Support for Practice Educators using
the “Cause for Concern “process.
Amanda Stears
QMU 25/10/2013
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 !
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.
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)
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.
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)
Early Warning behaviours.
Health or well
being issues
Attitude or
behaviour in
practice
Professional
boundaries
Lack of personal
insight
Early
warning
behaviours
Poor
attendance and
time keeping
Not meeting
proficiencies
Lack of interest
Poor
communication
and inter
personal skills
CFC Process
Cause for concern identified
Students struggling to meet expected competencies
Or displaying early warning behaviours
Arrange meeting with Student
Do not wait till midway to raise concerns
Contact students PAT or PBL Team
Formulate an agreed action plan with student
Set SMART goals and detail how these will be
achieved
Agree a review date and arrange extra learning
opportunities if required, document in CFC form
Review goals as required may be daily or weekly
Each meeting should be recorded and the completed paperwork forwarded to QMU at the end of the
placement. This does not replace weekly liaison with PAT/PBL
Student improves and completes placement or
Student does not improve and fails placement.
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
Worked examples P1,2 and 3
Evidence to support Cause For Concern
This may cover- conduct/behaviour/clinical performance/attitude
Contact Made by:
Date: 25/10/13
Name:____Jo Bloggs ___________________
Clinical Site :
Physiotherapy dept
Bloggs Royal Infirmary
Anytown
Any county
Position:_Practice Educator _________
Email:___jo.bloggs@nhsanywhere.co.uk__
Phone:_____________________________
Yes
*Professional Values




*Communication and
Interprofessional Skills
Practice Educator (if different from above)
Student Details
Name:_____A/A_______________________
_
Position:___________________________
Name_____Jack Smith___________________
Email:______________________________
QMU
Contact__Amanda Stears________________




Level ___BSc Level three________________
Phone:_____________________________

*Clinical Practice and
decision Making


Summary of cause for concern


Persistent lateness , was late Mon , Wed, and Friday first week, and is demonstrating a lack
of empathy toward the patient group, this has been demonstrated by inappropriate
comments about an elderly patient with weight issues in clinical yesterday.
*Leadership,
management and team
working




List of Key Contacts
QMU PAT/PBL Team
QMU Programme Leader
Contacted
√
Date
25/10/1
3
Whom/ method (phone /email)
Phone call
Any other concerns not
mentioned above
Demonstrates poor professional behaviour
and is unaware of professional boundaries
Is preoccupied with personal issues
Is unreliable e.g. persistent
lateness/absence/sickness
Not motivated and shows a lack of interest
Demonstrates a lack of empathy and caring
towards clients/carers and colleagues
Has no insight into weakness so unable to
change following constructive feedback
Does not respond appropriately to feedback
Practical , Interpersonal and communication
skills not appropriate to their level of
training
Demonstrates inability to manage
controversy
Does not meet the required level of
proficiencies for their level of training
Has inconsistent clinical performance for
their level of training
Has demonstrated unsafe clinical practice
Does not have the required knowledge for
their level of training or able to apply theory
to practice
Is unable to demonstrate preparation and
organisational skills to their level of training
Is unable to work within the team
Does not demonstrate respect for all
members of the team
Shows lack of respect and understanding of
role of external agencies and stakeholders
√
√
No
Background to cause for concern (please provide clear supporting
evidence)
Background to cause for concern (please provide clear supporting
evidence)
Jack has been late on 3 occasions in his first week with no
satisfactory explanation, and is demonstrating a lack of empathy
toward his patients . Yesterday he was heard making inappropriate
comments about an elderly patient who was in clinic yesterday with
knee pain ,where his weight was an obvious contributory factor.
Jack has been late on 3 occasions in his first week with no
satisfactory explanation, and is demonstrating a lack of empathy
toward his patients . Yesterday he was heard making inappropriate
comments about an elderly patient who was in clinic yesterday with
knee pain ,where his weight was an obvious contributory factor.
Assessment of the situation/ action plan required/SMART goals
used/additional support and learning offered.
Assessment of the situation/ action plan required/SMART goals
used/additional support and learning offered.
After discussion with Jack it appears that there is no regular bus
service, there is a regular bus that would get him here earlier . we
have agreed that he will catch the earlier bus and we will adjust his
patient list accordingly. With regards to professional behaviour we
have discussed the issues of professionalism and Jack will reflect on
the issues of obesity in the elderly with knee pain in his case study
for this placement.
After discussion with Jack it appears that there is no regular bus
service, there is a regular bus that would get him here earlier . we have
agreed that he will catch the earlier bus and we will adjust his patient
list accordingly. With regards to professional behaviour we have
discussed the issues of professionalism and Jack will reflect on the
issues of obesity in the elderly with knee pain in his case study for this
placement.
Action plan agreed with student : Review date set :
Yes/No
Yes
1st Nov 13
Action plan agreed with student : Review date set :
Yes/No
Yes
1st Nov 13
Outcome :
Outcome :
We have reviewed Jack’s progress this week and he has
demonstrated a more compassionate approach to his
patients and time keeping has improved. No further action
is required.
We have reviewed Jack’s progress this week and although
his timekeeping has improved he is still demonstrating a
lack of compassion with his patients and is showing little
insight into feedback given on the matter. A meeting has
been arranged with his PAT to discuss how this can be
addressed. In the meantime I have asked Jack to read the
CSP and HCPC standards on professional conduct.
Action Plan p.4
Action Plan Lead Jo Bloggs
Student Jack Smith
Practice Placement MSK OP
Date agreed
Review Dates____8/11/13_______ ___________________ ________________
Problem/s identified
SMART goal set
On-going unprofessional
behaviour demonstrated
towards patients.
To read and reflect on CSP and
HCPC standards of
professionalism,
Demonstrating little insight into
feedback given about making
inappropriate comments about
patients
To undertake pro learning
module on caring and
compassion and to shadow PE
to gain further experiience .
Action required (how will goal be achieved) Date achieved or
carried forward
Give a lunchtime in service to staff on what is
professional conduct
PE to discuss with department manager
running an extra tutorial on the use of
feedback with students on site.
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.
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
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 .
Questions