The purpose of this competency is to assess your performance as an observable indicator of your readiness to become a graduate entry level sonographer. The criteria assessed are that of the core minimum requirement for an accredited entry level graduate sonographer as defined by the Professional Competency Framework for Sonographers October 2021. There are six (6) domains of practice that are assessed: abdomen, breast, musculoskeletal, obstetric, superficial parts and vascular. In this unit you must demonstrate competence in three (3) domains of practice. The remaining three (3) domains of practice will be challenged in MEDS20017. You must have achieved a total of six (6) competency assessments on completion of MEDS20016 and MEDS20017, one for EACH domain of practice with no two competencies in the same domain of practice.

This assessment task measures your overall aptitude and competence in completing an ultrasound examination in one of the six domains of practice that you need to achieve.

The required levels of competency are:

• Vascular (carotid) to competency level,
• Superficial structure (thyroid or testes) to competency level,
• Breast (female or male) to competency level,
• Musculoskeletal (shoulder) to competency level,
• Abdomen to competency level,
• Obstetric - choose one of the following - 2nd trimester 18-22 week morphology scan (to advanced beginner level) OR 3rd trimester scan (to competency level). (Note: if you are to complete the assessment on an 18-22 week scan, you must log a minimum of 10 18-22 week cases before you can attempt the assessment OR if you are to complete the assessment on a 3rd trimester scan the you must log a minimum of 10 cases of 3rd trimester examinations before you can attempt the assessment).

For this practical assessment choose one of the domains of practice above. Then complete a practical test in this domain of practice to achieve the appropriate competency level as stated above. This task will be assessed by your clinical supervisor, or a delegate sonographer, using the standardised form provided. These forms are available in the section "Assessment" in the unit Moodle site. A copy is available online for your clinical site but it is advisable to provide a printed copy to your clinical supervisor at the commencement of your placement. Please print this form and read it carefully so you understand the criteria against which your sonographic skills, and relevant theoretical knowledge, will be evaluated. Discuss the best time to complete this assessment with your clinical supervisor. After the assessment ask for feedback so you can focus your efforts on improving weaker areas.

You are permitted 1 re-attempt to complete this assessment.

If you do not meet the required standard on your first attempt, you must seek detailed feedback from your assessor to critically reflect on and develop a strategy to improve your performance on the re-attempt. You must share your plan for improvement with your assessor. You may then re-attempt this assessment to achieve the required competency level. Your clinical supervisor must complete and sign the assessment form before you submit it through the assessment block in the unit Moodle site.

In this assessment you will demonstrate your ability to carry out all tasks of the ultrasound examination with minimal intervention, guidance or correction by the assessor. The assessment must be attempted prior to completion of the clinical placement block. You are permitted 1 re-attempt to complete this assessment if you received a fail on your 1st attempt. If a re-attempt is needed to achieve the required level, submit the assessment documents from both attempts. 

1. Professional Competency Framework for Sonographers [Internet] 2021 [Updated 2021 December 9, cited 2022 January 19].

Available from https://figshare.com/articles/online_resource/Professional_Competency_Framework_for_Sonographers/17148035

The assessment criteria will address the following areas of your performance in one of six domains of practice.

• Occupational health and safety including ergonomics
• Accurate documentation and communication of findings
• Ability to recognise the need to and extend the clinical examination where appropriate
• Recognition and understanding of the relevant anatomy and pathology demonstrated
• Interrogation of anatomy and acquisition of relevant images to demonstrate diagnostic sufficiency and completeness of information contained
• Knowledge of instrumentation including optimisation of survey and images through appropriate selection of parameters and technique
• Pre-scan, scan and post-scan preparation and tasks
• Patient care and communication

The required levels of competency are:

• vascular (carotid) to competency level,
• superficial structure (thyroid or testes) to competency level,
• breast (female or male) to competency level,
• musculoskeletal (shoulder) to competency level,
• abdomen to competency level,
• obstetric - choose one - 2nd trimester 18-22 week morphology (to advanced beginner level) OR 3rd trimester growth scan (to competency level).

To achieve a Pass in all competencies you must achieve Level 3 in all assessment areas. The exception to this is if you choose to undertake the obstetric morphology competency, where you must achieve at least Level 2 in all assessment areas. You must achieve Level 3 within the patient communication sections to pass the competency. Failure in effective patient communication will result in failure of the competency.

