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Early identification of underperformance is important, and students should never feel ‘surprised’ that they have failed a placement.  Student underperformance might relate to a specific critical incident, a series of minor incidents or a feeling that something is generally not ‘right’.

When considering underperformance, supervisors may find it useful to consider the following questions:

  • Does the student demonstrate a pattern of behaviour, or has the incident only occurred once or twice?
  • Did the incident impact the student’s learning, your teaching, and/or patient care?
  • Can you categorise where the underperformance exists?  Consider:
    • Inconsistent practice
    • Clinical skill/knowledge
    • Problem solving/clinical reasoning
    • Organising information
    • Time management
    • Professional behaviour and presentation (attire) (e.g. motivation, attitude, teamwork, arriving late)
    • Scope of practice
    • Not responsive to constructive feedback
    • Communication skills
  • Is the student able to demonstrate learning from minor errors, mistakes, or initial underperformance?
  • Are there external factors that are affecting the student’s performance?
  • Can I engage with colleagues who are experienced student supervisors to provide me with support or to assess the student to provide a different perspective?

Reflect on your interpretation of the situation and consider alternatives that might exist:

  • Example: If the student is frequently late, you may have interpreted this area of underperformance as inappropriate professional behaviour.  Consider whether the student’s concept of time differs from yours.
  • Example: If the student disregards input from other members of the multidisciplinary team, you may have interpreted this as the student having suboptimal teamwork skills. Consider if the student has understood the role of the other professionals and whether they have sufficient confidence to communicate verbally with other professionals. 

Reflect on the following placement elements to determine whether they have impacted on student performance:

  • Alignment between your supervisor style and student preferences for supervision.
  • Alignment between your feedback style and the student preferences for feedback.
  • Your expectations of progress/milestones and whether this aligns with university expectations.

Use the general checklist for assessing students to facilitate your documentation and communication when underperformance occurs.

Supervisor strategies to address underperformance

Should student underperformance occur, supervisors may tend to provide ‘more’ – more of the same strategies, more feedback, and more supervision.  This hypervigilance and ‘more more, more’ approach may not be the most appropriate approach for optimising the student’s success on placement.

The following table outlines a process that supervisors may find useful when managing underperformance:

Process

Strategies

Early detection to prevent escalation of underperformance.

Address performance concerns informally and constructively near to the time that the practice event has occurred – this will assist students to reflect on their performance and make adjustments to their practice.

Consider:

  • The standards that are not being met, in what ways, and for what reasons?
  • The need for additional learning supports required? (e.g., demonstration)

Act:

  • Document and discuss performance with the student.
  • Collaborate with the student to identify useful supports.
  • Request the student to complete a learning plan/contract and seek agreement from supervisor.
  • Implement the learning plan/contract.
  • Notify the university, depending on the nature of the underperformance.

Ongoing performance issues

Address the underperformance formally, categorise the underperformance, summarise the steps that have been implemented to date and whether they have been successful.  This is important to allow the student time to address these ongoing concerns.

The student needs to understand that non-achievement at this stage may result in placement failure or termination.

Consider:

  • The principles of providing feedback, highlighting the area(s) of underperformance focusing on the behaviour/action and not the individual
  • The additional supports, solutions or strategies are required.

Act:

  • Provide evidence summary to the student for further reflection.
  • Notify the university.
  • Request the student to adjust their learning plan and seek agreement from their supervisor (and university if indicated).

Significant performance issues

Student is at risk of failing - underperformance persists despite additional supports and learning plan. Placement milestones are not being met.

Or

A serious performance/behavioural issue that has endangered/put at significant risk the client, staff or the student, or significant reputational damage to the placement site and or the university.

Act:

  • Notify the university.
  • Discuss with the university whether the placement should be discontinued and who and when the student should report to

 

Deciding to fail a student

Ultimately there will be occasions, where, despite support and guidance from supervisor, organisation and university, a student will not meet the required standard and will fail their placement.  Students will require appropriate support to assist them through this event, which is usually provided by the university. It is important that supervisors maintain close contact with the university in situations where students are at risk of failing to support the student.

Useful resources:

References:

Please Note: References remain valid until superseded by later research. The resources referenced here are regularly reviewed and are considered current and relevant to the topics presented.

  • Bearman, M., Molloy, E., Ajjawi, R., & Keating, J. (2013). ‘Is there a Plan B?’: clinical educators supporting underperforming students in practice settings. Teaching in Higher Education, 18(5), 531–544. https://doi.org/10.1080/13562517.2012.752732
  • Brewer, M. and Duncanson, K. and Gribble, N. and Reubenson, A. and Hart, A. 2021. An intervention to enhance the supervision of health science students who struggle during work placements. International Journal of Work-Integrated Learning. 22 (3): pp. 149-166.
  • Milgate, W., Copley, J. & Hill, J. Failing professional practice placements in allied health: What do we understand about the student experience? A scoping review. Adv in Health Sci Educ 29, 301–327 (2024). https://doi.org/10.1007/s10459-023-10243-w
  • The Open University – Practice in supervision and assessment in nursing – the underperforming student.  Health Sport & Psychology.  Accessed April 2024 from:  https://www.open.edu/openlearn/health-sports-psychology/practice-supervision-and-assessment-nursing/content-section-5.2
  • The Royal Children’s Hospital Melbourne (2017) Management and Reporting of Performance Concerns for Student Nurses on Clinical Placement at RCH. https://www.rch.org.au/uploadedFiles/Main/Content/nursing-education/management-for-performance-concerns.pdf
  • University of Plymouth (nd) Managing poor performance.  University of Plymouth Accessed April 2024 from: https://www.plymouth.ac.uk/student-life/your-studies/academic-services/poppi/mentor-centre/managing-poor-performance
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