During the group interviews, there was a consensus that students did not get sufficient formal feedback.
The start is usually at the start, mid-point is usually at the beginning of the last week because finally they’ve [mentors have] realised hang on a minute we
haven’t done the mid one and you’re going to ask me for an end one in a few days, so that’s usually when that happens and the end one happens on the end date or you have to come back a few days later for it to be done (S37/T1/G8). Here, the students are slightly sarcastic about the feedback they should receive. They explained that despite the curriculum having allocated times for meetings this rarely happened. Other student groups supported this. ‘In terms of getting time with people [mentors] to do the meetings, I don’t know about you but I always found that very difficult to pin people down, when its busy, there’s no time (S45/T1/G10)’. To quantify when feedback was received, I developed a RAG rating score based on the timing of the feedback. The dates of the handwritten feedback to students in their PADs were cross-referenced to the dates they were allocated to the placement area. Green meant all meetings occurred as scheduled. The initial meeting was within the first week of placement with mid and end-point meetings evenly spaced. Amber was a delay of one meeting (greater than one week for initial) or one of the meetings was not completed. Often the initial and mid-point interview or mid and end-point were undertaken/dated together. Red was where the meeting occurred after the placement had ended. This was rated red because it was an inconvenience to the student and not pedagogically sound. The student had to return to the placement and had usually commenced their next placement before they had received feedback from their last. Consequently, they started a new placement without firm knowledge of how well they had performed or what they needed to develop next (See appendix 12 for RAG colour coded placements for three-year and 78-week students).
Placement Green Amber Red Total CDS 24 21 26 71 Community 36 12 11 59 Ward 7 6 5 18 MLBU 7 9 1 17 Total 74 48 43 165
Table 5.8 RAG rating for three-year students by placement area
Placement Green Amber Red Total
CDS 24/71=34% 21/71=30% 26/71=36% 71/165=43%
Community 36/59=61% 12/59=20% 11/59=19% 59=36%
Ward 7/18=40% 6/18=33% 5/18=27% 18=11%
MLBU 7/17=41% 9/17=53% 1/17=6% 17=10%
Total 74=45% 48=29% 43=26% 165
Table 5.9 Analysis of 19 three-year students’ feedback
Placement Green Amber Red Total
CDS 8 6 5 19
Community 11 2 1 14
Ward 3 3 3 9
MLBU 3 1 1 5
Total 25 12 10 47
area Green Amber Red Total CDS 8/19=42% 6/19=32% 5/19=26% 19/47=40% Community 11/14=79% 2/14=14% 1/14=7% 14/47=30% Ward 3/9=33% 3/9=33% 3/9=33% 9/47=19% MLBU 3/5=60% 1/5=20% 1/5=20% 5/47=11% total 25/47=53% 12/47=26% 10/47=21% 47
Table 5.11 Analysis of seven 78-week students’ feedback
area green amber red Total
CDS 32 27 31 90
Community 47 14 12 73
Ward 10 9 8 27
MLBU 10 10 2 22
total 99/212=47% 60/212=28% 53/212=25% 212 Table 5.12 Both programmes together
Table 5.8 represents 165 long placement reviews for 19 three-year student
midwives. Table 5.9 illustrates the analysis of all students RAG rated feedback from each area. The largest proportion (43%) of the student feedback was received from CDS midwives, with slightly less received from the community (36%).
Nevertheless, when the two placement areas are compared, the ability of midwives to adhere to the planned feedback varied. On CDS, there were 71 evaluations in total with 36% of the feedback rated red, 34% green and 30% amber. This meant students had almost an equal chance of receiving feedback as planned, late or after the
placement had finished. When this is compared to the community, the number of green rated evaluations was greater with 61% adhering to the curriculum. Reasons for this increased rate of adherence to the planned curriculum in the community may be attributed to better workload planning. In a busy hospital environment, planning time for mentors and students to meet is dependent on each shifts’ workload. There is a perception that the hospital’s workload is less
predictable. The interpretation of this finding is that the relative value of the scheduled meetings was low in the hospital especially. Formal feedback meetings were not prioritised, or able to be prioritised, by mentors in all practice areas. I suggest, it could also be a feature of the increased face-to-face contact between the student and mentor in the community that was lacking in the hospital.