You are permitted 1 re-attempt to complete this assessment. If you failed both attempts for this assessment, this will result in a fail grade for this unit.

The purpose of this competency is to assess your performance as an observable indicator of your readiness to become a graduate entry level sonographer. The criteria assessed are that of the core minimum requirement for an accredited entry level graduate sonographer as defined by the Professional Competency Framework for Sonographers October 2021. There are six (6) domains of practice that are assessed: abdomen, breast, musculoskeletal, obstetric, superficial parts and vascular. In this unit you must demonstrate competence in three (3) domains of practice. The remaining three (3) domains of practice will be challenged in MEDS20017. You must have achieved a total of six (6) competency assessments on completion of MEDS20016 and MEDS20017, one for EACH domain of practice with no two competencies in the same domain of practice.

This assessment task measures your overall aptitude and competence in completing an ultrasound examination in one of the six domains of practice that you need to achieve.

The required levels of competency are:

• Vascular (carotid) to competency level,
• Superficial structure (thyroid or testes) to competency level,
• Breast (female or male) to competency level,
• Musculoskeletal (shoulder) to competency level,
• Abdomen to competency level,
• Obstetric - choose one of the following - 2nd trimester 18-22 week morphology scan (to advanced beginner level) OR 3rd trimester scan (to competency level). (Note: if you are to complete the assessment on an 18-22 week scan, you must log a minimum of 10 18-22 week cases before you can attempt the assessment OR if you are to complete the assessment on a 3rd trimester scan the you must log a minimum of 10 cases of 3rd trimester examinations before you can attempt the assessment).

For this practical assessment choose one of the domains of practice above. Then complete a practical test in this domain of practice to achieve the appropriate competency level as stated above. This task will be assessed by your clinical supervisor, or a delegate sonographer, using the standardised form provided. These forms are available in the section "Assessment" in the unit Moodle site. A copy is available online for your clinical site but it is advisable to provide a printed copy to your clinical supervisor at the commencement of your placement. Please print this form and read it carefully so you understand the criteria against which your sonographic skills, and relevant theoretical knowledge, will be evaluated. Discuss the best time to complete this assessment with your clinical supervisor. After the assessment ask for feedback so you can focus your efforts on improving weaker areas.

You are permitted 1 re-attempt to complete this assessment.

If you do not meet the required standard on your first attempt, you must seek detailed feedback from your assessor to critically reflect on and develop a strategy to improve your performance on the re-attempt. You must share your plan for improvement with your assessor. You may then re-attempt this assessment to achieve the required competency level. Your clinical supervisor must complete and sign the assessment form before you submit it through the assessment block in the unit Moodle site.

In this assessment you will demonstrate your ability to carry out all tasks of the ultrasound examination with minimal intervention, guidance or correction by the assessor. The assessment must be attempted prior to completion of the clinical placement block. You are permitted 1 re-attempt to complete this assessment if you received a fail on your 1st attempt. If a re-attempt is needed to achieve the required level, submit the assessment documents from both attempts.

1. Professional Competency Framework for Sonographers [Internet] 2021 [Updated 2021 December 9, cited 2022 January 19].

Available from https://figshare.com/articles/online_resource/Professional_Competency_Framework_for_Sonographers/17148035

The assessment criteria will address the following areas of your performance in one of six domains of practice.

• Occupational health and safety including ergonomics
• Accurate documentation and communication of findings
• Ability to recognise the need to and extend the clinical examination where appropriate
• Recognition and understanding of the relevant anatomy and pathology demonstrated
• Interrogation of anatomy and acquisition of relevant images to demonstrate diagnostic sufficiency and completeness of information contained
• Knowledge of instrumentation including optimisation of survey and images through appropriate selection of parameters and technique
• Pre-scan, scan and post-scan preparation and tasks
• Patient care and communication

The required levels of competency are:

• vascular (carotid) to competency level,
• superficial structure (thyroid or testes) to competency level,
• breast (female or male) to competency level,
• musculoskeletal (shoulder) to competency level,
• abdomen to competency level,
• obstetric - choose one - 2nd trimester 18-22 week morphology (to advanced beginner level) OR 3rd trimester growth scan (to competency level).

