RESEARCH

 

Academic exclusion of Health Sciences students in South African higher education institutions - A rationale for institutional policy and processes

 

 

S Nalla^I; C Vincent-Lambert^II

^IPhD; Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, South Africa
^IIPhD; Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa

Correspondence

 

 

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ABSTRACT

BACKGROUND: Academic exclusion is practised in many national and international higher education institutions (HEIs), significantly impacting students' futures. Associated stress and anxiety remain a source of conflict between all role players. Reasons for, and the rationale behind, academic exclusion are complex and multifactorial
OBJECTIVES: To investigate and describe contemporary practices and core themes relating to academic exclusion by reviewing the academic policies and procedures in a sample of six South African HEIs within a health professions education context
METHODS: A prospective, pragmatic design was followed. This involved simple content analysis of source documents to identify similarities and differences in approach to academic exclusion, including the rationale and potential implications thereof
RESULTS: The rationale for exclusion remains multifactorial. The majority of institutions linked exclusion to continued poor performance and failure to complete qualifications within the maximum time. All institutions allowed for an appeal process; however, this differed significantly between institutions
CONCLUSION: There is a clear, defendable rationale for the exclusion, and practices that seek to prevent students from continuing should be guided by policies and procedures that are clear and contextually relevant. While the right to appeal exclusion is supported, arbitrary support for such appeals in the absence of merit defeats the aims, objectives and rationale for exclusion

Keywords: Academic exclusion, policy, rationale, performance, graduation, barriers

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In the current South African (SA) higher education context, space demand significantly outstrips supply. In simple terms, although a SA school leaver may achieve the minimum academic entrance requirements to study at a Higher Education Institution (HEI) there is a possibility that they will be accepted into their programme of choice. Many applicants are turned away at the start of each academic year due to limited spaces available. Consequently, the opportunity for further study in SA HEIs is especially cherished by society. This chance to study at an HEI after secondary school is due to the country's high levels of youth unemployment and the fact that few career prospects exist for persons who only have a school leaving certificate.^[1,2]

While a university degree may improve the opportunity for employment and upliftment for the individual and their family, unequal opportunities and poverty make higher education unaffordable for many.^[3-8] In an attempt to address this challenge, public HEIs receive a form of government subsidy per student, both at the point of entry (teaching input subsidy) and upon graduation (graduation subsidy). These subsidies significantly lower tuition costs at public HEIs, which would otherwise be very high.'⁵'

The government also makes a National Student Financial Aid Scheme (NSFAS) loan available to assist students from lower socioeconomic backgrounds. NSFAS is a bursary scheme funded by the Department of Higher Education and Training (DHET) for those students who do not have the financial means to fund their studies and cannot access bank funding, study loans or bursaries.^[9] The DHET applies specific criteria to qualify for this funding source. Students who are accepted to study at local HEIs but

cannot afford the tuition and related fees may apply to have their studies funded through the scheme. The 'fees must fall' student call appeared within the context of financial inequities and disparities faced by students entering the HEI environment, which has brought financial responsibilities to an already strained system.^[10] Although the NSFAS system does assist in allowing a wider base of students to access funding for higher education, some still face challenges in accessing this funding source.^[11] Another aspect related to financial challenges faced was the identification of a group termed the 'missing middle', referring to students coming from households whose income was too high to qualify for NSFAS but too low to afford the high fees charged at HEIs. ^[12]

In the financial year 2022/2023, the national government budget allocation for NFSAS student funding was ZAR49 billion. This constitutes a significant spending of taxpayers' money in a country with limited resources that must be channelled into other social projects. Ensuring that students who enrol at HEIs are successful and complete their qualifications in the maximum time or less for a specific qualification is essential as this will indicate a return on the investment made. The COVID-19 pandemic in 2020 also impacted student success rates, especially at national institutions.^[13-15] While historical data shows an improvement in completion rates, much work still needs to be done to improve graduation rates in minimum time and reduce the number of students who drop out of the system.^[16,17]

