Are we failing our students

1
Are we failing our students?

• Dave Green

2
Attrition rates

• Completion rates in UK clinical psychology
  training compare favourably with those of other
  healthcare professions (NAO 2001)
• However no extant empirical data on patterns of
  failure within the profession

3
DROSS research project

• DG has approached various UK training courses and
  requested data on the last 5 completed intakes
• Any students who have not completed?
• Details of pass, resit and failure rates on each
  of the course assignments that trainees have to
  undertake
• Covers academic, research and clinical components
  of training

4
A few hypotheses

• Less than 5 of those admitted to courses will
  fail to qualify
• Resit and failure rates on clinical placements
  will be lower than resit and failure rates for
  academic and research components
• Courses will differ from each other in their
  overall marking patterns

5
Pass Rates
6
Why do so few fail? ve

• Plenty of well qualified applicants
• Selection discriminates effectively
• The courses are well-designed
• The trainers are wonderful

7
Why do so few fail? -ve

• The cult of the positive Marzilliers
  critique of halo effects in UK clinical
  psychology courses
• Universities fear of litigation
• Penalty and bonus clauses regarding attrition
  rates in contracts between NHS purchasers of
  professional training and university providers

8
Why dont we fail placements more often?

• The remedial role of the tutor at the
  mid-placement visit
• Ambiguous expectations of good enough
  performance levels
• Limited evidence base on which to make decisions
• Problems in getting a second opinion unlike
  second marking an essay

9
Type 1 and Type 2 errors

• We can make 2 kinds of mistakes
• Fail people who should have passed
• Pass people who should have failed
• Looking back on your experience in training which
  category of error do you think your course has
  been more likely to make

10
Making the better mistake?

• In WW2 rudimentary radar systems could not easily
  distinguish between a flock of pigeons and an
  enemy bomber
• It was considered better to slaughter a bunch of
  innocent birds than to run the risk of letting a
  plane get through to London
• Nobody spoke up for the pigeons!

11
Checks and balances

• All universities have an appeals system for
  students who consider they have been failed
  unjustly
• All NHS Trusts have an appeals system for
  employees who consider they have lost their jobs
  unfairly
• Major Review requires courses to assess fitness
  for award, practice and purpose

12
Harold Shipman

• A graduate of Leeds University
• Misconduct early in medical career what about
  during training?
• GPs like CPs work mainly in private

13
The discomfort of failure

• The trainee will be upset
• The supervisors competence may be questioned
  plus their own doubts
• The appeals process will drag on
• Probably nobody concerned will have had much
  prior experience to draw upon so procedural
  mistakes and mismanagement are common

14
Differing attitudes to placement failure

• Contrasting views expressed in Green and Dyes
  (2002) Delphi survey
• If supervision is appropriate this should never
  need to happen
• Courses need to look at this- sometimes there is
  too much heroic work done to save an unsuitable
  trainee from failing

15
Training implications (1)

• Supervisors need to be aware of their
  professional gate-keeping role
• They will probably not have much chance to learn
  from experience
• The transfer of therapeutic skills and attitudes
  may prove to be more of a hindrance than a help
• Learn the importance of due process

16
Training implications (2)

• Courses can better operationalize the
  performance standards they expect (using
  competence framework)
• Trainees required to demonstrate competence not
  supervisors required to discover incompetence
• Clear communication and decent support systems
  for all concerned

17
Reference (1)

• National Audit Office (NAO). October 2001
• Results of an Analysis of NAO 2000 survey on
  future allied health professionals education and
  training Feedback to Higher Education
  Institutions
• Data on 1997 intake

18
Reference (2)

• Green D and Dye L (2002)
• How should we best train clinical psychology
  supervisors? A Delphi survey
• Psychology Learning and Teaching 2, 2, 106-115