Placements: assessment criteria and placement failure

Assessment of Clinical Competence (ACC)

All clinical placements are assessed using the 'Assessment of Clinical Competencies' (ACC) form on Pebblepad. The ACC is the learning contract and record of training and assessment drawn up between the supervisor and the trainee on each placement and overseen/facilitated by the trainee's clinical tutor. It identifies the goals of learning and the process by which those goals will be assessed and met.

More specifically, the ACC identifies 8 core clinical competencies that are the focus of placement experience and assessment:

1. Personal and Professional Development

2. Therapeutic and Working Alliance

3. Psychological Assessment

4. Psychological Formulation

5. Psychological Intervention

6. Research and Evaluation

7. Service Delivery and Organisational Influence

8. Supervision

Each core clinical competency has a set of Specific Learning Objectives (detailing what trainees aim to achieve on the placement) and a Placement Plan (how the objectives will be achieved). These guide the work that will be carried out on the placement. An ACC is completed for each placement.

Criteria for passing a placement

There are three stages in the assessment process of trainee performance on placement made by the supervisor: supervisor ratings for each of the core clinical competencies, an overall supervisor rating for the placement and a final stage in ratifying supervisor assessment of trainee learning which lies with the Board of Examiners.

1. The first stage is for the Supervisor to rate trainee performance for each of the specific 8 competencies. The Supervisor is asked to make a recommendation of 'Pass', 'Partially Achieved' or 'Fail' for each competence.

2. The second stage of the assessment process is based on the total assessment of the competencies; the Supervisor rates the trainee's performance on the placement overall as either 'Pass' or 'Fail'. In exceptional circumstances, a recommendation of 'Deferred' may be used. The Supervisor is advised to discuss the overall recommendation at the end of placement with the Clinical Tutor in cases of 'Fail' or 'Deferred' recommendations. The overall decision to pass or fail a placement inevitably involves professional judgement- the supervisor's and that of the Director of Clinical Practice/Clinical Tutor and other Programme staff.

3. The final stage is the ratification of the evaluation at the Board of Examiners.

Guidance for the process and criteria that must be met to Pass or Fail a clinical training placement is as follows:

CBT plus one other model of therapy

Upon completion of the third year all trainees must be competent to the level specified by the programme in the application of Cognitive Behaviour Therapy (CBT) plus at least one other psychological model, which has been identified on the record of placement logs. If a trainee has not been identified as competent in CBT plus one other model, they will be unable to pass the programme. This requirement will be tracked throughout training and may be considered during placement allocation to ensure that trainees have ample opportunity to meet the required levels of competency.

Failing a Placement

Trainees are expected to observe all relevant employment conditions and rules and be subject to the disciplinary procedures of SHSC and the host Trust in which they are working on a clinical placement. In the event of breaches of discipline, SHSC and/or University procedures apply. In the event of a failed placements and/or academic submission, Faculty of Science regulations apply.

Procedures for failing a placement

At the end of a placement the supervisor must decide whether to recommend that the trainee should be passed or failed on the placement. If the supervisor is considering recommending a fail, or is undecided, it is expected this would be communicated to the trainee and to the Clinical Tutor/Director of Clinical Practice. This and any subsequent discussions should be logged by all parties as they may be relevant to any later evaluation of the decision.

If the supervisor decides to recommend that the trainee should be failed the following procedures apply:

• The supervisor should indicate on the Assessment of Clinical Competence form that the placement is recommended as a fail. This should be communicated to the trainee and the reasons for failing clarified. It should be noted at this time that this is a recommendation from the supervisor and that the final decision rests with the Examiners. The ACC should then be submitted as soon as possible to the Director of Clinical Practice/Clinical Tutor, and in time for the relevant Exam Board.

• Where they have not already done so, the Director of Clinical Practice/Clinical Tutor will contact the supervisor, the trainee and (where applicable) the person responsible for placement monitoring, to discuss the reasons for the recommendation and to gather any additional information which may be relevant. If not already clear, an effort will be made to address such questions as: Was the trainee made aware of their shortcomings at the mid-placement meeting, or at any other time? Were there opportunities for the trainee to do something about these shortcomings? Were there any external factors beyond the trainee's control which interfered with their progress? This 'elaboration' phase will be undertaken within as short a period as is reasonably possible.