In a context such as that described above, it is evident that a country like SA cannot afford to have students who fail to perform return year after year and remain in the higher education system indefinitely.^[16] Rather, individuals who fail to progress are academically 'excluded' to create space for others who have not had the opportunity to access an HEI. This 'academic exclusion refers to the purposeful exclusion and blocking of an individual from further participation in academic activities of a Faculty, programme or institution. The rationale for academic exclusion is linked to creating more space for new entrants, but it is indeed multifactorial (e.g., optimisation of resources and granting the opportunity for potentially more dedicated applicants) and contextual (e.g., access for local applications from feeder schools near the HEI). Thus, academic exclusion has become a longstanding historical practice of many national and international HEIs. Consequently, most SA HEIs have developed policies to regulate and guide the management of academic exclusion. Policies regulating practices and procedures dealing with academic exclusion must be fit for purpose and contextually relevant. Thus, many institutions have specific policies that guide the management and application of academic exclusion and related processes.^[18-32]

These policies, rules and regulations are important to ensure that HEI processes are objective because becoming academically excluded significantly impacts any affected student's future.^[12] The associated stress and anxiety around academic exclusion remain a source of conflict between the affected role players. Therefore, it is no surprise that several studies on academic exclusion have been conducted. The early identification of at-risk students is an important step to mitigate academic exclusion.^[33,34] Such early identification would benefit both undergraduate and postgraduate students.^[35] Academic load was also shown to impact academic success, with an implemented change of module focus over the study period positively affecting student success.^[36] Studies on the reasons for academic exclusion identified financial difficulties to be the primary reason,^[37] with language challenges, poorly resourced feeder schools and low school grades being additional factors impacting student success and academic exclusions.^[38,39] The challenges of institutional transformation (or lack thereof) and its effect on the student's journey at SA academic institutions can also be added as an important element affecting academic exclusions.^[40,41] Studies examining factors within health-related programmes through scoping reviews^[42-44] and student academic failure at another African medical school institution^[45] highlight the requirement for a better understanding and context of academic exclusions.

In this study, we investigate and describe contemporary practices and core themes within the current policies and procedures of six different SA HEIs relating to academic exclusion and its rationale in a Health Sciences education context. This study aims to determine whether a 'generalised' HEI process exists or whether institutions are applying institution-specific criteria. This needs to be considered, especially within the context of qualifications offered in the Faculties of Health Sciences, where governance rules and regulations also exist from the legislative professional boards. Thus, objectivity in managing academic exclusion is enhanced within the HEI domain.

These findings will provide a foundation for critical reflection on academic exclusion's rationale and potential implications in a health professions education context.

 

Methods

A pragmatic, contextual, descriptive research design was followed to find a balance between speed and rigour, reliance on existing frameworks and new discoveries. Our methods included a generic qualitative inquiry and review of existing literature regarding academic exclusion to frame and contextualise the research. This was followed by a critical review of the academic policies and procedures listed on the websites of six pre-selected SA HEIs, all offering health sciences programmes (Table 1). These were preselected as representing the different types of the 26 SA HEIs. The critical review entailed retrieving the related documentation from the online portal. This allowed us to identify and describe similarities and differences in academic exclusion approaches by reviewing available policies and documentation that deal with academic exclusion and the appeals process for re-admission. Each document was thus evaluated with similarities, differences and omissions noted and grouped based on whether exclusion criteria and appeals processes and criteria were communicated. Summaries of these were then captured and grouped for reporting in the results section.

Ethical considerations

There were no participants in this study. All the materials and documents we sourced consisted of documentation already in the public domain. Consequently, we applied for an ethics waiver from the Research Ethics Committee (REC) of the Faculty of Health Sciences, University of Johannesburg. This was obtained on 22 May 2022. (NHREC Registration: REC 241112-035)

 

Results

All six of the institutions sampled practised academic exclusion. In this regard, we uncovered several institutional and faculty-specific rules, regulations or policies that describe the specific situations and circumstances leading to academic exclusion. The type of institution and location of such policies are summarised in Table 1.

The Rules and Regulations on academic exclusion are summarised in Table 2.

Rationale for academic exclusion

It was interesting to note that, while a rationale for academic exclusion certainly exists, the reviewed policy documents did not deal extensively with why the institutions practised it. Therefore, the potential justification of such practices is derived from the documentation used within the Faculty of Health Sciences context at the sampled HEIs. The core reasons that emerge from this review within the higher education sector for academic exclusion are as follows:

• Prevention of fruitless and wasteful expenditure of public funds

• Maintaining academic standards and credibility

• Protecting the reputations of Alumni and students within the system

• Protecting the student's finances and future

• Ensuring patient and community safety.

Presence and Management of an Appeals Process

We found that all sampled institutions allowed for an appeal by the student following their academic exclusion. However, there were differences in approaches to appeals management between the sampled institutions (Table 3).

