Web Resource 6.1: Pre-Test Questions

Before starting this chapter, it is recommended that you visit the accompanying website and complete the pre-test questions. This will help you to identify any gaps in your knowledge and reinforce the elements that you already know.

Why Assess?

Assessment is defined as a measurement and a process by which information about students is collected. The information about students’ learning and clinical practice is gathered over a period of time, generally by using a range of assessment techniques (Nugent 2004; Oermann and Gaberson 2009). Assessment directly relates to the quality and quantity of learning and, as such, is concerned with student progress and attainment. An assessment criterion provides transparency of what knowledge and skills are required in order to become a qualified practitioner (Nicklin and Lankshear 2000). Rowntree (1992) states that assessment has several purposes:

• Diagnosis – of needs
  
• Evaluation – of learning
  
• Grading – statistical and quality indicator.

Assessment is viewed as a key component of every health professional’s role and is a statutory requirement, laid down both to ensure that students are fit for purpose and for the overall protection of the public.

In 2008 the Nursing and Midwifery Council (NMC 2008b) made the facilitation of others to develop their competence (p 4) part of The Code to which all registrants must comply (NMC 2010) and brought in mandatory qualifications for mentors with the Standards to Support Learning and Assessment in Practice (NMC 2008a). In addition, the need for mentors/coaches of allied health professionals has brought about accreditation schemes such as the Accreditation of Practice Placement Educators for Occupational Therapists (APPLE) and the Accreditation of Clinical Educators for Physiotherapists (ACE), as well as a need to provide multidisciplinary mentorship training via higher education institutions to paramedics, operating department practitioners and members of the College of Operating Department Practitioners (CODP 2006). Ultimately governing bodies such as the NMC are accountable for ensuring that new entrants have undergone an appropriate educational experience and achieved a certain standard of competence in theory and practice. But, it is the role of the mentor to ensure that these standards are applied and adhered to in the area of practice where the student works. Assessment provides feedback on the effectiveness of the teaching. Failure to learn is not normally perceived as the sole fault of the student; poor facilitation of learning is often cited. Mentors are accountable for the decisions that they make with regard to assessing the competence of the students (Edwards et al 2001). Feedback from assessment, whether the outcome is positive or negative, can often motivate the student to progress, maintain high standards or improve on low ones. This feedback should be given in a timely, concise and considerate manner – communication is everything.

The Mentor as Assessor

A mentor has a pivotal position working with students in an educational environment where theory and practice come together. A mentor plays many roles (befriender, facilitator of learning and assessor). The right balance has to be achieved between all these roles to make an objective assessment of the student’s capabilities.

The quality of assessment varies enormously. Its nature and effectiveness depend on the number of staff in the practice area and the shape of the working day. Practice learning and assessment can compromise patient care, so mentors invest a great deal of their own time and effort to maintain patient safety while helping the student. Mentors do this at a cost to themselves in terms of stress and personal wellbeing.

• The role of the mentor is one of many functions; for most mentors, the first priority is getting through the working day; the second is providing quality care and the third is undertaking assessment. The working day is full of interruptions: mentors are frequently called upon to juggle several clinical tasks at once. There is rarely continuity of contact between the mentor and the student. Workloads and shift patterns may prevent mentors from observing the student and for many organisations assessment is viewed as an add-on activity to be done after the things that really matter have been completed.
  
• The majority of assessment is carried out informally by other staff who work alongside the student, but may not have received training in assessment and probably perceive the student differently from the mentor. In most cases, there is little time set aside for observation of the student or for systematic evidence collection and dialogue between mentor and other staff who have worked with the student. The most valid assessment takes place when there is an opportunity for close observations over a sustained period by the mentor working alongside the student.

Demands may include having more then one student, or you may be managing a ward/unit so you have little time to mentor the students as well as you would like.

Clinical practice has to meet the expectations of a range of stakeholders such as the public, the health professional, professional governing body and the employer. Health professionals sometimes have to do things to meet contradictory agendas. Therefore, there is a need for regular, constructive dialogue between all interested groups to develop curricula for learning and assessment that acknowledge the need for practitioners to juggle competing agendas.