• If the trainee wishes they may also discuss the situation with their Personal Tutor and/or submit a written account to the Board of Examiners, via the Chair of the Board of Examiners. Trainees are also encouraged to discuss the matter with their Personal Mentor.

• At the meeting of the Board of Examiners following the above phase, the placement documentation will be considered, together with any written submissions and any further information or views obtained from discussions/interviews with the trainee and supervisor by the Director of Clinical Practice/Clinical Tutor and the Personal Tutor. The Board may also consider evidence from other placements, coursework or general performance on the Programme in making a decision. At this meeting the Examiners will decide to pass or fail the placement. If the placement is failed for the first time, and the trainee has not reached the criteria for withdrawal, the Examiners will decide what will be required of the trainee by way of rectifying the failure.

• It should be noted that the failing of a single placement by itself is usually followed by the opportunity to demonstrate competence on a further placement. The question of withdrawal from the Programme does not, therefore, normally arise at this stage, unless the overall criteria for withdrawal (detailed later) are met.

• Trainees will be aware of the recommendation of their placement supervisor(s) prior to the meeting of the Board of Examiners and ratification by the Board of Examiners is not normally communicated to trainees in addition. The exceptions to this are in the event of a failed placement, or if a placement recommendation is not upheld. In such cases, the Chair of the Board of Examiners (or Director of Clinical Practice) will communicate the Board of Examiners' decision to the trainee verbally and in writing (via the Assessment Administrator) as soon as possible.

Consequences of failing a placement: changes to the placement pathway

When a placement is failed for the first time, the trainee will normally be required to undertake a further placement to demonstrate competency. The exception is if the trainee has previously failed two pieces of assessed work and have reached the criteria for withdrawal. The content, duration and timing of the 'repeat' placement will be decided by the Board of Examiners. A failed clinical competency or competencies will normally result in this, or these being specifically re-assessed on a future placement. The trainee must pass this competency or competencies on this placement and failure to do so will usually be considered as grounds for withdrawal from the training programme.

In some cases, the reassessment will take place in the next placement already planned. In other cases, a specific placement within a similar setting or with a similar client group may be undertaken immediately following the failed placement or during the trainee's third year instead of an optional placement or may be added on at the end of the third year. Where an extension to the normal three-year training period is required, an extension for the trainee's employment contract would normally be sought, but this would be at the discretion of the trainee's employer. Extension may therefore be based on an honorary contract without remuneration. Such as extension would be no greater than twelve months.

Following a failed placement, trainee performance will be monitored at relevant University Exam Boards. Additional placement visits, support and/or a specific Training Plan developed with the Clinical and Personal Tutors, will be put in place as required.

If a trainee fails to pass the failed competency on the next (or repeat) placement this normally is grounds for withdrawal from the programme. If a trainee fails two placements during their training this will normally be grounds for withdrawal from the programme. See the section 'Withdrawal from the Programme' for further details.

After following due process, if the decision is taken to exclude the trainee, this would then be communication to the trainee's employer and to the commissioners of training and would normally lead to the termination of the trainee's contract of employment and discontinuation of financial support.

In the event of serious professional misconduct, the Chair of the Board of Examiners and/or Director of Clinical Practice, may suspend the trainee from placement work and notify the employing Trust pending relevant disciplinary and/or Fitness to Practise proceedings. 

If, because of withdrawal from the Programme, the trainee's contract of employment is terminated, the usual NHS appeals procedures will be available to the trainee.

Communication with Supervisors Regarding Failed Placements and Coursework

Following a placement failure, the placement supervisor on the next (or repeat) placement must be informed of the failed placement, and reasons for failure, in order that they can help the trainee to address the identified points for competency development and understands the assessment process. The Director of Clinical Practice/Clinical Tutor will discuss with the trainee how this is communicated. The failure and reasons for failure will be fully discussed at the Initial Placement Meeting and the issues to be addressed incorporated into the placement objectives.

Where the trainee passes a further placement, the decision to inform future supervisors of the previous failure will normally be at the discretion of the Director of Clinical Practice/Clinical Tutor in discussion with the trainee. Where there continue to be concerns regarding the points which led to placement failure, these will be addressed in the Initial Placement Meeting of subsequent placements and the previous failure should normally be disclosed.

Failures of coursework (including OCSA) should normally be communication by the trainee to supervisors overseeing the placement during which the resubmission/reassessment will take place. This transparency is important for supervisors to be able to support the trainee as needed.