Guide for Students in Professional Program Placements, Clinics, Practica
The purpose of this guide is to help students in professional programs better understand how decisions about student performance in fieldwork, clinics and practica are made. The assumption is that understanding will help promote student success. The focus is on program expectations of professional behaviour; how things may go wrong for a student; and what a student can do when things go wrong. A checklist of professional behaviours concludes the guide.
This guide is not intended to take the place of any university document or policy, nor of information or advice provided by a student's program. It has no official status.
Some basics about placements, clinics, practica
In most cases a memorandum of agreement between the University and the setting (hospital, school, other facility) outlines the conditions of the placement. One feature of such agreements is that the setting can terminate an individual student at any point. Furthermore, the Dean, on the recommendation of the school or program, may also suspend a student's placement. See the Policy on Off-Campus Placements under Academic Information in the Calendar.
The supervising professional supervises students in addition to all his or her other duties. In some programs, the supervising professional will be a faculty member with the power to assign a grade; in other cases, grades are assigned by the program based on the professional's assessment report.
The supervising professional's responsibilities are both to guide the student in correct and ethical practice, and to evaluate the student's performance. In addition, the supervising professional is responsible to the setting, the profession and the public. These several responsibilities include protecting the setting and the public from undue risk or harm arising directly from the practice of the student.
Programs typically designate a faculty member to be the contact person (placement coordinator, faculty advisor - titles vary from program to program) for both the student and the supervising professional. Any student concerned with the way a placement is unfolding should contact the coordinator or faculty advisor as early as possible.
Most programs and professions subscribe to specific statements about professional conduct or ethics. Students should familiarize themselves with these statements early in their study and review them regularly. A student in doubt about what is or is not acceptable should always ask someone in authority in the program.
Students are expected to follow all the recommended steps prior to starting a placement, internship or practicum, for example, ensuring they have the required immunizations, have made contact with the associate teacher, and so on.
How things go wrong - student perspective
grade too low
feeling singled out or targeted by someone in power/authority
matched with unhelpful supervisor in a placement setting
someone in authority has unrealistic expectations of your knowledge base
student accused of some misbehaviour or error
feedback on student performance is inadequate; open to interpretation; or abusive
medical or compassionate circumstances impair student performance
Appealing a grade in a practicum, placement, or rotation
A grade may be appealed in a professional program, as in any other program. However, when the grade being appealed is a failure in a placement, rotation, or practicum, the only records of performance are usually the assessment forms completed by the supervising professional and any notes made by the student (for example, a journal). The performance as such is not subject to reexamination in the same way as an essay, lab report or written final exam. Thus, the only possible remedy may be the opportunity to redo the placement, rotation or practicum, as opposed to a revision of the grade.
This situation is frustrating for a student. No one wants to be told they must redo work which they believe they have already done in a satisfactory way. Furthermore, the requirement to redo the work can delay graduation. The costs of delay are borne entirely by the student. Students to whom this happens feel it is unfair.
Student: Couldn't there be a better system? Ombudsperson: Let's review the situation in more detail and see!
The student's responsibility is to carry out the duties of the placement, rotation or practicum as effectively, safely and appropriately as possible, while learning from the supervising professional. As in any learning situation, some awkwardness and error are to be expected, but how much error, and what kind of error, are specific to each setting.
Evaluation is typically informal and ongoing ('formative') as well as formal and periodic ('summative'). Supervising professionals may differ considerably in the way they use informal evaluation. Formal and periodic evaluations may require the completion of a detailed assessment report which is discussed with the student. The student may be required to complete a self assessment prior to the discussion. The student may be required to sign the supervisor's assessment report, as confirmation that he or she has seen it and had an opportunity to discuss it with the supervisor - even when the student disagrees with the assessment.
When the supervising professional concludes that a particular student should not continue in the setting because the student's practice is unsafe, or concludes that the student failed to achieve the objectives of the placement, practicum or rotation, the student's overall performance may be reviewed by the program in the light of the progression requirements and the student's record to date. The specific process followed is usually detailed in the Calendar, or in other program literature. The decision options vary for each program. A student may appeal the program decision by following the program-specific appeals process.