To achieve a Pass in all competencies you must achieve Level 3 in all assessment areas. The exception to this is if you choose to undertake the obstetric morphology competency, where you must achieve at least Level 2 in all assessment areas. You must achieve Level 3 within the patient communication sections to pass the competency. Failure in effective patient communication will result in failure of the competency.

You are permitted 1 re-attempt to complete this assessment. If you failed both attempts for this assessment, this will result in a fail grade for this unit.

The purpose of this competency is to assess your performance as an observable indicator of your readiness to become a graduate entry level sonographer. The criteria assessed are that of the core minimum requirement for an accredited entry level graduate sonographer as defined by the Professional Competency Framework for Sonographers October 2021. There are six (6) domains of practice that are assessed: abdomen, breast, musculoskeletal, obstetric, superficial parts and vascular. In this unit you must demonstrate competence in three (3) domains of practice. The remaining three (3) domains of practice will be challenged in MEDS20017. You must have achieved a total of six (6) competency assessments on completion of MEDS20016 and MEDS20017, one for EACH domain of practice with no two competencies in the same domain of practice.

This assessment task measures your overall aptitude and competence in completing an ultrasound examination in one of the six domains of practice that you need to achieve.

The required levels of competency are:

• Vascular (carotid) to competency level,
• Superficial structure (thyroid or testes) to competency level,
• Breast (female or male) to competency level,
• Musculoskeletal (shoulder) to competency level,
• Abdomen to competency level,
• Obstetric - choose one of the following - 2nd trimester 18-22 week morphology scan (to advanced beginner level) OR 3rd trimester scan (to competency level). (Note: if you are to complete the assessment on an 18-22 week scan, you must log a minimum of 10 18-22 week cases before you can attempt the assessment OR if you are to complete the assessment on a 3rd trimester scan the you must log a minimum of 10 cases of 3rd trimester examinations before you can attempt the assessment).

For this practical assessment choose one of the domains of practice above. Then complete a practical test in this domain of practice to achieve the appropriate competency level as stated above. This task will be assessed by your clinical supervisor, or a delegate sonographer, using the standardised form provided. These forms are available in the section "Assessment" in the unit Moodle site. A copy is available online for your clinical site but it is advisable to provide a printed copy to your clinical supervisor at the commencement of your placement. Please print this form and read it carefully so you understand the criteria against which your sonographic skills, and relevant theoretical knowledge, will be evaluated. Discuss the best time to complete this assessment with your clinical supervisor. After the assessment ask for feedback so you can focus your efforts on improving weaker areas.

You are permitted 1 re-attempt to complete this assessment.

If you do not meet the required standard on your first attempt, you must seek detailed feedback from your assessor to critically reflect on and develop a strategy to improve your performance on the re-attempt. You must share your plan for improvement with your assessor. You may then re-attempt this assessment to achieve the required competency level. Your clinical supervisor must complete and sign the assessment form before you submit it through the assessment block in the unit Moodle site.

In this assessment you will demonstrate your ability to carry out all tasks of the ultrasound examination with minimal intervention, guidance or correction by the assessor. The assessment must be attempted prior to completion of the clinical placement block. You are permitted 1 re-attempt to complete this assessment if you received a fail on your 1st attempt. If a re-attempt is needed to achieve the required level, submit the assessment documents from both attempts.

1. Professional Competency Framework for Sonographers [Internet] 2021 [Updated 2021 December 9, cited 2022 January 19].

Available from https://figshare.com/articles/online_resource/Professional_Competency_Framework_for_Sonographers/17148035

The assessment criteria will address the following areas of your performance in one of six domains of practice.

• Occupational health and safety including ergonomics
• Accurate documentation and communication of findings
• Ability to recognise the need to and extend the clinical examination where appropriate
• Recognition and understanding of the relevant anatomy and pathology demonstrated
• Interrogation of anatomy and acquisition of relevant images to demonstrate diagnostic sufficiency and completeness of information contained
• Knowledge of instrumentation including optimisation of survey and images through appropriate selection of parameters and technique
• Pre-scan, scan and post-scan preparation and tasks
• Patient care and communication

The required levels of competency are:

• vascular (carotid) to competency level,
• superficial structure (thyroid or testes) to competency level,
• breast (female or male) to competency level,
• musculoskeletal (shoulder) to competency level,
• abdomen to competency level,
• obstetric - choose one - 2nd trimester 18-22 week morphology (to advanced beginner level) OR 3rd trimester growth scan (to competency level).

