Many many years ago when I was a new nursing instructor and I was getting assigned to the things that nursing instructors get assigned to do, I was, for a few years, plunked in the skills lab for our spring session course.
We got the same instructions every orientation from the instructors assigned to organize the course. “Every person in this room, has to teach the skill in exactly the same way.”
And we’d all nod our heads and go off and teach it the way we knew how to do the skill. I guarantee we all THOUGHT we were teaching it the same way because, it’s a skill. It’s objective. There is only one way to do it, right?
My way. The right way. Which is the same as your way. Of course.
Why were we demanding skills consistency? I don’t remember any reason beyond the fact that it was students’ number one complaint on their course evaluations. What they were taught seemed to them to be very different from teacher to teacher.
We weren’t consistent.
Nearly 15 years later, we haven’t solved that problem. They still complain of inconsistency in skills instruction.
We never really got specific information about what part of the psychomotor activity wasn’t consistent from teacher to teacher, because psychomotor skills in nursing are really a set of safety and infection control principles that need to be adjusted slightly for context, but it seemed their consistency issues were as nuanced as hand position when holding the forceps that were holding the sterile dressing; or — here is a timely one — do you put your mask on before you put on your sterile gown and gloves last, or some other order? And does it actually matter? How drastically different could our demonstrations be from one teacher to another?
Why do we worry about consistency at all?
I began to question, why then, if it was not possible for instructors to present a guise of consistency with a psychomotor skill, why did we worry about consistency at all? What prompted complaints of inconsistency? And wasn’t consistency just about different teaching styles? The inconsistency problem forced me to sit through countless overly long skills demonstrations by our course leader attempting to get us to all agree on the procedure.
What resulted was 8 instructors interrupting her, Well, at my hospital, we do it this way.
I hold a pretty constant stance of being norm-critical, even back in those early days of my teaching career. I can remember, in an attempt to put myself out of the constant misery of the consistency meetings, speaking up and saying something like, “Perhaps, we should instead teach students to embrace the ambiguity. They need to learn to be adaptable and recognize when principles are being applied instead of obsessing over minor differences in technical performance.”
I think in some circumstances, inconsistency can be a real problem – as I complain about it incessantly every time I submit an expense claim at my institution and the rules are different, yet again. I can understand why in a lab experiment, you have to use the exact same number and drops of chemical using the same dropper in each replication. But in the real world we are dealing with independent thinking human beings. For the most part, what we and students call inconsistency is really just a euphemistic way to say, I feel things are unfair. It is probably a genuine lack of fairness — as recent events have taught us, inequities are perpetual in higher education.
That lack of fairness, however, in my opinion, is born out of insistent adherence to rigidity and black and white thinking in a context that is nuanced with situations that are never identical from person to person. And of course, rules always favour the privileged.
And here is a key point: students don’t complain about inconsistency unless they feel it has caused them personally to lose marks or be evaluated differently in some way.
Transferring consistency practices to writing instruction
Now let’s talk about what I am really here to talk about – consistency in writing instruction and grading. I mean, yeah, writing is not a psychomotor skill. This set of blog posts is inspired by a Twitter thread I wrote on the topic on the weekend. Then the US election was called and the thread sort of sunk into oblivion, but I feel I had more to say on the subject. It also ties in nicely with my PhD thesis work, so, hence, I blog.
You see, I believe the problem with psychomotor skill inconsistency wasn’t really with inability to tolerate minor differences in skill performance between instructors, it was more to do with inability to tolerate perceived differences in how they were evaluated on those skills. It was about grading. It was about feeling criticized when a teacher made a suggestion to change a hand position or do something in a different order which was not EXACTLY how they’d been taught. Those suggestions might have been about efficiency rather than evaluation, but – and this is a huge problem in clinical education – it’s really hard for a student to tell the difference between evaluation and just a suggestion when they always feel like they are being evaluated.
They have the same complaints about writing. They could tell me about all the things in their writing lives they felt were unfair.
“I had to use her words, her way, her everything,” one student told me during the interview phase of my research. “Otherwise I got a bad grade.”
Another student told me about getting a bad grade because they didn’t have a clinical experience that particular term that fit neatly into the assignment guideline instructions. This student asked the teacher if they could use an alternative — an experience from a previous term. The teacher refused to allow adjustments. The student, then, could only artificially address some of the required aspects of the writing assignment. No surprise, assignment comes back with a reduced grade.
These examples are of teacher behaviours that overgeneralize perceived rules that don’t take context into consideration. The first student felt like her writing voice was not valued. The second student didn’t understand why an alternative experience that was a better fit for the assignment, couldn’t be used. What did it matter what clinical rotation the experience was drawn from?
And both students could tell me stories of the opposite happening to them or other students with the same or different teachers — flexible teachers — which is what makes observing differences in instructor responses feel all the more unjust when you are the student forced to artificially fit your work into some tight boundary. There was no consistency.
What happens when we attempt to fix inconsistency with standardization?