Assessment must take into account several conditions if it is to be fair and comparable:

• It must recognise the constraints and possibilities of the clinical environment.
  
• Students should be systematically observed in a range of situations.
  
• A continuum of support should be provided, offering anything from a basic level through to helping those for whom there is a possibility of exercising choice, to those for whom there is a need for strategic action to bring about positive change in the context of care.
  
• Time must be allocated for the mentor and student to reflect together on the experiences of care giving.
  
• Competence should not only be considered as the ability to practise in the realities of today, but also be guided by a vision of possibilities for practice in the future.
  
• If the mentor is concerned that a student is not going to meet the minimum criteria to achieve proficiencies, contact should be made with the key clinical and university personnel at the earliest opportunity.
  
• The student should be given constructive feedback as early as possible.

Learning Environment and Audit

One of the key roles of a mentor as assessor is to create a positive learning environment to enable students to maximise what they learn during their placement experience, to be assessed adequately in that situation and to acquire the ability to transfer their skills to other environments. How the clinical learning environment functions as an educational environment will depend on how the student is perceived, e.g. considered solely as someone to be assessed, as a student or as a colleague (Edwards et al 2001).

If students are considered just as someone to be assessed, the assumption is that they have come from their course ready to practise. Everything that students do presents the mentor with an opportunity for assessment on how well they are performing. The clinical area is therefore an area where the student either does or does not fit in. There is no implication that the mentor has to teach anything or the student has to learn anything. This approach places the student’s education in the classroom – the education occurred before the student arrived for the placement. The problem with this way of thinking is that, if there are any problems, they can be attributed to the student’s education. This means that either the course is inadequate or the student has failed to learn because he or she has not been prepared properly (Edwards et al 2001).

If the mentor sees the student as a learner, a different type of assessment results – assessment of the learning environment to see how it might present learning opportunities for the student. To do this, it is important to reflect on how the education process is viewed. It might be about transmitting the mentor’s values, knowledge, attitudes and skills to the student. It may be about challenging the usual ways in which the mentor and student view practice in order to increase the potential for change and development, or it may be a combination of both.

When students are seen as colleagues, they must create the opportunities to improve the quality of their judgement, decision-making and action. The clinical area is an area of professional action where knowledge is created, tested and applied, and the effects monitored and evaluation.

Questions Asked

• Are the values, knowledge and beliefs of the clinical area appropriate to the delivery of high-quality care?
  
• Are we dealing with patients’/clients’ needs in the right way? Are the procedures used appropriate?
  
• Is the educational experience the best for students?
  
• What resources are available? Are they up to date and appropriate?
  
• Are there sufficient staff and sufficient staff time available?
  
• Is there appropriate access to information and research, and evidence-based knowledge?
  
• Is there positive leadership and evidence of roles being demonstrated in a supportive way?
  
• Are there support systems in place for all staff, so that everyone has an opportunity to give and receive feedback and for their voices to be heard?
  
• As a mentor, how research evidence based am I?
  
• Am I secure in my knowledge?
  
• What do I need to find out, research and understand so that I can help students to understand?
  
• What can I learn from the students?
  
• What do I need to know so that I can make improvements in the clinical environment?

When questions such as these are asked, the student is not viewed as a burden but as a potential colleague in education and development (Edwards et al 2001).

Quinn (1988) defines the learning environment as a holistic concept that encompasses all aspects of the workplace. This includes resources, policies and procedures, potential learning opportunities and, importantly, staff. It is within this environment that practice assessment of students takes place. Every clinical area is unique and it takes a while to become oriented. There are the concerns about meeting new people and worries about how compatible the personalities will be. There are routines to learn, and the politics of the setting and hierarchy as well as administrative demands. Over time particular ways of doing things have developed and become the norm; everyone knows who is good at what or who or what should be avoided. None of this is written down – it is the unwritten protocol.

