An OSCE Failure, a Parent in Government and Pressure on the Examiner
You are a clinical instructor in a School of Nursing. A final-year student, Mr C, has failed the medication-calculation and intravenous-drug-administration OSCE station on his third attempt, scoring 58% against a pass mark of 70%. He has completed 92% of his clinical hours but missed two weeks of placement with typhoid fever, and his logbook has three unsigned procedures. The examination board is due to meet tomorrow. Mr C's father is a permanent secretary in the state ministry of health and has called the provost, who tells you to 'find a way to help the boy' because the school depends on government support. A colleague suggests awarding 70% and arranging a private repeat after graduation. Mr C says he will sue the school if he is delayed.
1. Analyse the professional and ethical issues in the provost's instruction and the colleague's suggestion.
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The provost's instruction is an improper attempt to influence an assessment result because of the student's family connections and the school's funding. It breaches fairness, academic integrity and the principle that assessment decisions must be based on evidence of competence, not on external pressure. The colleague's suggestion is worse: changing 58% to 70% is falsification of an assessment record, and arranging a private repeat after graduation would allow an unqualified candidate to be presented as competent. Both actions would disadvantage other students and could endanger future patients.
The ethical issues include justice, integrity, accountability and non-maleficence. A student who cannot safely calculate and administer IV medication at the required standard should not be signed off merely because his father is influential. The threat of a lawsuit does not justify altering records; due process, proper documentation and a fair hearing are the correct protection. The instructor has a duty to resist pressure, declare the conflict of interest and ensure the board decides on the evidence. Sympathy for Mr C's illness is relevant to remediation and reasonable adjustment, not to retrospective mark inflation.
2. Recommend what should be presented to the examination board and why.
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Present the facts without exaggeration: the station assessed, the pass mark, the three attempts, the score of 58%, the attendance record, the two-week absence due to typhoid, and the three unsigned procedures. State clearly that the score has not been altered and that no private repeat has been arranged. Recommend that the board decide whether Mr C is eligible for remediation and a further supervised attempt, whether his clinical hours and logbook must be completed and signed, and whether any reasonable adjustment is needed for a future assessment because of his illness.
Do not recommend passing him on the current evidence. The pass mark is the agreed standard, and the board should apply it consistently. If the board has a policy for exceptional circumstances, it should be applied prospectively, for example by granting additional preparation time or a further attempt after remediation, not by changing the recorded mark. Minute the discussion, declare the provost's call as a conflict of interest, and keep the decision transparent. The reasoning is that the board's legitimacy depends on defensible, evidence-based decisions that protect the public and treat all students consistently.
3. Describe the remediation and due-process pathway for Mr C.
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Notify Mr C in writing of the outcome and the reasons, and give him the opportunity to respond before any final decision. Offer a structured remediation plan: supervised medication-calculation practice, simulation of IV drug administration, an updated learning contract, and completion of the unsigned procedures under a competent assessor. Set a defined period and a further assessment with the same standard. Provide counselling and, if needed, reasonable adjustment for the effects of his illness, but do not lower the safety standard. Record progress and sign-off.
Explain his right to appeal through the school's academic appeals procedure and his right to be accompanied or represented. If he still fails after remediation, the school should follow its regulations on progression and fitness to practise, including whether he can repeat the year. Do not arrange a secret repeat after graduation. Keep all correspondence, assessment records and board minutes secure. The overall aim is to be fair to Mr C while ensuring that only a student who has demonstrated safe competence is presented for registration.