This paper examines two core issues in clinical education: grading methodology and program accreditation. The author argues in favor of letter grades over pass/fail systems for clinical assessments, contending that letter grades provide richer feedback and distinguish meaningfully between students at different performance levels. The paper also explains the relationship between formative and summative assessment in clinical settings, before turning to educational regulation and accreditation. It distinguishes school-level regulations from external accreditation, emphasizing that nursing programs must hold recognized accreditation to ensure graduates are adequately prepared and employable in the healthcare workforce.
Clinical performance can be graded in two different ways. Letter grades are the most common, but some programs choose to use the pass/fail method instead. In that option, no letter grade is given; the person being evaluated is simply told whether they have passed or failed the clinical examination. As a member of the committee, I would favor using letter grades for clinical experiences. Letter grades provide much more feedback for the person taking the clinical examination, and a student who would clearly receive an A is not in the same position as one who would barely pass with a low C — or even a D. It is necessary to note this distinction because both students technically passed, yet they are not at all equal in their demonstrated competency. With that in mind, it would be inappropriate to simply tell both people that they passed when there are many areas one person needs to work on and significantly fewer areas the other person needs to address (Tyler, Gagne, & Scriven, 1967). Passing a clinical examination is important, but those who barely pass will still need meaningful instruction on how to improve.
Formative and summative assessments are both relevant to this issue. Summative assessments identify weaknesses that can then be addressed through formative assessment techniques (Glickman, Gordon, & Ross-Gordon, 2009). This is precisely what occurs in a clinical assessment, since the goal is to evaluate how well the person is applying what they have learned to a clinical setting. From that point, any problems the person has can be worked on, and a formative assessment of that progress can be conducted as the person moves toward stronger abilities and a better understanding of areas that need improvement (Glickman, Gordon, & Ross-Gordon, 2009). Clinical assessments are an effective means of identifying where a person's weaknesses lie and what they still need to work on.
Educational regulation relates to the curriculum that can and should be taught in schools, as well as the content that must be included in a particular program for a degree or certificate to be awarded. Accreditation, on the other hand, comes from an external governing body and is designed to confirm that the U.S. Department of Education has certified a particular school and its programs as meeting specific standards (Lenn, 1992). Most employers and other educational institutions prefer candidates who hold degrees from accredited schools. Without accreditation, a school may not be providing students with what they truly need to be prepared for advanced study or appropriate employment in their chosen field. This can be detrimental to the student and, by extension, to the clients or patients that student will serve in the future. In nursing, an accredited program is vital; nurses who have not completed accredited programs generally do not find employment, because they are not considered to be properly trained.
Regulations are based on each school and what it requires of its students and instructors. These requirements may encompass the curriculum the school offers, its admission requirements, the number of credit hours needed for a degree, and much more. Such regulations are set by the school itself, and each school may establish whatever internal regulations it chooses. However, a school's own regulations do not guarantee that it will meet the standards required for accreditation (Lakshmi, 2012). There are many fraudulent colleges appearing in the United States and elsewhere, along with institutions that are real but lack proper accreditation. These colleges still attract students because not all prospective students think to verify a school's accreditation status or confirm that any listed accreditation is recognized by an accepted body (Lakshmi, 2012). Without proper accreditation from a body recognized by the U.S. Department of Education, nursing school graduates will not receive the education they need to enter the workforce successfully.
Glickman, C.D., Gordon, S.P., & Ross-Gordon, J.M. (2009). Supervision and instructional leadership: A developmental approach. Boston, MA: Allyn and Bacon.
Lakshmi, R. (2012). Unaccredited, even fake, colleges in India add to education crisis. Seattle Times.
"Risks of fake or unaccredited nursing programs"
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