This essay provides a deep discussion of the key factors that directly and indirectly affect a mentoring relationship of a student and studies a range of key sources, theories and practices to provide a clear understanding of the theory concerning mentoring process and assessment and connect it with learning theory to support and substantiate this work.
The Role of a Mentor
Historically, the role of a mentor is discussed deeply in Greek literature, where it is written about in Homer’s Odyssey. Morton-Copper and Palmer (2000) state that Mentor, who was the Son of Alimus, was assigned by Ulysses to be a tutor and to look after his son Telemachus while he was away on a war for his kingdom.
It is important to understand the meaning of the term “mentorship” and to realize the rationale that explains why a Mentor exits within Paramedic education. The British Paramedic Association (BPA) (2006) gives a definition of mentorship in the BPA curriculum framework for Ambulance Education. It states that a Mentor must be “a qualified Practitioner/Paramedic responsible for guiding and supporting other staff and students and must have completed a recognised Mentors course” (BPA, 2006).
The BPA (2006) definition of a Mentor is related only to Paramedic Education and does not provide the deeper meaning of this term. Therefore, some other sources will be studied to give a wide meaning of the term Mentor.
Driscoll offers one more meaning of mentorship in ‘Understanding Clinical Supervision’ (2008), where the author studies the role deeper and states that “there is a defined relationship between the student and the mentor in which the student is classified as the junior member of staff and is mentored by an experienced member of staff that has been recruited from within the organisation. The mentor’s role is to directly influence the way in which the student develops, this is the classic apprentice/master relationship” (Driscoll, 2008).
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The rationale behind the evolution of the Mentor role in Paramedic education is formed by the British Paramedic Association’s Curriculum (2006) and the Health Professions Council’s Standards of Education and Training (2008). It is stated there that a Health Care Professional is not only responsible for his/her permanent professional development but also that of students embarking on a recognised programme of study that leads to professional registration and that the practice placement educator should be a well-qualified, registered practitioner and must have the appropriate knowledge, skills and experience to cope with the role of educator (HPC Standards for Education and Training, 2008).
Paramedic education has developed from training into education. As a rule, Paramedic training was delivered at regional centres or training schools and taught by protocol based learning and not by academic education systems. Nevertheless, as Paramedics have become autonomous practitioners, it has become clear that this style of learning was already outdated and did not represent the innovative role of the Paramedic in the modern health care system (Furber, 2006).
One more important driver for changes in Paramedic education was taken from the BPA’S Curriculum Framework for Ambulance Education (2006) and the HPC’S Standards of Education and Training (2004), therefore education was moving into the University. By that, it marked some changes in the way in Paramedic education and training.
It was considered the most important change in Ambulance education since 1971, where the first UK Paramedic scheme was implemented under the supervision of Dr. Douglas Chamberlain, who is Professor now. Douglas Chamberlain was developing the role of the Paramedic based on the trends in Paramedic training in the United States in the early 1970s (BPA Curriculum Framework, 2006).
One more important driver for change in Paramedic education rose as a direct result of the Bradley Report, Chief Ambulance Officer for London Ambulance Service and consultant to the Department of Health, who proposed a government white paper called “Taking Health Care to the Patient” (Bradley, 2005). This document emphasized significant changes to the way in which NHS Ambulance Services would operate and made important the role of the implementation and development of Emergency Care Practitioners within the Ambulance Service. The Practitioners would be recruited from Paramedic or Nursing backgrounds and would be able to decide well about the treatment pathways for patients. Moreover, the document was designed to help reduce the number of unnecessary A&E admissions and treat patients in their own homes (Bradley, 2005).
These key changes were resisted by most people from front line Ambulance staff. There were several reasons for that, for instance: fear of the unknown, difficulty to accept something new, forced out of their comfort zone, lack of understanding, failure to understand the reason for change, and the fear of failure.
These changes required careful management within the organisation, and to be sure that the rationale behind any change was communicated effectively, the changes were made. “A systematic approach to dealing with both planned and unplanned change in an organisation” (APPS 2133, 2010).
Finally, due to changes in ambulance education, the role of a mentor was quickly transforming into an integral part of the developing education programme for Paramedics in the UK.
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Learning Styles and Learning Theory
In this section, a mentoring relationship with a student will be considered and the theory that proves the process of learning will be studied in order to enable us as mentors to have the best possible learning environment for the students in the practice setting.
The first stage in the mentoring relationship includes understanding the theory forming learning styles in order to ensure that any teaching coordinates with the student’s individual needs.
Honey and Mumford (1992) designed a questionnaire that was widely used in education to assess learning styles. A series of eighty questions is used, they are scored and then plotted onto a graph to describe a person’s learning style.
Honey and Mumford (1992) identified four main learning styles such as: activist, reflector, theorist, and pragmatist. If mentor understands them, it will be possible for him/her to discover which of these styles fits the student the best. After that, mentors are able to create an environment which makes individual learning potential the highest.
