Mentorship: The Failing Student
Perhaps the most obvious and important part of a paramedic mentors’ role, is to provide their student with feedback and constructive critique on their practice. This can also be the trickiest part of the job, perhaps having to broach awkward conversations with students about their performance and clinical knowledge. Most texts recognise the importance of giving students feedback and students themselves actively seek it, recognising a key difference between a good and bad mentor, is one that can give accurate critical constructive feedback. Feedback is essential for growth as a student paramedic and when done correctly, it boosts motivation, confidence and self-esteem, allowing them to perform better. Students that don’t receive adequate feedback however, can end up comparing their performance to more senior colleagues, leading to inappropriate self-evaluation. It’s important to remember not all feedback is the same, and when done improperly or at the wrong time, it can either be entirely fruitless, or worse entirely destructive.
This week we’re looking at feedback to students, both how to give on shift feedback. How to give “negative” feedback and how to manage the dreaded situation for every mentor, a failing student.
Giving effective feedback
It is vital to understand that this is not a single conversation. effective feedback isn’t something that can be done with an acronym or proforma and suddenly you’re the best mentor on station. Feedback is a process, it is something that happens in stages across the course of a placement and is something that must happen in tandem with other good mentorship practices. [See episode 1 link]
Conversations should also be tailored to ensure they remain fruitful and not brutal. It’s important to reflect on your attitudes as a practice educator, whether you are quite forward in your critique? or whether you unconsciously ebb away from it to avoid conflict. Also consider how your student’s personality is with feedback. Lee et al (2002) found that more mature students are less concerned with how feedback is delivered, whereas younger students with less experience can be more sensitive to criticism (Lee et al as in Clynes and referty 2008).
So, ask yourself are they quite confident and headstrong, happy to be told every little detail they got wrong or is the student one that struggles with confidence and so conversations need to be sensitive and critique selective, so as to ensure the feedback conversation remains beneficial and not detrimental. This can be really tricky to do and on reflection is definitely a balance I’ve got wrong in the past, not tailoring my own feedback approach to my student’s needs.
There are many proposed methods for giving feedback. Pendletons rules advocate the learner and teacher should state what was done well, what could be improved and then agreeing on an action plan moving forward. This is sometimes referred to, or ridiculed as, the “carrot, stick carrot” method, or more popularly “the shit sandwich”. Sandwiching the shit...the critical feedback, between two pieces of positive feedback.
I don’t agree with this reference for 2 reasons. 1, it refers to critical feedback as “shit”, suggesting that it is in some way bad, unpleasant or to be avoided. This is simply not the case, students and mentors should have a healthy attitude to the critical elements of the feedback, it is vitally important, and treating it as an uncomfortable topic to be circumnavigated isn’t overly helpful.
Secondly, I don’t feel it is helpful to frame, “what went well” as mere “fluff” to make the critical elements go down better. Reinforcing positive practice is just as important as correcting poor practice and is key to supporting student’s confidence.
I don’t personally feel a format or acronym is that vital. Keeping some basic principles of feedback in mind and then having a natural conversation around the case, job, skill or placement is probably more useful and tailored to each student.
Ensure feedback is specific: “ You had no idea what was going on with that patient”, isn't helpful feedback as it doesn’t say what was wrong, or how to improve.
“ you looked like you struggled with that presentation and it’s probably because your assessment was unstructured, you did parts of a cardiac exam and then listened to their chest and then took a bit more history… try to follow a structure next time” is more constructive and offers far more detail to unpack and examine together.
Involved the student: Don’t dictate what was good and bad. Encourage the student to unpack positives and negative from their point of view, which will be unique to yours. This also encourages reflective practice on their part and aids in your assessment of that standard of practice.
