The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42

AbstractBackground: Many clinical educators feel unprepared and/or unwilling to report unsatisfactory trainee performance. This systematic review consolidates knowledge from medical, nursing, and dental literature on the experiences and perceptions of evaluators or assessors with this failure to fail phenomenon.Methods: We searched the English language literature in CINAHL, EMBASE, and MEDLINE from January 2005 to January 2015. Qualitative and quantitative studies were included. Following our review protocol, registered with BEME, reviewers worked in pairs to identify relevant articles. The investigators participated in thematic analysis of the qualitative data reported in these studies. Through several cycles of analysis, discussion and reflection, the team identified the barriers and enablers to failing a trainee.Results: From 5330 articles, we included 28 publications in the review. The barriers identified were (1) assessor’s professional considerations, (2) assessor’s personal considerations, (3) trai...