Mentor, coach, teacher, role model: what's in a name?

Realising professionalism: standards for education and training

The new outcome-focused NMC standards for education and training (NMC, 2018a; 2018b) offer approved education institutions and their practice learning partners greater flexibility and autonomy in the development and delivery of innovative pre-registration midwifery programmes. New titles, such as ‘practice assessor’ and ‘practice supervisor’, have been introduced into this new flexible model of student supervision and assessment, with the emphasis on students being proactive learners who are ‘supported to learn’, rather than passive recipients of knowledge. Table 1 details the roles and their responsibilities in further detail.

The title ‘mentor’ is conspicuous in its absence from the standards (NMC, 2018b): approved education institutions and practice learning partners must ensure that ‘there is a nominated person for each practice setting to actively support students and address student concerns’ while providing students with opportunities ‘to learn from a range of relevant people in practice learning environments, including service users, registered and non-registered individuals and other students as appropriate’ (NMC, 2018b:5).

Mentoring vs coaching

Midwives will now act as role models and coaches for student midwives, with the level of supervision being dictated by the individual student's needs, confidence and competence. A previous article (Power and Jewell, 2018) discussed the role of the student support midwife and how one Trust was preparing for the introduction of the new standards by adopting a new coaching model of student support. This approach was based on the Collaborative Learning in Practice (CLiP) model, which was developed in 2011 at the VU Medical Centre in Amsterdam (University of East Anglia, 2014; Ashton et al, 2016). Table 2 shows the contrast between mentoring and coaching.

Case study: Alice's reflections on practice

Before starting my third-year labour ward placement I was terrified: expectations were high, not just from mentors (Power, 2016) and colleagues, but also from myself—and no placement can put the pressure on the way labour ward does! When my mentor and I talked about my goals for the five weeks, my main aims were to develop my confidence, take the lead and plan care. I wanted to end the placement feeling that the move from student to qualified midwife wouldn't be a huge step, but a natural transition.

On my first shift working with my sign-off mentor, she immediately stepped back, saying, ‘you're taking the lead—just tell me what you want me to do’. She asked me what my plan was and encouraged me to justify my approach. She listened to my rationale, helping me to trust my instincts, and prompted me to see the bigger picture in cases that were more complex. She encouraged me in promoting normality and her positivity was infectious. The first time I performed a successful artificial rupture of membranes (ARM), I think she was as excited as I was. She empowered me to take the lead and I never doubted that if I needed her, I only had to ask. I was even given the chance to mentor a first-year student on an observational week. My confidence soared with every labour, every birth and at the end of every shift when she thanked me sincerely for my work.

By the end of the five weeks, I was ready to give my last shift everything I had. We were assigned a low-risk woman to triage and it was up to me to decide if she was in established labour and could be admitted. On examination, she was in established labour and we settled down for what I hoped would be a lovely shift. My mentor sat outside, popping in occasionally, and reassured me that if I needed her she would be there right away. It was a student's dream: a low-risk woman labouring in the pool, music in the background, lights low and everything calm. When the time came for the next vaginal examination to assess progress, my mentor came back into the delivery room. When I relayed my findings to her and confirmed that I intended to continue with my current plan of care as labour was progressing, she seemed unsure. As I updated the handover board, she spoke to the midwife in charge, before coming to me and saying that they felt it would be best to perform an ARM to augment labour—as the woman was getting tired, her progress was not what they would expect, and it seemed the best course of action.

I knew that the woman had had an upsetting experience while having her last baby 10 years previously and that she was keen for minimal intervention this time around. I was also confident that her progress was within the guidelines and that there was no indication for an ARM at this point. So that was what I said—as her lead carer that was not what I felt would be the most appropriate plan. My mentor and I discussed our justifications for our differing viewpoints and agreed to discuss both options with the woman so that she could make an informed choice. She opted for my plan to continue as she was, with a dose of pethidine to help her to rest. Two hours later she gave birth to her baby and was overjoyed that her experience had been so much better this time.

At the end of the shift, my mentor and I sat down to go through my final interview. When it came to my grade, she said that my performance that day had truly impressed her. She had reviewed the guideline after our discussion and found that I had been correct in my assessment of the woman's progress, which demonstrated knowledge of the guideline and of normal physiology and showed that I had been a strong advocate for the woman in my care. I told her that I was only able to do this because she had boosted my confidence throughout the placement by giving me the space to practice without undue interference or monitoring. Above all, I trusted that she would listen to and value my input as an individual and equal.

On reflection, my mentor practised mentorship in a different way to what I have experienced before, and to me it seems more in line with the CLiP model. The dynamic of our professional relationship felt that we were partners in care and instead of standing back and observing, which can be daunting, my mentor encouraged me to delegate tasks to her and liaise with the labour ward team as the lead. By asking questions and allowing me space to think when complications arose, my problem-solving skills also developed. This also gave me the opportunity to take responsibility for care in a way that I otherwise may not have done (Lobo et al, 2014). Based on my experience, I believe that coaching will prepare students for the responsibility of qualification and ensure that they are confident and self-aware as practitioners going into the workforce.

Moving forwards

Alice's experiences demonstrate the value and impact of students receiving high-quality support in clinical practice. A successful and productive relationship between the midwife as expert practitioner and the student midwife as novice should be based on trust, mutual respect and professionalism. The semantics of titles for this important role shouldn't detract from the main objective: women and their families receiving high quality, safe care from a well-trained, compassionate and skilled workforce.