January 29, 2014

Danger Zone: Failure Ahead

by Elaine Yip, Pharm.D., PGY1 Pharmacy Practice Resident, Kaiser Permanente Mid-Atlantic

John is a student in your class.  He has several unexplained absences, is unable to follow along during topic discussions, and has not turned in several assignments.  The end of the semester is approaching.  What should you do?  Wait for John to approach you for help? Give him a grade that is just enough to pass at the end of the year?  Fail him?

Luckily, I have not yet been confronted with this situation. However, as I engage in more teaching and supervise students during advanced practice experiences, I know that, sooner or later, I will be faced with this unfortunate and uncomfortable situation.  I am afraid that when that moment comes, I will not be prepared to handle it appropriately and will ultimately end up doing a great disservice to the student. I know that I am not alone in this fear.  In a survey of nursing student preceptors, approximately 18% reported a lack of confidence when dealing with and failing a student who was not performing well.1  I have often wondered, what is the best course of action when it seems that a student is headed in the wrong direction or faces a real danger of failing?

In order to appropriately address the situation, we must differentiate between the types of failing students we may encounter. There are “actively” failing students who usually attend class, take notes, complete assignments, and participate in learning activities.2 Despite this, they are still having a difficult time with the material. Thankfully, these are the students you tend to proactively seek assistance. The story can be quite different when dealing with “passively” failing students, like John. These are the students who skip class, don’t turn in assignments, and are not engaged in the learning process.  Most often, these are the more difficult students to work with as they may not be as receptive towards efforts to help.

Once you have identified which category the student falls into, it is important to understand the specifics about why that student is struggling. Whether it may be poor study habits, difficulty juggling multiple priorities, test anxiety, or other extenuating circumstances (such a learning disability or a mental health problem), each student should be evaluated on a case by case basis. In her study looking at nursing students who failed their clinical experiences, Duffy identifies common reasons including poor communication, lack of interest in the learning experience, persistent lateness, and lack of insight into professional boundaries.3

What strategies may be helpful in preventing students from falling into that danger zone in the first place2,3,4? Course design, clarity of communication, and including more active learning in a course seems to be helpful. One study looking at failure rates in introductory science courses showed that highly structured course a that incorporated active learning activities had lower failure rates when compared to a less structured course that was taught primarily by lecturing.4  The failure rate dropped from 18.2% in the low-structure course to 6.3% in the high-structure course.  Here are some things you can do:
  • Create a syllabus and set clear objectives: This conveys expectations and helps students understand exactly what they are held accountable for.
  • Perform an audience analysis: Identify the needs of the students. Take into consideration how far along they are in their training.  Is your level of expectations consistent with what they should reasonably be expected to do?
  • Use the Socratic Method:  Students are regularly engaged in answering questions and learn from the resulting discussion rather than simply being handed the information.
  • Use ungraded, active learning exercises: Ungraded sample exam questions, case studies and in-class demonstrations can help students digest and discuss what they have just learned. It allows room for error and the discovery of weaknesses without the pressure of a grade.
  • Use clicker/polling questions: These provide a helpful way to gauge audience understanding throughout the learning process. It enables the teacher to identify knowledge gaps early on that need extra review rather than wait until exam time.
  • Implement a weekly class summary assignment: Have students write down what they think was the most important concept introduced that week and at least one question they have about the material.
  • Provide frequent quizzes: This forces students to pace themselves and keep up with course content over the course of the semester rather than falling victim to procrastination.  Start quizzing early to identify students who are struggling and at risk for failing.
What if a student is already heading into the danger zone, like John? What can be done to get them back on track2,5,6
  • Talk to the student and do it early! Note your concerns and ask them if there is anything that can be done to help.
  • Develop an action plan. Include the student’s input. The plan should include the instructor and the student’s roles to resolve the situation. Together, decide what reasonable and measurable outcomes would represent improvement.
  • Schedule times for regular and constructive feedback.  The “sandwich method” can be used to help deliver negative feedback by first highlighting something the student has done well, then moving on to areas of improvement, and then ending with more positive feedback.  Feedback should not only occur when something is wrong.  Positive feedback will improve the student’s confidence and encourage continuation of that specific behavior.
  • Perform regular self-assessments. This can be done formally in writing or as a discussion. The student should be asked to evaluate themselves on their performance and progress.
  • Document, document, document. Make note of all of these interactions with the student and efforts made so far to resolve the situation.
Unfortunately, there will be some students who will not make any effort to acknowledge and act on your feedback. In these circumstances, you will need to make that difficult decision to fail a student.  Hopefully, by implementing these strategies, failures will be a rare occurrence.  If I’m ever faced with that decision, I will know that I have given it my best effort.


1.  Heaslip V, Scammell JM. Failing underperforming students: the role of grading in practice assessment. Nurse Educ Pract. 2012 Mar;12(2):95-100.
2.  Buskist, W., & Howard, C. Helping Failing Students: Part 1. Association for Psychological Science RSS.  Accessed on January 24, 2014.
4.  Freeman, S, Haak D, Wenderoth M.  Increased Course Structure Improves Performance in Introductory Biology. CBE-Life Sciences Education. 2001:10:175-186.
5.  Buskist, W., & Howard, C.  Helping Failing Students: Part 2. Association for Psychological Science RSS.  Accessed on January 25, 2014.
6.  Ideas When a Student Has Difficulty: Understanding the Failing or Weak Student. Philadelphia University. Accessed on January 24, 2014.

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