Mentorship: How to mentor
Mentorship Theory:
We’re going to start with a bit of mentorship theory, but that is absolutely not the purpose of this podcast and indeed we are not the people to do this subject justice. There is a tonne of information out there on learner theory and classroom styles and so what we are aiming to do is give a simplified overview of some of the terms you may hear from that literature and in fact we’ve selected the bits that most resonated with us in our own practice. For further reading see the references below/ in the article.
The role of the practice educator and Zip theory:
So, what actually is your Job? to supervise? to teach? to mentor?
All this and more! hence to college of paramedics use of the term “Practice Educator”. It can be best summed up using the “Zip Theory” as a guide.
The Zip theory has you imagine medical theory and medical practice are two separate sides of material. The learner is the zip, that is expected to join those two sides together, to create something that is more than the sum of its parts.
The theory has the mentor, or practice educator as the handle of that zip, the thing which provides the momentum and guidance to allow the learner to bring those two elements together.
Your role as practice educator is to guide and support the student, but also to provide the momentum needed to bring the two elements together. That might be through teaching, to help your student understand a key element of theory. That might be through demonstration, to help the student visualise a key element of practice. [Practice Educator Handbook 2017 new edition is 2020] There is often a disconnect that should be acknowledged, between the theory provided in the class room and applying it in the ‘real world’ of clinical practice.
The take away point is that your responsibilities are well rounded. Not focused on any one element, but providing enough support and guidance to allow your student to bring the two elements of theory and practice together.
Role as gate keeper:
As a practice educator you also have another responsibility, and that is to the profession. PEds act as gatekeepers to the title “paramedic”, flagging up any learners who may not be suitable to join the profession, or who may not yet be ready to take on the responsibility of a pin.
As a practice educator it is important to respect and understand this responsibility and is something we will expand upon in Part 2 and our discussion around “failing to fail”.
Role as facilitator:
Your job is to allow the student to practice in a safe environment and that MUST involve safe mistakes. The nuance of a mentor is allowing students to do things that you might otherwise not do, to allow them to find their own method of practice. Your role is to recognise when the student is making a mistake, recognise if you need to intervene or if this is a safe mistake, and then ensure learning occurs as a result. You can then assist, guide or demonstrate what a more correct action or conclusion may have been.
Toxic Mentors
Avoiders: The practice educator who is never available to their learner. Doesn’t facilitate time to review practice or to set goals.
Blockers: The practice educator to blocks the learners development i na number of ways, which prvents them from accessing learning. This can be through oover-supervising them, or delibarately witholding knowledge from them due to animosity or feeling threatened.
Some mentors may also block access to learning with a “you don’t need to know that” attitude.
Destroyers: Practice educators to who use things such as humiliation and overtly challenging behaviour as a teaching tool.
Dumpers: The type of practice educator who beleived in throwing students in “the deep end” which may destroy their self confidence.
Coddlers : Mentors who mollycoddle students, not facilitating healthy pressure on them nor allowing them to make safe mistakes. Assessing patients as “a team” and tending to lead or fill in gaps for the student. This leads to a false sense of achievement on behalf of the student, masking errors and resulting in a mentor that cannot assess their competence accurately as they “made it through the job”.
Are you ready to be a mentor…
Being asked to take your first student is an exciting time, but for some it might come across as a bit daunting. There’s a number of frank an honest questions that you should ask yourself before you take a student on, to be fair to them ensuring they have an appropriate educator, but also to be fair to yourself to ensure you are not adding undue stress to yourself if you aren’t ready.
Do you feel Confident: Are you confident enough in your thought processes and decision to take a student. Part of their role is to ask you questions and to challenge you and so you should be comfortable with this. Mentors who don’t like being questioned and challenged because of their own levels of confidence can rapidly become one of the Toxic mentors described above.
