently next time. Reflective questions such as “What have you done to build upon your skills since?” also placed the onus on the student to develop their skills and knowledge. At the end of the workshop, students completed an action plan.
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Practise, feedback and reflect
Recap the topic: after the reflective exercise, instructors gave a short didactic lecture on the key principles of the topic they failed. During this recap, we covered the learning outcomes and key features of the topic. This was followed by a Q&A session which helped us scaffold learning and differentiate students’ level of understanding.
Practise and discuss skills or theories: we practised skills in small groups of four students with one facilitator using role plays with simulated patients. We used Agenda Led Outcome Based Analysis (ALOBA) to structure and facilitate the session and asked students to share their personal objectives identified during reflection so we could tailor their practice and feedback to the areas they needed to develop.
Give immediate and personalised feedback: immediate feedback greatly improves student learning outcomes by quickly correcting errors and preventing confusion. Other students and facilitators provided feedback using the SET-GO method from The Calgary-Cambridge Approach to Communication Skills Teaching 2: The SET-GO Method of Descriptive Feedback. Those providing feedback outlined what they saw (eg, the patient became upset when you mentioned…) and what else they saw (eg, you allowed the patient to calm down before continuing). Then, the student who role-played shared their thoughts including potential solutions for improving the interaction. We ended the session by clarifying the goals taken from the feedback and with offers made by the group of ways to explore ways students can achieve their goals and clear strategies for improving future interactions. This format promotes descriptive, specific and constructive feedback to evoke reflection and provide specific actions to improve skills.
Take advantage of the hidden curriculum: leverage role modelling, student discussion and vicarious learning to maximise opportunities for learning. The experiential nature of role play which requires students to experience, reflect, conceptualise and experiment creates opportunities for incidental learning, even for students who are not actively engaged in role play. We also provided a handout of key skills to look for when observing to prevent window gazing. This later served as a revision prompt outlining the essential skills of the topic.
Consolidate learning: we concluded the session by asking the students to discuss their main learning points and describe the actions they would complete in their own time based on their personal development plans. We encouraged students to actively review their reflections when revising for future assessments.
Seek student input and reassess
We tracked assessment outcomes for the students who attended and evaluated the workshop to understand their reaction and guide change for future iterations. Students self-reported a subjective increase in skill level after taking part. Most significantly, they felt better able to structure the consultation and keep the interview on task, allowing for both doctor and patient perspectives to be met.
Individual and group reflective practice can help students come to terms with failure and facilitate future learning. For further information please get in touch.
Ellen Lowry is a lecturer at the University of East Anglia.
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