What can happen if the student appeals the actual grade awarded for practical work?
If the facts are in dispute, the program may seek clarification by discussing the matter with both the student and the supervising professional. The program may make the professional aware of the student's claims and request a response.
If the supervising professional affirms the original decision (the most likely outcome), the grade is unlikely to change. The student may be granted a chance to redo the placement, practicum or rotation; or may have to appeal specifically for permission to redo; or may be required to withdraw from the program.
Permission to redo practical work is most likely to be granted when
the program is aware of medical or extenuating circumstances which had an impact on the student's performance during the placement, practicum or rotation; or
the student admits things went wrong, but is able to articulate the lessons learned and has requested permission to redo the practical work; and
the student has a strong record in the program and is seen as responsible and credible; or
there is independent evidence, or some good reason, to suspect that there were factors during the placement, practicum or rotation over which the student did not have control, and which limited the student's opportunities.
Student: But, if something went wrong and it was not the student's fault, why must the work be redone? Ombudsperson: Because the program has to be confident that the skill and knowledge requirements of the practicum or rotation have been achieved. Student: It doesn't seem like a system that is very fair to students! Ombudsperson: If you mean by 'fair' giving the student the benefit of the doubt, you are right. But if students were given the benefit of the doubt in these situations, people would be unsure of those students' clinical and practical skills at the time of graduation. That would reduce public confidence in the profession, and, in the end, that could hurt us all. So in the big picture sense, it is fair to us all to have a system that provides graduates of whose skills we can be confident.
Feeling singled out or targeted
A student may believe he or she is being singled out or targeted by someone in power. The student may believe the treatment is unfair, and other students who witness it may concur.
It is difficult to make a case that you have been singled out or targeted. Trying to make the case is risky. Students in this situation worry that they will be perceived as troublemakers, or subjected to retaliation. On the other hand, feeling you are being treated unfairly is a serious matter. What can you do if this happens to you?
Keep a log of what happens and what is said. Be factual in your log - emulate a video camera in the hands of an impartial camera person. Why keep a log?
it can help you verify or disconfirm your feelings and perceptions
it can provide a record in the event that you decide to make a complaint or seek professional advice
it can help restore your sense of control over the situation
Review your own behaviour critically. Are you a good listener? Is there a message you may be missing? Are there things you could do to improve? Has the relationship between you and the other person become a power struggle?
Remember that students in professional programs are expected to behave professionally. Are you clear about what that means in your program? (See checklist later in this guide. See the policies and guidelines of your program on its website, in the Calendar, in handouts or handbooks, course outlines and other documentation.)
Try to have an ally in your program - someone you feel you can trust. This may be your faculty advisor, the placement coordinator, or someone else in a mentor role. If you do not know any person in your program well enough to trust, ask someone in authority if you can speak to him or her in confidence. Seek advice on how to handle the situation. If you present yourself as seeking advice, rather than complaining about Professor X, you are less likely to be seen as a troublemaker.
Do other students have similar problems with the person? Try to listen for hints, but avoid talking carelessly about your own situation. First, news travels and facts and feelings that are private may become more public than is comfortable for you; second, talk is sometimes a substitute for effective action. If you need to vent (and you probably do) vent carefully to a trusted few.
Friends and family members may give poor advice. Ask them to listen and offer comfort. For advice, go to someone more in the know - your placement coordinator, faculty advisor, director of the program, the ombudsperson.
Be aware of relevant University policies: Non Discrimination/Harassment Policy, and policies on the conduct of research, the use of computing resources, off-campus placements, and so on. Of course, be aware of and follow all policies specific to your own program.
Poor match in a placement setting
Be prepared! Associate teachers, clinicians, therapists and other students are each unique individuals with particular expectations. It is normal for you to learn more easily from some than from others. It is normal for you to prefer one person to another. And, as you know and fear, it is normal for the associate teacher, clinician or therapist to have preferences, too!
But those preferences should be seen, not as a barrier to your success or to the associate teacher or clinician's effectiveness, but as a normal professional challenge.
Professionalism is not a natural, spontaneous behaviour, like tears or laughter, but learned behaviour, like speaking a second language. The more you practice behaving professionally, the more professional you will become.
