Using the Performance Improvement Algorithm
The evidence from clinically–based learning is clear—instructors need to identify and act on underperformance or unsafe practice attributes early, ideally in the first days to weeks of a clinical course. Often the first signs that a student is in jeopardy of clinical failure is a “gut feeling”, that this student is performing differently than expected, or differently than other students in the clinical group. Often, students will have multiple concerning behaviours that occur in all domains. It is important to consider the etiology of clinical performance deficiencies, as these may include deficient fundamental knowledge base, not having had opportunity to develop independent thinking skills, immaturity, and cultural differences. When students have deficiencies across domains, the instructor should also consider underlying causes including learning disability, or impaired physical or mental health. Consultation with the Faculty Navigators (FN) and/or Student Support Chair may help you accurately identify the cause of attributes of underperformance or unsafe practice. Should fitness to practice and/or incapacity be considered, the student should be referred to the Associate Dean (AD) for discussion. If concerns are concurrent across domains, consider starting by addressing the most predominant concern or that which interferes the most with the student’s ability to meet course outcomes. The Performance Improvement Plan (PIP) algorithm is meant to clearly define for students and faculty, what constitutes underperformance and unsafe practice, as well as both the student and instructor roles include when students are at risk of clinical failure.
Start:
- You see any occurrence or attribute of underperformance of unsafe practice, which does not include actions/behaviours that warrant immediate clinical failure. Give clear, constructive feedback to the student about their performance in private. Consider using the WRAP feedback method detailed in Appendix A. If the student performance is such that you cannot trust the student to be in the setting without continuous observation OR the student’s presence in the clinical setting will significantly negatively affect your ability to attend to the other students, give the student feedback and send the student home for the shift. This is considered a temporary removal from the clinical site.
- Follow up with the verbal feedback in writing, and deliver via Blackboard messages. This constitutes a warning within the student non-academic misconduct policy. Ensure that the feedback includes (a) recommendations for in-situ remedial work (b) consequences if the student does not address your concerns; and (c) what your expectations will be for the next clinical shift. An example is available in Appendix B. At this point, you may consider connecting with the Faculty Navigators and emailing the Student Support Chair with a brief synopsis of your concerns and plan for the student, especially if the concern is significant or occurs across multiple domains.
- The student is expected to respond, in writing, to your written feedback prior to their next clinical shift. If the student fails to do so, they are not eligible to return to the clinical setting. If the student is eligible for clinical return, continue to observe student performance, consider additional measures to ensure success and safety, and continue supporting the student with high-quality feedback. If there are no further issues, the concern has been successfully remediated.
- If the student has a pattern of underperformance or unsafe practice, marked by a second offence, OR if the student cannot consistently practice at the level expected for their course year, sequence, and place in the term, a Performance Improvement Plan (PIP) is warranted prior to continuing in the clinical course. Instructors are encouraged to consult with the Faculty Navigators (FN) at this point. The student is informed of the need for PIP, and can (a) choose to stay in the clinical course under the parameters detailed by the PIP; or (b) voluntarily withdraw from the course. The PIP is to be developed with student input, as research suggests that self-determination is improved when students can contribute their thoughts about the etiology of their challenges, as well as strategies that are more likely to work for them. A copy of the PIP document is included in Appendix D.
- Once the instructor and student have signed the PIP, the instructor is to email a copy of the PIP to the Student Support Chairperson and the AD. If the student opts to take a voluntary withdrawal, the instructor is to complete the Post-Performance Improvement Plan Summary (P-PIPS) (Appendix E).
- Both instructor and student work to satisfy the terms of the contract. It is important that the instructor consider using team and FN resources to identify additional in-situ remedial activities to allow the student opportunities for growth while protecting safety. In-situ remediation are those additional teaching and learning opportunities that occur in addition to the curriculum to meet individual learners’ needs, especially if success in the course is at risk. In-situ remedial activities are detailed in Appendix C. The student and instructor should meet no less than weekly, to review the progress toward the outcomes of the PIP. Note: if a student demonstrates any of the attributes identified as warranting immediate clinical failure, they should be removed from the clinical course and receive a failing grade, regardless if they have/have not been issued a PIP.
Ending the PIP
Pass.
PIP end dates are flexible, and can be discontinued when the instructor identifies the student is performing at the level expected, consistently, for the course. If the student consistently performs at the level of cognitive, affective, and/or psychomotor expectations for the clinical course, they will receive a passing grade. The instructor will complete a P-PIPS for the student and the student’s file, in addition to the clinical evaluation tool for the course.
Fail.
If, following feedback, in-situ remedial activities, and adequate time (> 3 clinical days) under the parameters of the PIP, the student fails to make progress at meeting course outcomes or the PIP terms, the student should be removed from the clinical course and a failing grade be given. The instructor will complete a P-PIPS for the student and the student’s file. Students who are unsuccessful in a clinical course will be required to meet with the AD to review the issues with performance, as well as to identify the next steps in their trajectory.
The Post-Performance Improvement Plan Summary will be reviewed by that AD prior to placement on the student file. As indicated, and to foster success in future clinical courses, the AD may make the P-PIPS available to subsequent clinical instructors. For instance, to share activities that supported student learning, or for habitual and perpetual concerns.
©Maggie Convey, 2022