So, what tends to happen when we attempt to respond to student complains of inconsistency in our programs? We standardize things. We standardize things because we think its like having to use the same dropper in all replications of a chemical experiment — it is more rigourous. Sometimes we implement standardization practices on our own and sometimes it is handed down to us from administration – “everyone will use this standardized rubric for academic papers.” We give more instructions instead of less. We remove choice. We prescribe the exact details of what we expect students to say in their papers to the point that the guidelines are longer than what students are expected to hand in.
In my doctoral research, students described a really rigid writing environment. They told me that writing in nursing was actually “pretty basic,” “fill-in-the-blank,” everything was right there in the rubric – put this, this, and this, for 5 points, no wiggle room for creativity. I’m loosely typing their exact words. All 20 students in my study described some kind of rigid context for writing in at least one nursing classroom which suggested to me that a push toward standardization is the norm rather than the exception.
And, guess what — this won’t be a shock — they still complained of inconsistency. You can read more about what my students said about the writing context specific to nursing education in my previous blog: It depends on the professor.
Faculty in the two nursing programs I sampled from in my study, turned to what they thought to be an objectivist solution – standardization, very specific rubrics, identical fill-in-the blank type writing assignments – and it did not solve the problem of inconsistency. Consistency is really another word for reliability. The lack of reliability in grading was both inter- and intra-rater. The perception of inconsistency existed from student to student whether those two students were being graded by the same teacher or different teachers.
Herein lies the paradox: In addition to still complaining about inconsistency, some students also resented being hemmed in. They resented that they couldn’t write about the things they were interested in. It made them put less effort into writing and researching – “it will be the first sources I find…. BOOM…. That’s what I’ll use to write my paper.” (Again, loosely quoted, except for the BOOM).
So standardization kills exploration, curiosity, creativity, innovation, independent thinking. It also trains students to expect you to deliver assignments that provide them with 100% certainty and eliminates all the ambiguity from the learning environment. Is that a worthy trade off? Especially when that standardization has essentially no effect on the problem it was designed to solve in the first place… inconsistency.
Like using the same dropper in a chemistry experiment, standardization attempts to set up equal conditions for all students. It professes to increase fairness. But we know students aren’t all standing on equal ground. My data showed that privileged students – students with previous educational experience or who had family members who understood higher education – had no problems adjusting from teacher to teacher and their different rules, pet peeves, and biases. They had the skills and knowledge of academic life, to do that and accepted it as normative. But international students, Indigenous students, and students from first-gen and disadvantaged backgrounds felt they could never figure it out their teacher expectations. To them, the so called rigid rules were a bunch of senseless arbitrariness.
Standardization, privileges the already privileged.
Why do we keep thinking standardization works?
I sense we are uncomfortable with our students’ discomfort so we are driven to eliminate it, even though learning is not supposed to be all comfort and roses. I also think standardization is implemented to serve more than just the reliability problem. It also is implemented to quell the anxieties among faculty who are not comfortable assigning and grading writing. Maybe they feel assigning the same fill-in-the-blank style “essay” (I use that word very lightly here) on the same topic to every student will help them better compare one student to another and more fairly assign grades? I’ve also heard the argument from some faculty that they have to control the topics students choose because they don’t want students choosing a topic they don’t know much about themselves because they won’t know if the student addressed the topic correctly.
But all of this is anecdotal. There is not much research exploring what drives faculty decisions in creating writing assignments in nursing…. Or in other disciplines for that matter.
Needing to control the content is a sign of anxiety as well. It’s like faculty doubt their own skills to be discerning readers who are capable of recognizing clarity in text and engaging writing. Faculty, as consumers of academic material, have the ability to know when they are learning something, when ideas are presented effectively, and when something seems off or improbable in the information given.
Anxieties like this are not uncommon among faculty in nursing programs. Most nursing instructors are not PhD prepared. Nursing has not yet reached that state of PhD prepared surpluses present in most other disciplines. Most individuals teaching undergraduate courses in nursing are Master’s prepared. They also tend to be more comfortable in the nursing practice area rather than the academic arena. We need to better understand their learning needs for writing instruction.
Flexibility breeds perceptions of consistency
I think we’ve been thinking about the inconsistency issue all wrong. Structuring and standardization makes complaints of inconsistency increase through providing a false sense of objectivism. Standardization isn’t really standardization at all when everyone reads the so-called standard and develops a different interpretation for defining what is a correct representation of that standard.
Standardization then removes validity from the assignment; thus the assignment no longer elicits the learning it was designed to assess. Students are so focused on rules and APA and grades that they no longer think about content or engaging a reader. The reader is the teacher. We instead assess ability to follow rules and deliver what a teacher wants. Students in their course evaluations then question fairness and question the point of writing. The students in my research who could not figure out how to read teachers, resented being hemmed in, and they disengaged with writing.
I’ve often said, we are key contributors to student bad writing by making them write things they don’t care about. How then can flexibility help?
Next: Part II. Looking at using flexible practices to reduce inconsistency.
Also: Watch the video that outlines some of my study findings.
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