As an example, let’s identify a student as a pragmatist who wants to act rapidly and becomes irritated with long explanations. It this case, practical teaching will be beneficial.
Leaning can be defined as “a quantitative increase in knowledge” (Ramsden, 1992, p. 26); this knowledge does not simply appear, it is formed from a wide range of sources which we have learned since birth and becomes more advanced according to the amount we study, usually from a combination of academic input, studied experiences, and the experiences of other people (Ramsden, 1992, p. 26).
New students who enter the workplace may have plenty of acquired academic knowledge but may lack the so-called “emotional intelligence”. For instance, an experienced Paramedic will have through long exposure to certain situations developed an almost sixth sense and often describe a special feeling which may alert them to situations that can carry a potential danger or gauging the reaction of a bereaved family member. This is not a knowledge that can be taught but a skill that is received during exposure and experience. “Emotional intelligence is the ability to monitor ones own and others feelings and emotions to discriminate among them and use this information to guide ones thinking and action” (APPS 2133, 2010)
Another important factor in the learning process is correlated with the motivation for the learning as the most important and as a key way to successful learning. Students must be interested and as Knowles (2005) states, adult people who learn have generally goal arisen and motivated to receive new skills as the final result may be specific such as promotion which will in its turn provide better pay and conditions; the author refers to this as “external motivators” (Knowles et al., 2005, p.68)
Knowles’ (1984 and 1994) opinion about adult learning also explores Andragogy and Pedagogy (the process through which adults learn) and explains that Pedagogy is known as a more suitable method for child learning and development because it is purely input based, the word historically coming for the Greek word “to lead the child”. Andragogy, in its turn, as described by Knowles (1984 and 1994) is the style of teaching that is aimed to discover the best in a student and helps the individual to become as well-skilled as possible (Rogers, 1969).
Mentors nevertheless must support a balance with their students to diminish toxic mentoring occurring. Three types of toxic mentors are defined, such as: Dumpers, the people who are not available for their students and who use a ‘sink or swim’ principal; Blockers, those who avoid satisfying the student’s needs; Destroyers, or criticisers, a type of mentors who destroy the student and wilfully sabotage the students’ learning process (Darling, 1986).
Learning in the clinical environment
Much of the learning process that occurs with the mentor will occur in the clinical environment and will not be structured like a classroom learning process. This factor leads to some challenges in the method in which the learning will actually take place. Clinical environment is often very pressured and busy; in addition, there is a requirement to coordinate with the highest clinical standards, to reach aims and at the same time ensure that the best care is delivered under quite difficult circumstances.
One more important challenge during learning in the clinical setting, particularly with the Ambulance Service, is the problems concerning ensuring sufficient time after a call to do the job quickly and to remember and learn at the same time; this often occurs under some pressure to attend the next call, and the last job is often forgotten.
In spite of the challenges while learning in this environment, it is important that the practice placement still stays the most effective way to develop knowledge, professional attitudes and skills, and by that to interconnect theory and practice (Levett-Jones & Lathlean, 2008).
Mentors can help by allowing their students to have some time after dealing with an incident to be sure that any learning difficulties can be addressed and questions answered.
In Bloom’s Taxonomy (1956), learning is divided into three domains: the Cognitive, Psychomotor, and the Affective domain. In its turn, each domain contains six levels of learning, from the lowest to the highest (Waxler & Adam, 2005).
Bloom’s Taxonomy (1956) has become a generally implemented teaching tool and recognised the three main domains in which learning would take place and further breaks down into the six levels. The teaching can occur from the lowest general denominator to the highest; as a result, the learning process can take place on different levels and can be used not only in the classroom setting but also during the mentoring relationship as a way of teaching within the three main domains.
Psychology of Learning
“There are three basic approaches to understanding the psychology of learning: the cognitive, the humanist and the behaviourist” (Kinnell & Hughes, 2010, p. 61).
The area of study concerned with the learning process in psychology is the “behaviourist approach”. This theory is described as a behaviour created from a learning episode (Kinnell & Hughes, 2010).
One of the greatest theorists in learning psychology is Pavlov (1849-1936). He developed his behaviourist theory (1927) by implementing the stimulus-response experiment with dogs. The aim was to prove that a specific stimulus (dog food) leads to a specific reaction of the learner (dog’ salivation process).
This theory can be applied to the overall learning process, but it is more linked to the psychological rather than the practical aspect of learning. For example, a Paramedic attending an emergency call will produce certain predictable psychological and physiological responses, much like Pavlov’s salivating dogs theory.
The bell ringing on the station emergency phone is the stimulus in this case. It turns the individual into a heightened state of alert, and he/she will associate it with a call for help; this factor will generate a response in the autonomic nervous system, particularly the sympathetic nervous system and create increased heart rate, increased release of adrenaline, increased breathing rate, shutting down the digestive system, and preparing the person for a fight or flight response to that situation.