Refer to expectations and ILOs: Many a time student may leave a call feeling bad because they didn’t pick up on something or do something which is above their level of practice. Reinforce where they should be and what you expect from them. It’s important to only take away the correct amount of learning from a call and part of your responsibility as a mentor is to support that principle in the student. I.e. If your first-year student has worked up a chest pain well and then performed a 12 - lead which they thought was normal, but missed the subtle RV strain changes that suggest it could be a PE, it’s important not to let them feel like they under performed on this call, as they have met the reasonable expectations for their stage of the course.
Ensure there is adequate time to give feedback: This is a recurring feature when it comes to mentorship. Practitioners and workplaces are all guilty of seeing mentorship responsibilities as an add on to their day job, instead of a core responsibility.
Feedback that is rushed, without adequate explanation or time for questioning is ineffective. Ensure you make time to debrief calls. Timing of the feedback is also crucial, leaving it too long and the impact or elements of feedback may be lost on the learner. But doing it immediately after a difficult patient when the learner is distressed will exacerbate negative feelings of self-worth or loose key learning points.
Whichever method you use be clear in your verbal and written feedback. It is ok to say you are at risk of failing if you don’t achieve XYZ- this clarity is especially important during the midpoint interview mentioned in episode 12. If the message is fluffy, or obscured then they are often surprised when they fail at the final interview.
Failure to fail:
Failure is a part of any academic course, there are times when we have all failed at something at some point, it is from failing that we learn. However, deciding when this is a problem is challenging. Students on the more traditional BSc pathways have often invested in excess of £80,000 in their education, not an insignificant amount to have nothing to show for it. Those on apprenticeships or internal trust routes are often colleagues of the PED’s- these are students who are potentially at risk of losing their livelihood if they fail, both are considerable pressures for a mentor to be under. However, the key point to consider is the patient- is this person safe to practice as an autonomous practitioner? Would I want them attending my relatives?
Failure to fail however is bigger than this, it is around the mentor’s skill at judging where the student is, and does it match where they should be. And if they aren’t- how can the gap be addressed. A student that is struggling in year one is often given some points to work on and the benefit of the doubt. In year 2 they may scrape a pass as they’re ‘not too bad’ this then leaves the problem of the final year 3 placement- are they ready to work as autonomous practitioners in a matter of a few weeks time? This is where they often become unstuck, and those students that are doing ok academically this may be a surprise.
Developing Action plans tips and thoughts:
Most courses- be that BSc, MSc, diploma or apprenticeship have policies in place to help support both students and PED. When you have identified an issue, it is not enough to say ‘you need to improve’ the student may know this but not have the skill to work out how best to approach this. One method of supporting this are the SMART and GROW models. Grow stands for: Goal, Reality, Options, What, When? And can be utilised in conjunction with SMART (Specific, Measured, Attainable, Relevant and Time Bound) to provide clear and time defined targets for the student to achieve and for the mentor to measuer against.
Break down of relationships:
As mentioned student educator relationships may break down for a variety of reasons. We looked at the concept of toxic mentors in the 1st episode. But you can be the best practice educator there is and if the student isn’t receptive to feedback then the relationship may become strained. If you are the students sole PED then it is always good to see if you can arrange for the student to have some shifts with another PED to see if they have a similar take on the situation as you, they may also suggest alternative ways of supporting that student.
If the relationship between you does break down then remain professional and objective in your assessment. If you feel you are unable to assess the student fairly then speak to your educational leads, the link lectures, or education provider. Keep all documentation clear and factual- use examples of the students practice where possible. As mentioned before, don’t be afraid to write at risk of fail in their documentation- but this needs to be done far enough in advance for the student to improve- the penultimate shift is not the time to mention this!
Conclusions:
It’s ok not to know everything
Be open to challenge and questions from students- it will help keep your practice up to date
Know where the student is in their educational journey- does it match their practice?
Tell students early if you have concerns and support them to address them.
A Massive thankyou to Sarah from the University of East Anglia for recording these podcasts with us. Remember, clinicians are responsible for their own practice. These podcasts are produced for informative purposes and should not be considered solely sufficient to adjust practice. See "The Legal Bit" for more info.
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