The 78-week students had slightly better green rated placements overall (Table 5.9) with 53% (compared to 45% in three-year programme). However, there was still some variation between placements. Most community placements (79%) were green rated. Mentors in the hospital, on the ward and CDS, were least able to offer timely feedback. Table 5.10 shows both programmes. Less than half of students (47%) received feedback as planned. One in four student placements (25%) were red rated. Compliance with practice feedback was discussed in relation to medical education (Hiller, et al., 2016; Lawson, et al., 2016) in section 1.1.3. However, there is little evidence in the nursing and midwifery literature of this phenomenon and its potential effect on student learning and outcomes.
Some students appeared to have better luck or could perhaps negotiate the schedule of their meetings (Appendix 12). Five of the 26 students managed to have only
amber or green placements. So even for students who might be most able to negotiate their placement evaluations the ones which were delayed or combined, were in the hospital environment. Other students were either less fortunate or perhaps unable to negotiate or organise feedback from their mentor; these students had far more red evaluations than amber or green.
Two students’ PAD demonstrated difficulties with placement evaluations. S31/T3 despite being on the three-year programme only had seven long placements in all. Of these, five were rated red; one was amber (community) and one green
(community). Sh/T1 on the 78-week programme had 4 red rated evaluations; all in the hospital. The only student from the sample this seemed to have a profound effect on was S31. It nearly affected her ability to qualify; her case is explored in Chapter 6.
Some individual mentors though, regardless of where they worked, hospital or community were noted in the PAD to either fall into a likely to be green category or likely to be red category. Mentors who agreed to be part of the study M13/T1/H and M10/T1/H regularly managed to complete the paperwork as planned despite
working on CDS, yet another CDS mentor at another Trust seemed to be less able to provide timely feedback. Similarly, one mentor on the community always seemed to require students to complete their paperwork after their placement, sometimes a month later.
During the mentor and student interviews, reasons for conducting the meetings late were discussed. S14/T2/G4S was reluctant to have her first interview too soon and did not particularly value the meetings.
I like a week to settle in and then I’ve a week before my second interview and then two weeks before my final interview…. If I’ve got them [mentors] working with me and I have time to do the interviews in the first place three interviews in four weeks is not, it seems a bit stupid really to be honest (S14/T2/G4S).
As a 78-week student with a master’s degree already, she may not have felt the need for such frequent feedback. However, other students wanted the reassurance they were meeting expectations as some were uncertain about their progress.
When asked if assessments were conducted in work time many students and mentors reported that there was no time for this to happen within the working day.
My mentor last year did come in on her day off basically. Bless her (S5/T1/G2).
They shouldn’t have to (S7/T1/G2).
No, they probably shouldn’t have to but then they don’t get time (S5/T1/G2).
Were the assessments carried out in work time (SCM)? Hell no (S9/T2/G3).
True, we never get them done in work time (S10/T3/G3).
No, I’ve always had to arrange them out of work. Some mentors preferred to conduct these meetings in their own time (S9/T2/G3).
I’d rather do it in my own time because, you know it’s really difficult to arrange a time with someone whether it’s just for the grading or anything to do with the student’s paperwork (M1/T3/H).
Therefore, some of the red rated interviews may have been mentor or student’s preferences rather than necessity. One student revealed, ‘There were times we could have done our meetings and she [mentor] was doing other things, not midwifery, that I allowed to go on because I thought fair enough, I know my book will be signed in the end’ (S13/T2/G4S). The inference made by the student is that she permitted the mentor to avoid the paperwork, knowing it would be completed eventually. However, I suggest the student did not have the authority to negotiate a meeting, despite it being necessary for her development and a requirement of the curriculum. Other students recognised they were a potential burden for mentors. ‘I always find it really hard to get a mentor, like to get a meeting together and I always feel that I am being an inconvenience’ (S30/T1/G7). From an educational
competence or performance.