 

Discussion

Great effort goes into selecting students with the academic potential to complete their chosen qualifications successfully, as reflected by the minimum academic requirements for admission into the higher education system. Higher education institutions have specific minimum admission criteria that need to be met by any applicant before being admitted into the institution.^[5] Despite this, some students fail to perform and progress at the higher education level after having gained entrance into an academic programme based on the identified potential at their time of application. Consequently, it becomes essential to recognise and identify poor performance early on and to put support structures and interventions in place to assist struggling students.^[16] However, in instances where all efforts have been exhausted and progress remains poor, students have to be excluded to allow them an opportunity to redirect their resources, time and efforts.^[33-35]

How do students become academically excluded?

Our analysis of the institutional policies and documents reviewed supports the view that academic exclusion is not easily implemented. The rules and regulations across the sample HEI documentation used in this study indicate that for a student to face academic exclusion, they must have consistently performed poorly over an extended period. The following are examples of what institutions see as constituting 'poor' performance.^[35]

a) Failure to complete a minimum number of credits in an academic cycle

Universities have rules that prevent readmission to a qualification should the stipulated number of modules or credits not be achieved in a specific academic cycle (usually the first year of study). This is to ensure that there is a systematic and objective operational set of criteria that can be implemented at the respective institution. The different HEIs reflect these in their policies and documentation that are shared with the registered students as well as are available on their student portals and institutional websites for access and future reference. The documents reviewed in this study also showed these rules explicitly.^[18-32]

b) Exceeding the maximum number of attempts allowed to demonstrate competence

Many students experience academic challenges and identified risk factors during their studies, resulting in delayed graduation.^[34-36] In the health sciences context (especially for clinically orientated disciplines), additional considerations are linked to the time taken to achieve prescribed levels of clinical competence for safe practice. Students who fail to demonstrate clinical competence on a first attempt can repeat the failed module/s. However, some students must demonstrate clinical competence after a second attempt (often with a reduced workload). In such instances, one may question whether the individual can become a safe healthcare provider.

c) The need to complete qualifications within the maximum time allowed

Many factors can impact the time students graduate or drop out from university-based studies. Some of these factors, such as a student's age, sex, race and financial status, may be easier to measure than the student's level of motivation for studying, the level of academic integration and the type of living conditions that exist at the university where they want to study.^[36-39] A general convention is that students retain credit for modules passed for seven years, provided no substantive changes to the curriculum have been made.^[36] The practical implications become that if an undergraduate student undertaking a four-year degree completed their first-year modules in 2010, they must have completed their qualification at the end of 2016; if they were allowed to return in 2017, their first-year credits would be seen to have expired.^[42]

Consequently, all sampled universities explicitly referred to a maximum allowable time to complete their respective qualifications. In a health sciences context, this may be particularly relevant because the rate of technology change and associated assumptions of clinical competencies acquired in preceding years, and their retention, may not support safe practice for graduates who take 7 or 8 years to complete a four-year qualification.^[42,45]

The rationale for academic exclusion

The rationale for academic exclusion remains complex and multifactorial.^[44-50] As enumerated below, academic exclusion within the SA Higher Education context of health sciences may also be argued to achieve additional end objectives.

a) Prevention of fruitless and wasteful expenditure of public funds

In SA, the government subsidises students' tuition fees within public sector HEIs. Simply put, a significant portion of the costs of keeping students within the higher education system comes from public funds (i.e., taxpayer's money). Therefore, SA universities rightfully place great emphasis on student success, academic support structures and the monitoring of academic performance. These efforts themselves cost money. Consequently, students who repeatedly fail to progress strain institutional resources and limit the available space for new entrants.

b) Maintenance of academic standards, regional and global credibility

The higher education environment, nationally and globally, is a competitive one. Another argument for academic exclusion is the protection of an institution's name, reputation and the credibility of its qualifications. The calibre of graduates, particularly vocational offerings, substantially affects an industry's perception of graduate capabilities and competencies, thereby impacting an institution's national and global reputation.^[33,34] Therefore, requiring students to complete their qualifications within the maximum time is one measure of ensuring that graduates are seen to be capable, competent and academically credible.

c) Protection of the reputations of Alumni and students within the system

It may sound contradictory that academic exclusion is utilised as a mechanism for 'protecting' alumni who have graduated from a particular institution. This 'protection' relates to the academic merit and relevance of the qualification obtained from the institution in which they studied. Especially in the context of health sciences, the reputation of a qualified health practitioner is based on the established competencies developed and nurtured during their training at the HEI where they were registered. Thus, academic exclusion may also protect the good name, reputation and standing within an industry of past graduates and students currently in the system. The context is that, rightfully or wrongfully, industries and professions judge institutions not only by the excellence of their historic graduates,^[44-45] but also based on the competencies of students within the system and those of graduating cohorts that continue to emerge.

