p.p1 a mentor and assessor of midwifery

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This essay explores and evaluates my role as a mentor and assessor of midwifery students in current clinical practice, through the critical reflection of my assessment experiences with a student midwife, given the pseudonym Rosie*, on her first year maternity ward placement. It will explore the learning theories utilised for student assessment, explore how they underpinned the processes used and then it will discuss the importance of validity and reliability within the modern professional,legal and ethical frameworks of clinical practice.  I will also reflect on my contribution to the practice learning environment and to the development of workplace opportunities and team-working with colleagues and peers. 

The concept of mentorship is believed to originate from ancient Greek literature and translated as wise, trusted one (Kinnell & Hughes, 2010) which has evolved and filtered into contemporary society as a designated individual to help develop, teach and progress another person. Within the healthcare context, the role of mentor has also adopted the responsibilities of an assessor and can also described as a role model, confidante and counsellor  (Gopee, 2008).  Within midwifery, a mentor has the responsibility to formally assess a student’s progress within their clinical placements which represents 50% of their degree programme grading (NMC, 2008) and they themselves must have undertaken appropriate mentor training to facilitate this role (Kinnell & Hughes (2010). The NMC has strict standards for the learning and facilitation of assessment in practice within a framework that supports the education of both students and also of mentors so they may effectively guide and assess their students (NMC, 2008). Midwife mentors are responsible in ensuring students have relevant learning opportunities, have valid and reliable assessments which will ultimately formalise that the student is deemed competent to become independent, effective practitioner (Chamberlain, 1997). 

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Opening communication channels can be considered key to the creation of a positive and productive learning environment (Gopee, 2008) and I felt I began to create this from the start of the placement by introducing Rosie to the whole team before ward handover, showing her around the workplace and reading her Ongoing record of achievement (ORA) which contained her learning needs and expectations for the placement. Students who feel they are valued as a colleague can be more receptive to learning opportunities (Thompson J., Keyword L. & Wilson A., 2012). 

As it was Rosie’s first ever midwifery clinical placement I felt it was important to communicate that she was considered part of our team within which her individual learning needs would be met and any anxieties would be addressed and supported.
West (2007) recognises that a mentor should expect a student to have a heathy level of anxiety starting a placement and would . evidence suggests that Maslow’s hierarchy of needs (Killgallon ) should be utilised to effective teaching and leanring,identifies that  anxieties and security are considered throughout

 Students can identify a good first clinical placement as one that involved a mentor making them feel included as part of the team (Jokelainen et al, 2011) as well as recognising them as an individual, which when ignored, can often be a barrier to effective learning in practice (West, 2007). Promoting a professional and supportive relationship can empower students to recognise their personal attributes and increase their awareness of learning opportunities was they are operating within a trusting and open working environment (Jokelainen et al, 2011).
Thunes & Sekse (2015) found that recognition of a student’s past experiences and their current expectations of clinical practice is essential in formulating teaching and assessment approaches which is crucial at the start of their midwifery journey. We discussed her past work experience, her expectations for skill development and the assessments for her placement and explained that she would received a formative assessment halfway through her placement as well as a summative, final assessment at the end of her placement. 

Mentors must be the bridge between a student’s university lecture theory and the contemporary, clinical setting (Thompson J., Keyword L. & Wilson A., 2012) ; they must utilise relevant learning theories to teach and help integrate the individual student’s knowledge and skills and thus driving their development into a competent and accountable healthcare professional (Fulton & Shaw, 2012). There are three main learning approaches that can be used during mentoring and assessment: Behaviourist, Humanistic and Cognitive (Fulton and Shaw, 2012). Mentoring and teaching midwifery students in a clinical setting could use one or a combination of these different approaches dependant on the learning experience and the student.

A cognitive approach, such as Experiential learning is important within healthcare setting as it involves learning by practical involvement and then reflection of the event, which is considered a cornerstone of midwifery learning and development (NMC, 2010). Reflective practice helps prepare the student for professional practice and re-validation (XXX) but also helps them disseminate what new knowledge they have attained from the event and how they will approach a future similar encounter (Thompson et al, 2012). Cognitivism  approaches allow students to have more meaningful experiences, understanding that they have problem solved rather than simply repeating a memorised experience (Casey & Clark, 2011).

Behaviourist theory can be useful in learning new clinical skills such as manually taking a blood pressure reading as it a formulaic task learnt by repetition that is needed to underpin overall clinical practice experience (Gopee, 2008). The student gains praise for achieving a particular competence which can motivate them to learn further clinical skills however it is validated on a benchmark of generalisation population rather than focusing on an individual’s learner needs (Fulton & Shaw, 2012). 