So if there is a problem with the approach taken by your new associate teacher, clinician or therapist, do not count on him or her to make a change. By all means, discuss any problem with the supervising professional or program coordinator, but also ask yourself what you can do. Own your own feelings and deal with them.
Examples of student complaints with 'professional' responses in italics.
I cannot understand Dr. X. He has a heavy accent, and also mumbles. I make sure to stand close to Dr. X in rounds, and do my best to follow what he says. Being well prepared helps me tune in to what he's explaining. When I have a chance, I check a key word or two with him. He seems to appreciate my efforts.
My first associate teacher was very understanding about my preference for managing the classroom. The associate I have now is inflexible; if things aren't done her way I can tell she doesn't like it. She really gets on my nerves! My current associate teacher has many strengths, and so I am doing my best to understand her expectations and to learn from her. Whenever I feel frustrated, I remind myself I only have three more weeks to go. I also try to appreciate the best things about her - like her kindness to her students.
I overheard the supervising professional describing my difficulties with a particular client to another student. It was embarrassing for everyone when they realized I had heard them. I said: "I'm sorry, I realize you didn't know I was there. It sounds as if we need to talk about how I can improve my work with that client." They could see I had no hard feelings.
I asked to meet with Professor Y, to talk about the problems in clinic. He made an appointment to see me, then did not show up. I wrote him a friendly letter, explaining why it was important for me to meet with him, and heard nothing back. I went to see him during his office hours, but he wasn't there. I feel he is trying to punish me by ignoring me. It makes me very angry! I am going to seek some advice from the program coordinator about how to handle this humiliating situation!
Expectations of your knowledge base seem to be not realistic
Students may feel the expectation that they know a particular detail is not realistic. They may complain that, despite using the wrong word in a situation, they actually knew what to do. Some argue that when they asked fellow students, they, too, did not know that particular detail.
What are realistic expectations in a professional program? First, the student is expected to take responsibility for his or her own learning. This includes being honest about not knowing the answer, but then doing the necessary research so you know the answer next time. Second, each student is expected to develop a knowledge base (think of this as intellectual muscle building, since much of that knowledge base will be acquired through memorizing vast amounts of material). Finally, the student is expected to develop skills, often quite quickly.
When we first learn the alphabet, we go through a stage during which we must return to 'A' if we are interrupted while reciting it. Once our alphabet knowledge base is in good shape we navigate it with relative ease. The ability to focus on problems productively while navigating a strong knowledge base is an essential part of being an effective professional.
It is difficult to tell in advance what an individual's capacity is for building a strong knowledge base. Some students enter medical school or dentistry programs or other professional programs, and discover that they cannot cope with the enormous amount of detail the profession's knowledge base requires. Whatever your own capacity, you may become frustrated at having to "go back to A". What can you do if questions are raised about your knowledge base by your instructors or advisors?
Ask instructors what they believe you can do to improve.
Seek the help of a learning skills counsellor. He or she may be able to give you tips on working smarter.
Self esteem may be a problem. Lack of confidence looks a lot like not being sure of the answer. Talk to a personal counsellor.
Listen to your fellow students. Do you think they are more knowledgeable than you are? What are their strengths and weaknesses? What are yours? What can you learn from them? Is there a good learning culture among students in your program? If there is, take advantage of it!
Understand your own learning style. Is there some material you pay less attention to because it goes against the grain?
Reevaluate your professional goals. If you had a million dollars, would you still want to be a nurse, teacher, dentist, physical therapist? Why? Why not?
Accused of misbehaviour or error
Professional programs expect students to behave professionally. A breach of the written or unwritten codes for your discipline and profession can get you into trouble. What do you do then?
Resist blaming someone else, especially a supervisor or person in power. You are expected to be responsible. You are the bottom line.
Acknowledge fault, apologizing when that is appropriate. Fault which is acknowledged is fault which can often be remedied.
Avoid challenging the judgments of those in authority. Show respect for those judgments. At the same time, do not be afraid to state how you perceive the situation. Use of phrases like, "It appeared to me...." can allow for different ways of seeing a situation and create opportunities for constructive dialogue.
Be truthful. Honesty is a professional obligation.
