Most professional disciplines require performance by trainees to be supervised and assessed: doctors and health workers; teachers; social workers; hotel management; catering; building trades… the list goes on. In my own career in education and training, I was involved in these processes over many years. This started when I was teaching English to recent immigrants (in industrial locations in Leicester) and became an assessor for the Royal Society of Arts (RSA). It led on to my mentoring trainees.
It continued across two decades of working in South Africa, where the Universities (newly merged into non-racial institutions) were coming to grips with what professional and practical disciplines require. I researched what placements entail, from the perspective of both the students and the supervisors (I prefer to call them workplace mentors). I developed a course on mentoring.
Midwifery students left hanging
So it is with special concern that I have followed the plight of the 130 midwifery students in Kent whose course at Christchurch, Canterbury, was struck down by the Nursing and Midwifery Council (NMC), the midwifery national accrediting body, last year, leaving the students unable to complete their placements or graduate. The story started last year when some of the students reported that they were not being supervised adequately in their placements at William Harvey Hospital, Ashford, and the QEQM, Margate. Some had even been left alone with patients for their entire shift.
After this had been investigated, and the decision to withdraw accreditation was made, Christchurch was forced to suspend its three-year midwifery programme for the September 2022 intake. Now the good news is that the University of Surrey has made an agreement with East Kent Hospitals University Foundation Trust (EKHUFT), to take over the students so that they can complete their placements and graduate. A spokesperson for EKHUFT says that local hospitals are delighted to be welcoming back these midwifery students.
The students are returning to the same hospitals where it all went wrong. So what has changed? The original complaint was lack of supervision. Now the EKHUFT hospitals have completed a practice education audit. They have also updated all midwifery staff with practice assessment and supervision of students.
Where does the buck stop?
Whose responsibility was it in the first place to ensure the staff were equipped to supervise students? This is the nub of the problem and the answer is not simple.
Let’s start with my own experience in industrial language classes in Leicester decades ago. I was a young mum with three children under seven. I was able to pick up contract teaching hours that fitted around parenting, as the trainees were also young parents who often had to rush back to their family responsibilities. When our classes were designated suitable for RSA trainee placements, this involved a trainee doing practice lessons. These needed to be discussed with the trainee immediately after class. But there was no extra pay for the extra half-hour. If I was late going home, who would pick up the children from school and nursery? I have found this issue – the unpaid extra work of supervising trainees – undermines placements in many diverse disciplines.
Another example, from the same period of my life, was when I was working with an education outreach centre. We needed extra workers and had the bright idea of contacting a University to get students on six month placements. We were delighted when the University got busy allocating us two students – and then they sent us through the contract to sign, and we realised it involved a huge amount of assessment. We looked at each other in dismay – which of us had the time to do all that? Actually I was glad it fell to me eventually as it gave me insights into what practice supervision means in another discipline (community outreach) and the responsibilities of the accredited university – all useful when I took this up in my work in South Africa.
Supervising in South Africa
There I developed a postgraduate course on mentoring in practice disciplines. It mainly attracted lecturers from the nearby Technikon. Their students all had to do some placements as part of their qualifications, for careers in hotel and catering; in fashion and retail; in office management and so on. The class was a fascinating mix where we could discuss what was common and what was different in trainee practice in different settings. Most of them had enormous problems getting enough placements. They hit the problem just described from my own work experience: it is just too time-consuming to mentor a trainee properly in many settings. As one put it – the manager I approached said the kitchen is just too busy to take a trainee student!
I guess that was the attitude of the EKHUFT maternity ward managers towards the students last year whom they failed to supervise properly. Now in order to get the students back they have had to put in serious effort, assisted by University of Surrey and the NMC. They stated to KM Online, “As a trust we have also increased the practice development team, identified student support available from professional midwifery advocates..we have shared feedback to our team regarding the importance of supervision in clinical practice, with escalation pathways now in place.”
“Escalation pathways” needs decoding. It is about when a worker, or trainee, has concerns that something is not working and management needs to do something. Lowly trainees are often frightened to tell tales in case it counts against them. But in fact they have to realise that training is not just about their personal performance but also about how they interact with the organisation and how its routines and systems fit (or don’t fit) the situations the trainee actually faces. In our mentoring course, we did a whole session on what are dubbed “critical incidents” (in teacher training called “teachable moments”) when the greatest know-how can be gained from a crisis or misunderstanding, if properly analysed by mentor and mentee.
There is a difference between mentoring, supervising and assessing. A mentor is someone who can be trusted to help even with the bad experiences of the trainee. A supervisor is closer to management, who has the say-so over wages and promotion. An assessor might be handing in scores that count towards a qualification. A novice worker needs all three. But can they be combined in one person? This was something to be discussed, and it played out differently in the various practice settings.
My overriding conclusion from those years helping to develop mentoring, is that it is an essential but undervalued aspect in many workplaces. It should be an accepted part of career progression to have experiences as a mentor before taking on supervisory roles, or assessing newcomers into the field. I still think in some fields it should be paid pro rata.
This means not only paying mentors but also remunerating properly those academics in practice fields who do the arduous work of finding placements and interacting with the host organisations. A problem is that Universities, because they are ranked and receive grants from an evaluation of their research, tend to underestimate the amount of staff and resources needed to organise placements in the practice professions. I guess this was the problem with Christchurch University, which is struggling financially.
A University’s duty towards its students
The result for 130 young people was dire. How did they cope for nearly a year when they could not graduate and get paid as midwives? Were they given another student grant to cover this or did they have to quickly find some zero-hours contract to bring in the money? Is Christchurch refunding their fees for their lost year? In answer to the question who was to blame, it is evident that although apparently it was EKHUFT that had failed to supervise, in the light of how it is being put right, it is clear that the University which offers a practice qualification also has a duty to ensure that the placements are well run.