In the behaviourist model, including Pavlov’ salivating dogs (1927), the activity itself is the most important, known as the active phase. Through repetition, a certain skill can be acquired and certain physiological responses can be characterized. However, it really demonstrates the link between the theory and practice.
For instance, the skill of intubation can be learnt through practice; however, a paramedic must have basic theoretical knowledge to understand the theory behind the skill that is being performed. This factor is especially important because this is the knowledge that helps people to recognise if something is wrong and therefore allow them to fix the problem; the combination of skill and learning is more important than just the skill itself.
The Cognitive mode studies the concept of understanding the way of human’s thinking (Kinnell & Hughes, 2010). It has been studied by many prolific psychologists, including Sigmund Freud (1923), Jean Piaget (1963), the work of Honey and Mumford (1992) in the learning styles questionnaire.
“It is suggested that mentors should reflect upon their previous knowledge of psychology applied to healthcare and update as required by reading appropriate text in this area” (Gross, 2005; Hayes, 2005).
The final sphere within the psychology of learning is studied by two main theorists in their works on the humanistic approach, Maslow (1970) and Rogers (1969), who, as it was mentioned above in this essay, are concerned with “the self”. The self actualisation process occurs when an individual seeks to fulfil the fundamental desire to achieve the best result for himself/herself, reaching realisation through rational thought.
A person must not forget that there can be other external factors that can affect the mentoring relationship with a student. One of those factors is the “student welfare” and developing the right environment for learning process.
The weight of an effective induction system must be always appreciated, because this helps to begin the “socialisation process” and allows the student to feel well in his/her new environment.
Maslow (1970) proposed a certain hierarchy of needs. There are many levels of human needs, and if you want to reach self-actualisation, you must satisfy first the basic requirements such as psychological needs, safety, a sense of belonging, and self-esteem (Maslow, 1970). If any of these needs are not met, good learning is impossible.
What may seem usual issues are in fact growing when you get involved into a new area of work. It must be kept in mind that the student attending the ambulance station can be there on placement and can feel out of place. If the basic human needs are addressed, for instance, where to go to the toilet, where and when to have meals and whom to ask if there is a problem, the student will feel satisfied and can then concentrate on the more important challenges such as learning.
The link between mentorship and assessment
Welsh and Swann (2002) studied six reasons for assessing students: “To select for educational courses, to maintain standards, to motivate students, to give feedback to teachers and to socialise students to their future working environment” (Welsh & Swann, 2002).
The assessment process together with evaluation are the important parts of learning because through assessment, we measure competence, and through competence, standards are identified. However, the process must be credible and quite reliable, any assessment that occurs must be led against a number of criteria that should lead to the same results even if conducted by different assessors. The simple definition is that the assessment process should be able to make a difference between a satisfactory or unsatisfactory performance (Walton & Reeves, 1999).
Kinnell and Hughes (2010) state that evaluation follows a process which is considered to be an essential component in the mechanism of quality assurance and can be noticed in many evaluation tools, following a similar model: feedback, review, discussion and implementation of change, if it is needed.
In order to check the effectiveness of teaching, effective evaluation should be considered, the analytical process of deconstructing the learning and assessment process together with identifying all areas that could have been done better as well as the reasons why certain results may not have been reached, and recognising the positive results of the students performance.
Clynes and Rafferty (2008) investigated the importance of feedback and found that the most frequent complaint among students was that they felt lack of feedback that was given by the mentors on their practice placements. The students felt they did not receive enough vital information on the general evaluation of their knowledge, skills, and attitude. In this area, mentors are able to address these problems with conducting a number of “meetings” throughout the practice placement to address the issues and give feedback at the discovered points.
The mentoring relationship between the student and the mentor is a very complex process that is interconnected with responsibilities; therefore, through this relationship, a student must be able to accept and learn new skills and get knowledge to help the academic study being gained in the course period. Thus, it is important that the people chosen to be mentors within the organisation are good persons who have good communication skills, appropriate clinical knowledge, and give positive examples for their students.
The availability of systems that help to accommodate and support students in the practice placement is important, and the mentor can help with basic requirements such as checking station inductions, introducing students to colleagues and helping them to feel good in the placement by professionals and supportable persons. All those areas should be kept in mind during the process of building the mentoring relationship with a student.
The mentor should keep in mind the importance of his/her own education level and give the students knowledge, skills and experiences gained through academic study and learned experience and try to influence this knowledge among the students by means of providing good practice and building an environment where it is possible to reach “self-actualisation” through both theory and practice.
Finally, one key factor that should not be missed is the importance of an effective assessment and evaluation process, because through this process people can improve their accomplishments, asking themselves the question of how they could do this task better next time. We should recognize that everything we perform in clinical practice is interconnected with theory, it links practical experience back to this knowledge and enables us to receive a better understanding of what we can do to improve our clinical practice. This is evaluation.