Do you feel Competent: Are you competent in your role? This doesn’t mean knowing exactly what to do in every single situation. In fact, one of the amazing things about our job is that regularly you are in an unfamiliar situation and have to “wing it”. But you should be clinically competent an all aspects of the paramedic scope of practice, as you don’t want to pass on blind spots or areas of poor practice to the next generation of paramedics. This is something that can be discussed at professional discussions or yearly learning reviews with a senior.
Aware of your weaknesses?/ dunning kruger: We are ALL going to have areas of practice that we are less comfortable with and perhaps struggle with more than others. It’s important to be aware of these and know how you are working to overcome them and to be open to students questioning how things are done- practice changes and keen students are a fantastic resource for latest research. A really common one is ECG’s. We often hear colleagues say they aren’t confident with them. What is important is that you have a clear learning plan about how to overcome this weaker area. It is not acceptable to say “I’m not confident with ECGs” for 5 years. Be an example to your student by being open about your areas to improve and where you struggle AND show them how you are improving in that area.
Are you in the right Mental state: We all go through ups and downs with the Job and there may be times where you have “fallen out of love” with it. This is absolutely not the time to be taking on a student, particularly a 1st year student. This is how bad attitudes get passed on, difficult relationships form and how spirits get crushed. If you don’t feel that you can be an example to a student right now, that is ok, sometimes we need to just come to work and do the job for a bit. Some students also bring with them their own lives and may discuss any issues at home or university with you, whilst you are not there as a councillor, this may take its toll on you. If this happens encourage the student to speak to the link lecturers, their personal advisors, student support services or even TASC. For may this is the 1st experience of work or living away from home and may need more support.
Are you Qualified: - Many trusts will offer budding mentors a “mentorship” module or course as a stepping stone to achieving band six, and getting ready to take a student. These can be excellent ways to start topping up degrees or gather level 7 modules for future roles.
These are very very useful modules…try to complete one first.
Most of us started taking students before completing one of these modules, and I for one wish I hadn’t. My mentorship style TOTALLY changed during my mentorship course and it actually helped to provide support to students that struggled. There’s nothing a struggling students’ needs less than a struggling mentor.
Try and get access to a mentorship qualification of some sort before becoming a full-time mentor as they provide really useful reflective opportunities.
Social media:
This is a topic in of itself, and there are lots of sources that discuss this topic well [Mallinson et al, JPP]. However, you should offer guidance to your student on this matter as “MedTwitter” has been increasingly popularised and increasingly controversial.
Remember, what the student places on social media will be coming from your calls and is reflective not only of themselves. It is prudent to tackle not only the HCPC and trust expectations of SM but also your own.
In my practice, I made my expectation clear that nothing of what was encountered at work was put on social media, simply to avoid any ambiguity over what may or may not have been acceptable.
Also, is it appropriate to be friends with your student on social media? This is for you to decide, but you are there as a supervisor, and as a part of a professional relationship. Whilst the nature of the job means you do get close to the people you oversee, while you are assessing them you need to ensure you are doing it from an objective perspective. Also, if a student is of a good standard academically but struggling on placement, you may be the person who has to fail them. A good rule of thumb is to say I’ll be happy to add you once we are colleagues.
DAY ONE:
Your New Student
So, the day is here, your new student has been allocated and you’ve been sent your first placement together….what now.
Touch base before the shift:
It is really good practice to try and touch base with your student before your first shift together. We all know what the modern ambulance service is like and if you wait until the morning of your first shift to make introductions, you very well may be 9 hours in, 40 miles from base in a hospital queue before you’ve actually got time to speak to them properly. That’s not good for you as a mentor and that’s not good for a brand-new person who may never have stepped onto an ambulance before.
Introductions: It may vary between education provider, some students may email in advance but if not Send an email and arrange to meet. Introduce yourself and arrange to meet for a coffee, ideally at the ambulance station you’re having your first shift in. That way they know where to go, won’t be late on the day, and can be given access codes so they’re not having to sit in their car at 0530 waiting for the crew to arrive. It’s also nerve wracking on their first day in a new station. No one can perform well if they’re very nervous and don’t feel comfortable. Having and informal meet up over coffee is a good way to establish a relationship early and allow the student to feel more comfortable on shift.
