Underperformance and failure in allied health practice placements: a scoping review

Introduction/Background:
The experience of underperformance and failure of allied health students undertaking practice placements is largely absent from the literature. Placement performance can be disrupted for reasons beyond poor academic performance. This review aimed to describe the experiences of allied health students and clinical educators relating to underperformance and failure.

Methods
Twenty-two allied health professions were included in the review undertaken according to Arksey and O’Malley’s framework for scoping reviews. The search strategy included six e-databases (Medline, Emcare, Scopus, PsycINFO, CINAHL, Web of Science) and Google Scholar for grey literature. The titles and abstracts, and then full text of citations were reviewed against the eligibility criteria by two independent reviewers. Reference lists of included studies were searched, and forward citation screening was completed. Occupational Adaptation Theory [2] was applied to deductively code the key elements of Occupational Adaptation relating to the phenomena of underperformance and failure.

Results/Evaluation
The initial search resulted in 11,977 citations, with 43 studies representing seven countries across eight allied health disciplines meeting the eligibility criteria and included in the review. Six key themes relating to the underperformance and failure of allied health students undertaking practice placement were developed: (1) Contextual interactions, (2) Learning from underperformance and failure, (3) A good fail, (4) Gatekeepers, (5) Power and (6) Convergence. Themes described the processes of adaptation that influence the achievement of relative mastery.

Discussion
Gaining a better understanding of the problems and the experiences of student underperformance and failure, may enable educators, universities and placement providers greater insight into the complexity of the phenomenon. The application of theory offers a perspective beyond looking at ‘who’ is impacted and delves further into the influencing factors. This may lead to more positive, cost-effective and high-quality learning experiences and shift the deficit discourse of failure that often positions students as the problem.