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Mentors lacking time for student feedback, finds patient safety commission


Mentors are lacking the time to both give and receive adequate feedback from students on placements despite the importance of the process in improving patient safety, an independent commission has found.

At the same time, a “hidden curriculum” is entrenched in organisations – where real-life practice undermines the theory students have been taught – which sends out “mixed messages” about standards, it said.

“The vocational nature of healthcare training means that mentorship is a significant contributor to a learner’s development and future practice”

Commission report

The commission, set up by Health Education England, concluded that trainee nurses, midwives and other healthcare students were often not given any opportunity at all to give feedback to senior colleagues.

Meanwhile, students themselves sometimes only received feedback on their work at the very end of placements, said the report by the Commission on Education and Training for Patient Safety, which was chaired by Sir Norman Williams, former president of the Royal College of Surgeons.

Students contributing to the commission’s research also said there was often a gap between what they had been taught and the practice they actually saw on placements.

This so-called “illegal-normal” is often not discussed between students and senior practitioners, which sends “mixed messages” about the importance of high standards for safe patient care, said the report.

“The vocational nature of healthcare training means that mentorship is a significant contributor to a learner’s development and future practice,” said the report.

The commission called for Health Education England to work with employers to ensure mentors are supported to raise and respond to concerns.

Senior colleagues should also be trained to bring their knowledge up-to-date with what students are being taught on courses, said the commission.

“The system needs to learn from errors and embrace transparency”

Wendy Reid

A total of 12 recommendations were made by the commission for Health Education England and the healthcare system to improve patient safety through education and training over the next 10 years.

It noted major changes were needed in areas such as multi-specialty and team working and reporting systems to ensure the NHS has a culture of learning rather than blame.

Health Education England set up the commission to look at how education and training interventions can actively improve patient safety.

Wendy Reid, Health Education England’s director of education and quality, said the report was different to previous ones on patient safety because of this focus on training.

“We welcome this report and thank the commission for its work,” she said.

“The system needs to learn from errors and embrace transparency. Patients should be at the centre of care and we need to actively involve patients, carers and families in how we raise patient safety standards,” she added.


Readers' comments (8)

  • michael stone

    '... a “hidden curriculum” is entrenched in organisations – where real-life practice undermines the theory students have been taught'.

    Telling people one thing, doing another: telling one group of people one rule (for example patients), another group of people using a conflicting rule (for example 999 paramedics) - I see that all of the time, and it really angers me, in my end-of-life debate.

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  • Ho hum, nothing changes.

    Back in the '80s when I trained we frequently, including in the school of nursing to our tutors, referred to the "theory/practice gap". However, some of us were able to recognise the poor practice we saw on certain placements and react to that by deciding never to do those things - indeed my most useful placement was also my worst.

    Mentors lacking time for students is indicative of an organisational failure: trusts are paid for taking students and so should be supporting mentors in terms of time for mentoring and relevant training, so if mentors (as we all know they do) lack these things then senior management have some serious questions to answer.

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  • I have just finished an amazing placement with a great mentor but his time was so limited that we had no real opportunity meet for feedback. The only way any paperwork got done was for him to take it all home and do both the midpoint and final reviews in one go with no opportunity to interact with me in the process. It seems such a shame that there is no protected time for this necessary interaction to happen

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  • I am a mentor and take my role seriously, however whenever I arranged times to meet with my student, something always happens where I am pulled away in another direction. I have stayed on at work to complete the midpoint and final reviews. We should be able to have protected time with students as they are our future nurses.

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  • I am a passionate mentor. My students can see that in reality there is never enough time to be thorough as theory in practice. I teach them to do things the model way, and then introduce a real workload to see how and why they prioritise tasks, and discuss this with them.
    Unfortunately any piece of warm meat is forced to be a mentor to increase revenue, sucks up any education funding that may benefit patients, and creates a dead end for all band 5 progression.
    Graduate profession??? More like colony of minions... Don't believe the hype - a 1st class graduate will get treated and paid like a 40% scrape-by diploma student.

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  • I'm a final year student and yes, agree, it has been hard for mentors to find dedicated time - we all know & understand the pressures of work - though the vast majority of my mentors have been fantastic. Unfortunately my last placement has been marred by a mentor that, despite being able to, did not seem to want to make time for me away from interruptions nor has completed everything so I have to now use up valuable study time to travel back after the placement is over to get everything signed off. To me, and to all the other mentors I've had, this isn't good practice. It's frustrating but as a student you feel unable to point such things out to the very people who are evaluating you.

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  • I'm a second year adult nursing student in South West London. My experience of being mentored within the four clinical placements that I've had so far has been well below what I believed a mentor, student learning relationship would be. Often, I found I wouldn't have been appointed a mentor, or that those I had been appointed, did not want that role. I believe that this hugely due to the fact that these nurses, do not have the time for the practical and theoretical teaching. These nurses barely have enough time to give adequate personable care to their patients. I hear so often 'I just feel like I'm a robot, I haven't had a chance to talk to any of my patients all day- I'm rushed off my feet'. I have witnessed this as true. There's no dedicated time for mentors to work with their students, or to take 45 minutes and go through our initial, mid point and final interview paper work and reviews? I don't understand why there is not cover for these nurses to do this properly. I hear from a Swedish nursing students that they are allocated protected time for these things to happen. Why is this not part of mentorship here? On many occasions mentors have had to write my PAD at home, in their own time, without me..pretending to do the review together.. It's not right. It makes me sad that we are supposed to be learning with nurses but more often than not, the mentors are stressed out, and seem to really not want to take us on. I should expect If it was organised in a structured manner this wouldn't be the case, and nurses would be happy to teach us.. We are after all the next generation, who will be working alongside them in a few short years.
    There's so much that could be done better. As for the theory/practice gap. That's, up to the individual. We are taught how to do things legally, ethically, safely, and best practice. If we see a difference in this, it's up to us to choose not to follow suit. Time restraints, short staffing issues, and maybe a lack of pride might be some of the reasonings behind bad practices on the wards?

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  • Bring back the Clinical teachers! I trained years ago and the Clinical teacher was an invaluable part of the learning process. He/she had protected time to spend with the students, which allowed the nurses to get on with their jobs.
    As far as lack of pride goes, I was never more proud to be a nurse than when I was able to spend time with a student who was eager to learn. However, there was a minority who regularly displayed less enthusiasm that was required, usually in response to my asking them to do something that didn't involve a book or computer. I have observed students with feet on desks, reading magazines; I have observed students refusing to assist with a patient as they had 'already done that' and I have taken a call from a student who had slept in so could she do a late instead of an early please?! Pride in one's work and profession cuts both ways and whilst there may well be harassed nurses who are less than welcoming of yet another student whose presence will further reduce the time he/she spends at the bedside, there are many, many more who take the responsibility of passing on their knowledge, skills and expertise very seriously indeed.

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