TIPisode Hygiene Edge Takeover: Tips for Success in Assessing a Student’s Failed Skill with Shelley Brown

This week on A Tale of Two Hygienists TIPisode we are speaking to all the clinical educators out there! We are joined by Shelley Brown, RDH from Hygiene Edge to talk about the dreaded moment when you need fail a student.

“You have to decide if the student is prepared to preform the skill without supervision.”

“Am I calibrated on the rubric to explain to the student in black and white why they failed?”

“If left alone today in private practice would the student be able to correctly and safely perform the skill?”

“I want to do this in a way that conveys respect to the student.”

“The question technique allows the student to take responsibility for their failure.”

Hygiene Edge: https://www.hygieneedge.com

More TIPisodes: https://ataleoftwohygienists.com/tipisodes/

This TIPisode has been transcribed for your viewing pleasure:

Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode. 

Shelley Brown: Hello, all. This is Shelley Brown from Hygiene Edge. I’ve been working as a dental hygiene educator since 2009, and I’ve had the pleasure of working with hundreds of students over the years. This TIPisodes is for all the clinical educators to help you navigate the dreaded moment when you have to fail a student. 

So the story goes, as you may have experience or may soon experience, where your student informs you that they’re ready to pass off a clinical skill. You prepare for your evaluation of the student with the correct forms, and as the student is demonstrating, you observe that they’re not performing the skill correctly. So you might give a prompt on a few aspects you want them to correct, but they continue to revert back to the incorrect technique.

So this is the point where you have to decide if the student would be competent to perform this skill on a patient without supervision. This is the moment where you start to sweat just a little bit because you know, based on the criteria, that this skill was not performed to competence level. 

So there’s a few things that go through my mind at this moment. Four big things. The first one being that if I fail this student, they’re going to be sad, and I don’t want them to give up. I don’t want them to cry in front of me or in front of the patient. So that’s one thing that crosses my mind. 

The second thing that crosses my mind is that this might put the student behind in clinic. Remediation might be needed, and this might be a skill that they need to build on and pass before they can move on to the next skill, so I’m knowing that this is probably going to put them behind in clinic. 

The third thing I think is I don’t want to ruin that teacher-student relationship. I want to be able to have the student trust me in the future for help, and I want them to be successful. So I have to be able to do this in a way that keeps that relationship strong still in the future. 

Another thing that goes through my mind is did I see it correctly? Am I calibrated according to the rubric to be able to explain to the student in black and white why they failed? It’s not just going to be based on my opinion. It needs to be black and white based on the rubric you’re given to grade. And the student should also understand that rubric, of course. 

For example, [indiscernible] works on a prompt system. So, if you have to give a prompt to the student maybe on the correct working end, it’s a deduction. The second time you have to give that same prompt, it’s a fail. So the student knows that, and that’s a little bit more black and white as to why did I fail this skill? 

And I always then ask myself one big question that gets me over some of these fears: if left alone today in private practice, would the student be able safely and properly treat the patient on this skill? If I can say no, then I have an ethical duty to have the student remediate and try again. 

So the big question is how do I best tell the student that they failed at this skill and that they need remediation while at the same time setting them up for future success? There’s a lot of different factors that come into play here, right? The student’s personality, their skill level, their preparation, when do I tell them, where do I tell them, how do I tell them. There’s several factors. 

So let’s start, for example, with the when and where. If they’re working on a live patient, you do not want to say in front of that live patient, “Student, you have failed.” We want to tell the student privately away from the patient because we want that patient to have confidence in the student and in their treatment where they’re receiving it. That’s really important to me. 

If the student — if it doesn’t affect any of their future skills, I might tell them after the patient is dismissed or at the end, even, of the clinic session. That’s also another option. If I feel like they need remediation right then and there, I might even glove up and remediate the skill with them without even telling them that they have failed. That’s okay to do too. It’s okay to wait just a little while before you talk to them about that, the where and the when. 

Now, the how. One of my goals is to do this in a way that shows respect and that is constructive to the student because I want them to be successful in their dental hygiene career. I want to build them up for success. So I would highly recommend telling them verbally versus just letting them see the word “failed” circled on a form. Very important to have that conversation with them. Verbally communicate that. 

Now, the way you do that is — the way that I recommend doing that, at least, is to do what’s called a “failure sandwich.” So what you’re going to do is package the negative failure between two positive compliments. 

So an example would be “you did an excellent job on your clock positions, and you have your adaptation down. You have those aspects perfect. However, you did use the incorrect end three times, and based on the criteria, I need you to practice this skill more before you can pass it off officially. I know that you can master this skill, so let’s work together on it a little bit more.” 

I always start with informing them of the positive aspects that they did correctly. That is an important foundation for them so they know where to focus. Then I’ll inform them of the negative news as to the reason why they failed. Now, this allows them to know where they need to focus and remediate the skill. And, in this section, you have to be really direct and really specific in this meat portion of the failure sandwich so that they can successfully do it correctly the next time and practice and remediate that skill. Then you want to follow this up with some positive encouragement, that they can do this, you want them to succeed, and that you’re on their side. Therefore, a failure sandwich. 

Another technique that I use sometimes to inform the student of failure is the technique that I call “guided questioning.” I use this technique when I feel that maybe the student wasn’t prepared, but they attempted it anyways. So this involves asking the students questions that leads them to self-assess their attempt at the skill, and then let them guide themselves to the knowledge that they’ve failed. 

So, if they need, for example, to pass off the intraoral exam and they forgot several aspects, I might say something like, “I’ve underlined the following areas that you’ve missed. How do you think that you did based on the evaluation criteria?” That allows them to have a conversation with me about how they feel like they did. 

Another example is “you needed several prompts to get through this skill. What do you think you need to do to improve on?” And maybe even after that follow up with “can you tell me why you struggled with these aspects today?” If they say something like, “I feel like I did a great job,” then we have bigger problems, right? Either with their ability to perform this skill or not knowing how they’re properly evaluated. Those are bigger problems. 

But, in general, the student will say, “I didn’t study the material beforehand. I didn’t feel fully prepared. These are the reasons why.” And they usually end up deciding on their own that they’ll come better prepared in the future so that they can not have to remediate these skills.  

So the question technique allows the students to actually take responsibility for their failure versus me as the instructor having to tell them that they failed. Sometimes it’s a bigger learning experience for the student and more beneficial. 

Overall when needing to fail a student and guide them through this challenging time, remember that original question: if left alone in private practice, would the student be able to safely and properly treat the patient on this skill? And sometimes I’ll even repeat that to the student and say this is my concern. 

The human mind actually weights failure much heavier than it does praise. Think of anything that you’ve failed at in your life and how much greater the long-term effect of that failure had  on you. So the student, too, will remember that feeling, and they’ll be able to master that skill and work really hard on that skill to be able to successfully treat patients. 

 Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at ataleoftwohygienists@gmail.com, and keep listening for more awesome content from your unofficial dental hygiene podcast.