A humanistic approach reinforces the Maslow’s hierarchy of needs (1987) as it suggests addressing psychological needs of the student as the foundation for successful learning outcomes. Humanist theories focus on the experiences and feelings of an individual by promoting a holistic approach to learning based on a student choosing own direction and the mentor facilitating the direction taken (Thompson et al, 20120). This theory is useful in preparing the student for autonomous practice as a registered professional in the future  but Duffy (2003) warns that personal feelings can cloud judgement when comes to  reliable assessment and course progression. 

The NMC’s guidance (2008b) has emphasis on supporting students in practice by making the workplace a constructive teaching environment but Jokelainen et al, (2011) found that students themselves valued feeling cared for and shown empathy as equally important to effective learning.  I felt using humanist techniques for learning was more relevant to Rosie as felt this approach acknowledged her feelings, supported self-awareness and aided her ability to recognise areas of weakness or lack of knowledge and therefore direct her own learning (Gopee, 2003). I felt this was supported by use of an ORA and action planning as well as her university provision of problem based learning which is self directed teaching used to highlight gaps in knowledge and broaden existing comprehension (XXXX). 

tyes of assessment….

Gopee (2003) states there are four essential  principles of assessment of competencies within healthcare setting; validity, reliability, discrimination and practicability. 
Validity refers to expectation that the assessment measures what it is expected to measure , ensuring the correct competencies areas are addressed, in keeping with the professional standards (Kinyell & Hughes, 2010; NMC, 2008b). Through different types of validity I was able to ensure a measured and effective assessment process; construct validity was achieved through service user feedback following assessment of Communication ESCs during a postnatal check. Using observations from the woman regarding Rosie’s attitude helped validate the assessment as it reinforced the importance of keeping the woman at the centre of the care and has been found to enhance the student’s self awareness in practice (Davis & MacIntosh, 2005). Content validity was shown through utilisation of the structured NMC Essential Skill Clusters and related evidenced reflections populated in Rosie’s ORA. The validity of the formative assessment was enhanced by reviewing Rosie’s personal learning goals at the beginning of the placement and at the intermediate as well as Rosie’s self assessment marking grid. Reviewing self assessment progress with the student present can adjust goals and expectations leading up to the final, summative assessment and help increase a student’s self awareness within the learning journey (Quinn & Hughes, 2013).


Non-verbal feedback contributes to the summative and formative assessments documentation on the student’s online ORA however verbal feedback can be given throughout the placement and also then revisited and summarised at assessment interview. Verbal feedback between assessor and student is considered vital for the learning potential as it can improve confidence and increase motivation (Goppe, 2011) however if not delivered effectively and positively, can cause increased anxiety for the student and form a negative connotations  associated with the placement and mentor (Mullholand & Turnock, 2012). Giving good quality feedback can be facilitated through allowing the student to firstly self assess and reflect on an experience then giving praise before 
Assessors must provide continuous feedback as they are responsible for approving a student’s competency for professional practice (Elcock & Sharples, 2011) so close observation with constructive feedback allows assessors to recognise a student’s scope of practice. Facilitating positive feedback can be achieved through active listening and a shared reflection of events which can also enhance the co-operative relationship of the student and assessor (Jokelainen et al, 2001: Thompson et al, 2012).
Being my first experience as mentor I was mindful to give feedback from the beginning of our relationship and although Rosie was a competent student, I found it challenging when she needed to be corrected. I found utilising my colleagues for advice to plan my constructive feedback was invaluable and that giving praise before criticism helped give balanced and honest feedback (Mullholland & Turnock, 2012). Students need to be able to use feedback to enhance their practice and skill confidence and this is also relevant for assessors who themselves are lifelong learners.
Healthcare service users have a pivotal role within the student’s clinical experience and within the wider maintenance of healthcare standards therefore regular clinical audit is essential to maintain these standards. Clinical audits, using patient feedback, are administered at local, regional and national level and are regularly run to identify ongoing quality improvements, potential issues and possible gaps in provision  (NHS England, 2017).  On a trust network level, the local University and hospital trust work with Health Education England, to ensure high quality education and utilise the feedback from students to regularly assess that educational needs are being met. 

Hysong et al (2006) found that feedback synthesised from an audit is more likely to be actionable when its individualised and timely. McKellar L. & Graham K.(2015) adds that strong partnerships between education institutions and placements can only enhance the clinical experience for both students and service users because of robust and trusting communication channels. This is reflected in the student’s experience of the Practice Placements Quality Assurance (PPQA) website which is accessed after every assessment in placement rather than annually and the questions obtain individual experiences of placement areas rather than cohort generalisations. It also cover over 3000 practice placements so the data can be disseminated on both local and national levels to contribute to ongoing quality standard audits.
Mentors who are assessors,  must develop collaborative and communicative relationships with students, colleagues and university link lecturers to provide safe, ethical and quality learning environments. It is of utmost importance to maintain high standards of clinical education to prepare students for professional and accountable practice. This is achieved through effectively recognising learning needs, providing valid and reliable assessments and using managing feedback to enhance the student’s educational and clinical experience.



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