Students arriving at the clinical placement have to get their bearings, in a situation where everyone else seems to act as if everything is obvious, and not worth explaining – added to which, everyone is busy. As a mentor with a new student, several questions need to be asked:

• What does the clinical environment look like to a person seeing it for the first time?
  
• What does it feel like to be a stranger here?
  
• What sort of person is the student?
  
• What previous experience has the student had of working in a place like this?
  
• What does the student already know?
  
• What do I need to assess?

Being a mentor involves understanding and making judgements about the decisions and actions of others within a particular context. How are fair judgements made? What can be used as evidence of professional development, competence and action? The role of a mentor is complex. If it was only a matter of using an assessment document to check a range of techniques and qualities to be demonstrated, the task would be relatively simple. But for assessment to be appropriate for everyday professional practice, the assessment needs to be explicit. The problem is that experienced staff often take for granted the ways that they act and think (like a car driver who has been driving for years). But as a mentor you need to take a fresh look at the ways things are done. Only then can you challenge old assumptions and behaviours and pass on what is of value to students (car drivers develop bad habits and take short cuts over a period of time). A mentor needs to take a fresh look at the working environment and see it instead as a learning environment.

Maslow (1987) suggests that certain categories of needs must be met before the next category can be achieved. By relating this theory to students, it can be seen that physiological needs, e.g. the need to know where lunch can be bought, or the location of the bathroom facilities, will enable them to feel more settled on the ward and able to achieve the next level of needs. The following example provided by New (2010, p 16) describes a student’s first day in an operating department as a practice student; this description helps to provide understanding:

The day is scary and the theatre environment is an alien one with everyone appearing to know what they are doing.

Students often worry that they will be left in a situation where they will be uncertain about what to do – initially they may not feel safe. Their concerns about safety may also include travel arrangements and practical issues around conflict within the learning environment. Unless students are able to feel comfortable within an environment they will not be able to learn adequately, articulate their knowledge or demonstrate competency when the time comes for assessment.

The third level of Maslow’s hierarchy is love and belonging. This might be achieved in a small way by issuing students with a name badge and referring to them by their correct name rather than referring to them as ‘the student’. Including them in team discussions and on the off-duty rota ensures that others recognise the fact that students are part of the team, even though they may be supernumerary. Students often say that they feel as if they are a ‘spare part’ while being supernumerary because they find it difficult to ascertain what their role actually is (Raine 2005).

Students often perceive that their learning needs take a low priority within the placement area because staff are too busy to make their learning a priority. They complain that they are frequently referred to as ‘the student’ and stated that it gave the impression that mentors could not be bothered to learn or remember their names. Some students have personal issues that hinder their learning, perhaps a disability that they feel awkward about disclosing or concerns about their progress. This impacts on their self-esteem as a student. The PANDA Report (Phillips et al. 2000) supports many of these findings such as when practice was assessed in the clinical area. It considered the interaction of what assessors did, the way that the organisation was structured and how resources were distributed. It found that mentors were hard-pressed by the demands of the workplace and were often unable to undertake valid or reliable assessments.

You may find that you have already begun to identify barriers to learning that occur within your workplace. Note these down; we return to them in the next few pages when we consider educational audit.

At the pinnacle of Maslow’s hierarchy is self-actualisation (self-esteem, confidence and self-respect). To achieve this, students need mentors to take a keen and personal interest in their learning. A dialogue will be required to find out what motivates and interests the student. It may be that the student is passionate about maintaining dignity for older people or developing a very firm evidence base for clinical practice. Students may not even be able to articulate their interests particularly well and further exploration will be needed to identify learning opportunities that enable competencies to be met and the wider knowledge and skills to be developed.