Ground rules: Establishing ground rules is a really important step to forming a learner / mentor relationship. It’s important the students know what you expect from them and indeed what they should expect from you. When I was mentoring I had an a4 sheet with all of the topics to discuss at the start of placement. This included things like my expectation they arrive 20 minutes before the shift to help me check the truck, what mental health support was available and where they could get it to our responsibilities around scene safety. Students will also have their own learning objectives from their university or education provider, these vary between courses and institution so ask to see their pad at the start to become familiar with what they can and can’t do, and topics they have covered so far in their course.
How you will assess them: This is not only really important for the student to understand but can also be useful for you as the mentor to discuss it through so it is clear in your mind. This will serve as a useful term of reference to refer back to if they aren’t meeting the expected standard.
This can normally be found in their university documentation. I used a combination of the expected standards and learning outcomes from the university and which tie in with the HCPC standards of proficiency. Use the initial meeting to set out your expectations and to see where their expectations are. A student on their 1st year 1st placement may have a different opinion to you on what they need to concentrate on. Ensure you do have the midpoint meeting, this is often at the half way point and this is crucial if you have any concerns with the student’s performance. This is the point to praise their hard work but also state clearly that they are at risk of fail if they don’t improve. If this is the case, you need to be developing action plans using SMART objectives to give the student the structure they need and the time to demonstrate their improvement, we will cover more of this in episode 2.
Where you expect them to be in…: This is probably more helpful for later placements, when you have a better grasp of how the student is but can be useful to discuss at the start of a placement. For their first ever placement I would advise they watch and ask questions for several shifts, get used to speaking to patients and get used to using the equipment on the ambulance. This can be adjusted for each placement based on where they are in their education. My final year students who were pre-registration I expected to sit in the front seat, run every job and to make all of our referrals.
Code phrases: This may be of more benefit in later placements when students are leading assessments and trying to make decisions. Some students struggle to have open discussions about their thoughts in front of patients so a phrase like “Ok, I’m just going to nip out to the ambulance to check a couple of guidelines and then I’ll be back in to let you know the plan” may be beneficial. This was often the key for me to follow the student outside so we could talk openly about what they thought whilst our ECA took down some more details.
Ideally, getting to a stage where they can discuss this in front of the patient is ideal when they are surer of themselves, and more likely to be correct. But certainly, in the early stages and when they’re not sure, this can be useful to allow them to develop their clinical acumen without you the mentor having to take over and correct them in front of patients.
Educational responsibilities:
Some mentors are of the opinion that education is not the responsibility of a mentor, that their job is to guide and to simple join up theory and practice as in the zip model above. That is not the case however, the CoP Practice educator document states that we should be “educating” our students and even the very name Practice Educator suggests an element of teaching.
Clearly if you think about it, you can’t be an effective mentor to a student if you aren’t able to and willing to fill in the gaps in their knowledge. It isn’t very effective for every response to a knowledge gap to be “go away and look it up”.
There are different ways to achieve this and indeed different mentors will find things that work for them in their work place. I was fortunate to have a fantastic ECA and friend as my permanent crewmate who really bought into the education idea of students. Before meal breaks he would take on the majority of the restocking or cleaning in a shift, allowing me and my students to have 15 – 20 minutes relatively undisturbed every shift to go over some theory. Sometimes this was on a white board, sometimes this was the students teaching me a subject I had asked them to prepare.
Other colleagues I’ve had would have students write up a page of notes on a subject during the shift, enroute to jobs. Working quite rurally this would sometimes mean 2 hours + of time they spent learning a subject, which they would then have to teach him towards the end of the shift.
Simon when he was my mentor as a student would quiz me on the way to jobs, If I didn’t know the answer, he would give me guidelines and evidence to read before the next shift where I would find it. However you try to work in education to the shift, it can be done and is an important aspect of helping support your student.
Thanks again to Sarah from the University of East Anglia who recorded these podcasts with us.
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