To achieve a Pass in all competencies you must achieve Level 3 in all assessment areas. The exception to this is if you choose to undertake the obstetric morphology competency, where you must achieve at least Level 2 in all assessment areas. You must achieve Level 3 within the patient communication sections to pass the competency. Failure in effective patient communication will result in failure of the competency.

You are permitted 1 re-attempt to complete this assessment. If you failed both attempts for this assessment, this will result in a fail grade for this unit.

Clinical placement occurs in the professional workplace. As a clinical student you are provided access to that workspace on the condition that you demonstrate behaviours and attributes of a healthcare professional and present a positive image to the clinical facility’s staff and clients. As a medical sonography student in Australia, you are also required to be working towards compliance with the Code of Conduct for Medical Sonographers and the standards as described in the Professional Competency Framework for Sonographers.

Clinical sites mention professional behaviour, particularly team work and empathy, as paramount in their decision to employ a sonographer. This assessment considers your ability to communicate professionally with a diverse cultural audience of patients and staff, demonstrate professional respect for all, and function as a reliable, well organised member of the health team.

Your clinical supervisor, or delegate, will be working in the sonography area with you, directly observing your day-to-day performance, and/or obtaining feedback from supervising sonographers who are doing so. These observations and collected feedback relate to your demonstrated knowledge, skills and behaviours over a span of time, not limited to a particular scan type or patient case. The observations and feedback are then used to complete the Global Assessment of Professional Attributes (GAPA) form provided.

There are three main sections to the GAPA form: Section 1: Applied Knowledge, Section 2: Psychomotor Skills (Scanning Skills) and Standard of Work and Section 3: Professionalism.

In each section there are multiple observed behaviours that you are required to demonstrate throughout your placement. Your assessor will score your performance based on how frequently and to what extent you demonstrate each of the listed behaviours. Your assessor is also encouraged to provide comments to expand the scoring feedback.

The assessment occurs twice during the placement.

The first occurs as the mid-placement point, at the end of week 9. The mid placement GAPA assessment is formative, meaning its function is to provide you and your unit coordinator with formal documented feedback on your performance, but there are no minimum required scores related to your final grade. Your clinical supervisor will submit the assessment via email directly to the unit coordinator. The unit coordinator will assess all the GAPA submitted and will provide feedback and support to the student if required. You will be notified by the unit coordinator when all completed forms will be available to view on your unit Moodle site. You are expected to use any feedback from the supervisor or unit coordinator to reflect on your performance, develop an action plan to address any areas of performance that are not yet at the target level for this placement, and use the remaining weeks to achieve those targets.

If there are any serious concerns at any time during the placement about student behaviour the supervisor will contact the unit coordinator directly and a GAPA assessment may be requested at this time. An interim GAPA may be issued at any time by the clinical supervisor and this GAPA can be sent as evaluation by the clinical site. This GAPA assessment may be directly sent to the Unit Coordinator.

The second or end-of-placement GAPA assessment occurs towards the end of Week 19, the final week of the placement. The end-of-placement GAPA is summative, in that its primary use is to evaluate and document your performance relative to the stated targets. The minimum required scores are listed in the Assessment criteria below. Your final grade in this assessment depends on where you stand relative to those performance targets. As this placement is the third of four in the course, you should use this end-of-placement assessment as formative as well, to address any areas of performance that are not yet at a target level, and to form a plan for improvement in your final placement.

It is your responsibility to ensure that you remind your clinical supervisor at least a week prior to the assessment that it needs to be completed, and book a meeting with him/her toward the end of the week that the assessment is due. This gives your supervisor the opportunity to collect feedback and to designate an alternate assessor if he/she will not be available.

If there are extenuating circumstances at the clinical facility that prevent you from being assessed during the required weeks, you must contact the unit coordinator in a timely manner. This will require obtaining approval for an assessment extension through the Moodle site. It is also your responsibility to ensure regular access to the technology needed to upload your assessment by the submission due dates. In the absence of an approved assessment extension, if you have not met all of the requirements listed on the Assessment Criteria section by the stated due dates, you will Fail this assessment, and because this is a pass/ fail unit that means you will receive a Fail grade for this unit.