All professional and regulatory bodies have their own standards that can be found on the relevant websites. Within the workplace there is a range of students from different professions who are at different educational levels. All these students have one thing in common – they are adult learners. There are specific principles that are useful to be aware of in relation to adult learners. Knowles’ (1990) adult learning theory suggests that adult learners:

• need to know and understand the rationale behind what they are learning
  
• have a self-concept and need to be seen by others as being capable of self-direction
  
• need to utilise their own life experience in their learning (called experiential learning) and background, including learning styles, motivation, needs, goals and interests; utilise ways of learning that build on students’ experience such as case studies, discussions and problems-solving exercises
  
• have a readiness to learn, knowing that there is essential learning that needs to take place to reach the goal, e.g. a learning contract
  
• are oriented to learning in real life; task-based or problem-centred contexts enabling knowledge to be applied to real-life situations
  
• may be motivated by external factors such as promotion; however, internal goals are the best motivators for adults, and might include job satisfaction, self-esteem, quality of life and personal development.

These are useful principles to consider, but it is also worth considering that every student is an individual and ensuring a holistic view of the student and their needs is particularly important. Being aware of these principles will encourage mentors to design learning opportunities that are underpinned by these values.

Web Resource 6.2: Case Studies

Visit the accompanying website and review the case studies for reflection.

Educational Audit

The Royal College of Nursing defines educational audits as:

… the monitoring, measurement and evaluation of the practice placement, to ensure that the required quality standard is met.

(RCN 2007, p 27)

The standards to which this document refers are those of the Nursing and Midwifery Council, but all healthcare student regulatory bodies have similar standards laid down for learning environments. Before attending the learning environment, students will have received underpinning academic knowledge leading to professional qualifications. Awarding bodies or education institutions require assessment of the learning environment via educational audit in order to maintain professional or regulatory standards. Audit tools and criteria may be set by the education provider, university or awarding body. When an educational audit takes place, there is an opportunity for the mentors to work in partnership with others, and define any further audit criteria in addition to those required by the audit tool. This is an opportunity to ‘size up’ the learning environment.

Audit review considers the availability of mentors, their qualifications, suitability of particular learning opportunities and the particular profile of the client group. The learning resources in the environment might include IT access, books, articles, learning packs, patient leaflets, introduction packs for student, staff with special expertise, audiovisual media, client/staff policies and procedures, mission statement, philosophy of care, and professional codes and standards. Audit also reviews the processes and management of the placement by asking about issues such as evaluation of the placement, welcome procedures, etc. (RCN 2002). Audit processes that review the learning environment contribute to the continuous quality improvement of the placement and can highlight areas of best practice to share with others, as well as highlighting areas for further developments.

Coercion in Mentoring

Ousey (2008) noted that staff find themselves taking on the mentoring role for a variety of different reasons. The quality assurance frameworks employed by educational commissioners, as well as professional and regulatory bodies, require education providers to provide sufficient qualified mentors for the numbers of students. This has led to a number of challenging situations in practice:

• Considerable pressure being put on the clinical staff to take students when they don’t have the capacity or the motivation to take them
  
• Unsuitable staff being pressurised to undertake mentorship training
  
• Staff being pressurised to undertake mentorship training when they feel that they do not have time to undertake the training or having to do so in their own time
  
• The Knowledge and Skills Framework (KSF) in the NHS (Department for Health or DH 2004a): the requirement to undertake mentoring is linked to promotion and progression and therefore some mentors feel that it is an issue that may hold them back professionally if they do not undertake the role
  
• Becoming a mentor in the hope of gaining promotion
  
• Staff often complain of taking ‘back-to-back’ students and not getting a break from the mentoring role.

Community staff, both nursing and allied health professionals, who were traditionally paid to mentor students have had their payments removed and integrated within their salary following the Agenda for Change (DH 2004b). Subsequently, many staff did not get their mentoring role recognised within their final banding, thereby losing money and status. This resulted in no designated payments for mentoring and was seen by staff as a retrograde step with the perception that their contribution was not valued or recognised. This mass demoralisation of staff contributes to the unwillingness of some staff to support student learning and the feeling that the contribution they made is undervalued. Gray and Smith (2000) undertook a longitudinal study looking at what students felt were the qualities of an effective mentor. One finding from this study, unsurprisingly, was that unwilling mentors were not effective.

Stay updated, free articles. Join our Telegram channel

Join