The medical-surgical instructor was appalled when she learned that one of her students had volunteered to perform a complex wound irrigation — a procedure in which the student was thus far untrained. Throughout the semester the student had required extra supervision and guidance, and despite this her performance had been marginal at best. Written assignments were disorganized, incomplete, and revealed poor grasp of theory, while clinical skills were consistently below acceptable levels.

But the instructor was even more appalled when other faculty members opposed her decision to give the student a failing clinical grade. “Too harsh,” they said. “Give the poor kid a break.” The instructor followed her own judgment and conscience and failed the student, but never received any support for her decision from the school's administration or faculty. Some time later, in talking with faculty from other schools, the instructor learned that her experience was not unique. Others had similar problems: resistance to failing and even not-so-subtle pressures to pass students whose performance the instructor deemed to be substandard.