On occasion, clinical sites inform us of student behaviours which either compromise the reputation of the clinical site and/or the university, or compromise patient/staff safety and/or wellbeing. In these instances students will be notified that they must cease attendance at the clinical site and discuss their position with the unit coordinator and the Head of Course. This may result in student behavioural misconduct procedures in line with the CQUniversity Student Behavioural Misconduct Procedure.

In order to achieve an overall grade of “Pass” in this assessment, you must: - undergo both the mid-placement and end -of-placement assessments by the due dates listed - on the end-of-placement assessment, meet the minimum required marks in all three sections, - ensure the documentation of each assessment is complete, and - upload the completed end-of-placement GAPA form into the unit Moodle site by the due date.

A fail in the mid placement GAPA will not result in a fail for the assessment. If the mid placement GAPA is failed you will be given a chance to improve, however you will be given notice that you are a student at risk of failing this assessment. If there is no improvement or you fail the end of placement GAPA you will fail this assessment which will result in a fail for this unit.

At either the mid- placement or at any stage identified by the supervisor or unit coordinator, students may be identified as a ‘Student at Risk’. This occurs with failure to meet minimum levels in the GAPA.

Any student identified as a ‘Student at Risk’ will be notified by the unit coordinator who will provide formative feedback. Review of progress will be completed a short time later, or at any time requested by the clinical supervisor. Unsatisfactory levels in a second GAPA will result in a fail grade for the unit.

Occasionally student behaviour is beyond acceptable risk to clinical sites. Clinical supervisors should contact CQUniversity academics immediately when this occurs. A GAPA assessment is requested at this time (which could be at any time of the placement). If the outcome of this GAPA is unsatisfactory, and/or the site feedback indicates that they can no longer host a student due to the risk incurred, then this one GAPA alone, or site refusal to host, will constitute a fail of the unit. Where such risk exists the placement will terminate immediately and a Fail for MEDS20016 will occur.

Students must maintain a log of each case they perform. The students are required to record a minimum of ten studies in any three of the six domains in which they are undertaking a competency assessment: Abdominal, obstetric/gynaecology, carotid, superficial structures, breast and shoulder studies, which they completely perform during this placement. Students actually log a wide variety of studies. The remaining studies in other domains will be completed in MEDS20017.

The clinical logbook serves as a record of your depth and breadth of experience attained during the placement. It demonstrates the degree of progression of your skill development within and across examination type. You should analyse this record at regular intervals to assist in the formulation of learning goals that will support your achievement of the unit outcomes.

Each case will be categorised into one of the following areas: Abdomen (including renal), Superficial Structures (thyroid, testes, lumps/bumps, etc), Breast (female or male), Obstetrics (first, second or third trimester. However please note that to attempt obstetric practical assessment you must have a minimum of ten logbook entries for the domain you will attempt, for example, 10 Morphology scans must be logged to then attempt the practical assessment for a Morphology scan) & Gynaecology, Vascular (carotid, DVT or other) and Musculoskeletal. Each week of the logbook must be signed by your clinical site supervisor, radiologist, sonographer delegated by the clinical supervisor or sonologist with the appropriate ultrasound qualifications. The clinical logbook and further information on how to complete the logbook and minimum examination numbers required are available in the section "Assessment" in the unit Moodle site.

Please read these information sheets carefully so you understand the criteria against which your logbook will be evaluated.

You can submit 'outside clinical placement' log books dated between the end of year 3 term 2 placement and the commencement of year 4 term 1 placement. The 'outside clinical placement' cases must be obtained as either an employee or in a learning capacity with you being supernumerary to workplace requirements. The outside clinical placement logbook is available in the section "Outside Placement" in the unit Moodle site.

Please note: The logbook must be verified (signed) by an ASAR accredited sonographer, radiologist or sonologist with appropriate ultrasound qualifications. Details of either your insurance, or employment, must be entered onto the outside clinical placement logbook. If you are located at a site which does not provide access to certain scans then it is possible to credit surplus log book numbers from MEDS13006 to MEDS20016. Please contact unit coordinator for permission.

This assessment task measures your overall ability to complete an ultrasound examination in three of the six general sonographer domains of practice. The required minimum numbers in your logbook by the conclusion of this clinical placement are completion of three of the categories listed below.

Complete three (3) of the six (6) requirements below. The remaining three must be completed in Clinical Unit 4.

