Experiences of Clinical Educators with Underperforming Radiography Students in Zambia

Introduction: Clinical competence in Radiography training programmes is assessed through continuous evaluations conducted by clinical educators, who are also responsible for providing feedback and managing underperformance. However, the literature indicates that clinical educators often fail to recognise underperformance, thereby missing opportunities to support students. This study explored the experiences of clinical educators in identifying and managing underperforming Radiography students during clinical training in Zambia. 
Methods: A qualitative interpretive design was adopted. Twelve clinical educators were purposively sampled from 40 Radiography clinical training sites across Zambia and engaged in two virtual focus group discussions in January 2025. Participants had diverse experiences in assessing Radiography students’ clinical performance. Discussions were recorded, transcribed and analysed using a framework approach. Data saturation was achieved during the second focus group. 
Results: Three overarching themes emerged: (1) identifying underperforming students, which highlighted two major early warning signs, insufficient foundational knowledge and negative student behaviours; (2) managing underperformance, which revealed strategies such as individualised support, constructive feedback, and peer-assisted learning (PAL); and (3) recommending failure, which uncovered the emotional burden faced by Radiography clinical educators when advising that a student should not progress. Reported feelings included frustration, disappointment, heartbreak, and compassion, illustrating the complexity of balancing professional standards with empathy for students. 
Conclusion: The study concludes that managing underperformance is a demanding process that places both professional and emotional strain on clinical educators. Their experiences underscore the need for structured guidance, institutional support, and enhanced collaboration with academic educators to ensure fair, consistent, and effective student assessment.