For this reason, institutions may inadvertently 'damage' the reputation and standing of their alumni if they allow students currently in the system to fail repeatedly, run over time and spend years in the system without check, some of whom are seen to graduate by default, eventually.^[47-51]

d) Protection of the student's finances and future.

Despite government subsidies, registration and tuition fees strain an individual's as well as an institution's finances. For this reason, it becomes essential to identify individuals who cannot complete their qualifications in time and to exclude them so that they can redirect their resources, time and efforts.^[40-42] While students may not see it this way, arbitrarily supporting their appeals to return year after year is not always in their best interests. This will then perpetuate the challenge of having students too long in the system, leading to further financial constraints experienced by all role players.

d) Ensure patient and community safety

This aspect is especially related to the health sciences domain regulated by bodies, such as the Health Professions Council of South Africa (HPCSA) and the Allied Health Professions Council of South Africa (AHCPSA). These are national legislated and authoritative bodies primarily established to provide oversight of relevant health qualifications and monitor the competence of graduates. This is to ensure that independent health practitioners protect the public with its vulnerable societies from potential harm and malpractice. Only competent graduates who have met certain qualifications standards are thus allowed to interact with the public as health practitioners.

Appeals processes

While the sampled institutions showed similarities between their approaches to identifying students facing academic exclusion, their management of appeals against exclusion differed significantly. We found that related documentation describing the appeals process was missing from the websites or student portals of one of the HEIs studied.

Our reading of the current sourced documentation and literature shows that persons and committees dealing with an appeal should base their final decisions on the following:^[49,50]

• The appellant's circumstances, including their explanations for their poor performance and the strength of the motivation for their return or continuation of studies, together with any supporting evidence.

• If the appellate already had a previous academic exclusion lifted on appeal, and the request under consideration is related to a second or third exclusion.

• If the appellate has already received an academic warning and/or was allowed to continue subject to agreed conditions and performance expectations and whether or not these have been met.

• If the qualification can still be completed within the maximum allowable time.

• The number (and level) of outstanding modules or credits required to complete the qualification.

 

Conclusion

There is a clear and defendable rationale for the academic exclusion of non-performing health sciences students. The practices that seek to prevent students from continuing should be guided by policies and procedures that are clear and contextually relevant. SA HEIs practise academic exclusion guided by institutional, faculty and programme-specific rules, regulations and policies. Most academic institutions link exclusion to continued poor performance and/or failure to progress and complete qualifications within the maximum allocated time. The rationale for academic exclusion in a health sciences education context is multifactorial. It includes the prevention of fruitless and wasteful expenditure, the maintenance of academic standards, and credibility and the protection of the student, patient and community.

Institutions must allow for an appeal process that considers the student's circumstances and context, as some institutions do not offer this opportunity. However, the routine arbitrary support for such appeals without clear merit frustrates the system and defeats the aims, objectives and rationale for academic exclusion. Further studies should consider tracking the performance of students who were initially excluded but had their exclusion overturned on appeal, to determine the percentage of these students who ultimately complete their qualifications. These findings provide a foundation for critical reflection on the rationale and potential implications of academic exclusion in a health professions education context.

Limitations

The purposeful sampling strategy applied in this study, which only included six HEIs, can be considered a limitation. However, given that our aim and focus were merely exploratory and descriptive, we argue that our sample was sufficient to support the narrative and conclusions. The authors acknowledge that the practices described in this manuscript may not be consistent with those across all HEIs in SA.

Declaration. None.

Acknowledgements. None.

Author contributions. SN and CVL conceptualised the article and drafted and edited the manuscript. SN collected the data.

Funding. None.

Data availability statement. Not applicable to this study.

Conflicts of interest. All authors declare no conflict of interest.

 

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Correspondence:
S Nalla
shahedn@uj.ac.za

Received 23 February 2023
Accepted 5 June 2024