• vascular (carotid) -10 studies
• superficial structure (thyroid or testes) - 10 studies
• breast - 10 studies
• musculoskeletal (shoulder) - 10 studies
• abdomen - 10 studies
• obstetric - choose one - 2nd trimester 18-22 week morphology OR 3rd trimester growth scan - 10 studies

As a healthcare professional your attendance is relied upon for the provision of quality patient care. Your absence impacts service delivery and safe patient care. This unit is part of a professional accredited course within which students are expected to complete 50 weeks/ 2000 hours of clinical experience. For this unit you must attend 19 weeks/minimum 760 hours of full time clinical placement. Your rostering, daily start and end times, is determined by the clinical supervisor of the allocated placement site. The roster depends on the scheduling of ultrasound procedures that are relevant to your educational requirements and the smooth operation of the clinical practice. You should not expect the roster to be modified to suit your personal life. There are no allocated personal leave days during this placement.

You are required to achieve a 100% attendance to the minimum 760 hours (19 x 40 hours) of clinical attendance. This is defined as attending all hours relative to quantity of time that you have been rostered by your clinical supervisor to achieve 19 weeks of full time placement, minus any absence that is approved by both your clinical supervisor and the unit coordinator. You are not required to attend on any national or relevant state public holidays that fall within your rostered weeks. Any time you are away from your clinical institution, you MUST supply a verifiable supporting document indicating why you have not attended. If you need to be absent for a part or full day of placement, both your clinical supervisor and unit coordinator MUST be informed, preferably in advance of the missed time. In situations where you are unwell and cannot attend the rostered shift you must inform the supervisor as soon as possible and the unit coordinator on the day of the absence or shortly thereafter.

Any absences for part, or all of, a working day must be made up after, or during (e.g., Saturday/evenings if available), the clinical placement. Any time to be made up is to be scheduled at the convenience of the clinical site. This may result in extension of the workday or week. Note that not all facilities have extended hours of operation, so opportunities to make up time are site dependent. If you attend outside of your normally rostered hours (e.g., late day, evening or weekend), you must be still under direct supervision and working within your scope of practice. All hours worked must be entered into the clinical attendance form. The record must be accurate and complete. You must include any episodes of absence, lateness or early departure. This form must be signed by your clinical supervisor, or sonographer delegated this task by your clinical supervisor, radiologist or sonologist with appropriate ultrasound qualifications. The clinical attendance form is available in the section "Assessment" in the unit Moodle site. Please read this form carefully so you understand the criteria against which your clinical attendance will be evaluated.

Optional

You can submit “outside of clinical attendance” attendance hours if you undertake employment in an ultrasound department between your clinical placements.

Please note:

• The hours must be verified (signed) by an ASAR accredited sonographer.
• Details of your employment, must be entered onto the outside clinical placement attendance form for insurance purposes.

You can submit 'outside clinical placement' hours if appropriate as determined by the UC, to a maximum of half the required hours (320hours). You must be either employed by the clinical site or engaged in a learning capacity which means you are supernumerary to the workplace requirements.

You can attend Zoom tutorials and this time will be eligible to enter on your clinical attendance form. This can be entered as one hour per hour of attendance. You will be required to listen and provide feedback to your peers. The unit coordinator will keep a record of the students attending Zoom tutorials and will sign off on these hours in your clinical attendance log book. This will NOT be available for students that only watch the recorded tutorial session as the unit coordinator will be unable to verify your attendance.

To Pass this assessment you must achieve a minimum of 760 hours (19 weeks x 40 hours) of clinical attendance. Any days away from your clinical site must be documented.

To obtain a Pass grade in this placement attendance task, you must:

• complete 100% attendance as defined above,
• have documented all attendance accurately and completed in your clinical attendance form, 
• have submitted the completed clinical attendance form by the stated due date, and

At the end of the scheduled 19 weeks of placement, if you have not met the 100% attendance requirement AND you have documented justifiable grounds for your absenteeism, you will be provided additional scheduled time to make up the time you have missed. (This scheduled make-up time may be immediately following the scheduled 19 week placement, and/or at the same placement site, depending on the clinical availability).

At the end of the scheduled 19 week placement, if you have not met the 100% attendance requirements AND you do not have documentation or grounds to support your absence, you will score a Fail for this assessment item and a Fail for this unit.