Disclose mitigating circumstances promptly. Don't gamble on not having to disclose them. "I am truly sorry....I was very upset yesterday, as I had just learned the troubling fact that..."
Be aware that students have been required to withdraw from professional programs for such breaches of conduct as telling a lie, wearing the wrong clothes at the wrong time, being late or absent without notice, being under the influence of alcohol or drugs, failing to follow rules or guidelines of their placement setting, and expressing their feelings in ways that seemed inappropriate, intrusive, or threatening to others.
Feedback on performance inadequate or open to interpretation
Supervising professionals are usually very busy people. While some will take the time to give you clear detailed feedback on your performance, others may say little or nothing.
This may not be a problem for you as long as your performance meets expectations, but when you discover at the end of a rotation or placement that your performance has not been satisfactory, it is a shock.
Look for a moment at the problem from the point of view of the supervising professional. She or he is trying to teach and encourage students and evaluate them at the same time. The duty to teach and encourage can sometimes have the effect of putting a positive spin on negative feedback, masking it. You may need to learn to unpack statements which seem positive but may contain critical assessments, such as:
"That was much better than yesterday." (Could mean If you continue to improve, you may pass.)
"You seem very comfortable with that patient." (Could mean You usually seem awkward with your patients.)
"It's obvious that History is your favourite subject." (Could mean Your dislike of Mathematics is all too clear.)
"You may find it easier to...." (Could mean This is the correct way to do that....)
If you feel you are being left in the dark about the adequacy of your performance, ask for feedback, and be prepared to listen carefully to it. Don't just assume everything is fine - or terrible, for that matter. Check with the supervisor whenever there is any uncertainty about what a comment really means.
If you feel the feedback you are getting is abusive, humiliating or demeaning you may want to discuss the matter with the supervising professional. Three part statements (fact, impact, what you would like to see in future) are a useful strategy and are more fully described in the guide, "Student Instructor Relations: Handling Issues Fairly". If the prospect of such a difficult conversation is daunting, try these alternatives:
remind yourself that it is not your fault that the person has not learned to give critical feedback more gracefully;
remind yourself of all those who treat you well and champion your efforts;
give yourself a comforting treat to help make up for the distress;
and of course, consider discussing the situation with the placement coordinator or other trusted person in your program.
Medical or compassionate circumstances impair performance
Medical or compassionate circumstances can affect anyone. If your performance of professional duties may be affected by temporary ill health or by some other circumstance, you must weigh carefully whether to seek some alteration in your duties or whether to carry on. Try to discuss your doubts with your supervisor or academic advisor. A competent professional is keenly aware of his or her own limits, and avoids putting others at risk. At the same time, professionals must often persist in conditions that are far from ideal.
It is sometimes possible to take a leave of absence from a program; if that seems appropriate in your case, discuss the matter with your academic advisor.
Professional behaviours - a partial checklist
be a good listener
manage time well
respect boundaries and roles
show respect for others (it's not just a feeling: it's actions)
refrain from vulgar language, questionable humour, long speeches
observe the dress code, whether written or unwritten
follow all the rules, for example, keep all confidential information confidential
learn to take criticism and use it constructively
show appreciation of others
when criticising others, find ways to be constructive, supportive and truthful, all at the same time
be aware of the impact of your words on others
be responsible for your actions - don't make excuses
be reliable - follow through on commitments
be mindful of your own limits
think critically; avoid assumptions and other mind traps
know your stuff
LOVE YOUR WORK
Note: This guide is one of a series produced by the Office of the Ombudsperson. Frances Bauer wrote the text, but the comments and suggestions of faculty and staff in the Faculties of Education, Health Sciences, Medicine and Dentistry, and Theology and the School of Social Work were invaluable, as were the comments of Theresa Morrissey of the University Secretariat. The guide reflects the experiences of numerous professional program students who, over more than a decade, used the services of the Office of the Ombudsperson. If you have questions or suggestions, we would like to hear them. This text can be downloaded and duplicated. Permission to adapt it for other institutions will be granted upon request to the Office of the Ombudsperson, WSS 3100b, The University of Western Ontario, London, ON N6A 3K7. Email: email@example.com www.uwo.ca/ombuds/