Leadership and management skills, including critical thinking, decision making and prioritisation, are integral components of the daily care provided by midwives (Kebede et al, 2023). Leadership skills describe practical elements of care, including managing interactions within or across multidisciplinary team, while management skills include resource management, staff organisation and efficient direction.
The importance of leadership extends beyond clinical aspects of care and encompasses education, as emphasised by the International Confederation of Midwives (ICM, 2023). The Nursing Board for Brunei's (2013) core competency standards for registered nurses and midwives state that professionalism and competency in patient care are paramount, including proficiency in leadership and management skills. These skills not only impact patients but also the quality of communication among multidisciplinary team members and midwives in clinical settings (Folkvord et al, 2023).
Midwives in leadership positions must advocate, set a positive example and enhance team dynamics and coordination, ensuring the delivery of quality patient care (ICM, 2023). Effective leadership and management skills contribute to increased professionalism, holistic care and competency among individuals (Nawagi et al, 2023). This positively affects their ability to perform activities that benefit themselves and those around them. These benefits are crucial for ensuring adaptability and awareness of surroundings, enabling the effective use of available resources for efficient teamwork and high-quality midwifery practice (Palimbo et al, 2023). Therefore, leadership and management roles have a profound impact on the entire healthcare system.
Midwifery students need early exposure to leadership and management skills so they can prepare to take on these roles on becoming registered midwives (Sheehan et al, 2023). Early education on these skills can mitigate burnout or stress when facing issues such as conflict or miscommunication, which require good leadership and management capabilities (Arundell et al, 2024). Having a deep understanding of the role of leadership and management also ensures students are skillful and knowledgeable, becoming good role models for future generations of midwives, and offering extensive knowledge and experience in leading and managing team members (Palimbo et al, 2023).
Mentorship plays an integral role in preparing students for effective leadership and management in clinical settings. Mentors must ensure that midwifery students are thoroughly equipped with the necessary skills and knowledge, so they are confident and competent in performing tasks independently (Sheehan et al, 2022). Acting as guides, mentors serve as a bridge between the theoretical knowledge and practical skills acquired in academic institutions and their application in real-life clinical settings. This involves addressing challenges related to patient care, communication with women and family members, and collaboration in the midwifery team (Anderson et al, 2022).
Midwifery education in Brunei
Midwifery education in Brunei is provided through two health institutions. Politeknik Brunei offers a 3-year diploma course in midwifery, while the Universiti Brunei Darussalam offers bachelor's degrees in midwifery, which can span 2–4 years depending on a student's academic background and previous qualifications. This education programme encompasses both theoretical and practical learning opportunities, allowing students to develop clinical skills as they progress through their course (Universiti Brunei Darussalam, 2021). Throughout each semester, midwifery students undergo clinical attachments in hospital settings, such as maternity wards, labour rooms, accident and emergency departments and clinics. These attachments provide invaluable hands-on experience, allowing students to apply the knowledge and skills acquired in the institute to real-life settings involving members of the community, including women, caregivers, healthcare teams and multidisciplinary team members (Universiti Brunei Darussalam, 2021).
During the clinical attachment period, students are paired with registered midwives who serve as mentors. These mentors are tasked with supervising and serving as role models for the midwifery students, aiding in the practice and development of their clinical, leadership and management skills. To enhance students' adaptability and flexibility, mentorship assignments vary each semester, exposing students to different leadership styles and management approaches (Universiti Brunei Darussalam, 2021). The duration of mentorship aligns with the length of the clinical session, which can range from 2 weeks to 6 months depending on the academic year and semester. In the framework of the leadership and management module offered as part of the education programme, mentors are expected to impart skills such as resource management, task delegation, prioritisation and decision making. Students are encouraged to actively engage with their mentors, seeking clarification, guidance and feedback within the constraints of the clinical setting's limited time.
Aims
A positive mentorship experience provides an invaluable learning opportunity for students to embrace their leadership and management roles more effectively and to rectify misconceptions or doubts before transitioning to registered midwives. However, the extent to which mentorship experiences influence the preparation of midwifery students for leadership and management roles, as well as the challenges that impact the effectiveness of mentorship experiences in clinical settings, remain unknown. This study's aims were to explore these questions by gathering insights from student midwives on their mentorship experiences, as part of their leadership and management preparation. This was completed as part of a larger project exploring midwifery students' experiences of the leadership and management module, part of which was previously published (Abdul-Rahim and Abdul-Mumin, 2024).
Methods
This descriptive qualitative study assessed final-year midwifery students' involvement in leadership and management modules and mentorship during their clinical attachment period. The evaluation session took place at the conclusion of the modules in May 2023.
Participants
Participants were purposefully selected through the university's assistant registrar, who served as a gatekeeper. The study targeted midwifery students from Universiti Brunei Darussalam enrolled in the final-year leadership and management module. This ensured homogeneity in the sample regarding their course content. The inclusion criteria selected for students fluent in either English or Malay, to facilitate communication and data collection. Students were not excluded on the basis of variables such as age and previous clinical placements, as the goal was to gather diverse opinions and feedback from the student population. Overall, 43 of the 47 students opted to contribute to the study. This was offered to students as additional coursework that not affect their academic grades. Four students opted out of the study.
Data collection
A total of 43 students provided essays reflecting on their overall clinical experiences, including mentorship, during their clinical attachment period. The essays had no word limit or restrictions and were written in English. Participants were given 1 day to write their essays, which were then placed in a tray outside the researcher's room at the university. Collection was done at a separate time to avoid unnecessary encounters between the researchers and participants.
Data analysis
The students' essays were thematically analysed using Braun and Clarke's (2006) guidelines to identify patterns of similarity or contrasting perspectives. The themes found during analysis were discussed among the authors to assess their relevance to the research aims.
Reflexivity and bias
To mitigate power imbalances between the researcher and students, the researcher used bracketing and limited unnecessary interactions beyond the research scope with the participants. Gatekeepers were used to recruit participants to minimise interactions.
During data collection and analysis, the authors engaged in frequent discussions to ensure that the results were purely derived from the students' feedback and were not manipulated or influenced by the authors' opinions. Bracketing was done to promote full transparency of the findings, which is essential for producing rigorous and credible research outcomes. Written consent was obtained during all interactions as a form of reflexivity.
Ethical considerations
Ethical approval for this study was granted by the Universiti Brunei Darussalam's Institute of Health Sciences research ethics committee (reference: UBD/PAPRSBIHSREC/2022/143).
Prior to participation, participants were asked to give informed consent and were briefed on the study's purpose. Students were invited to participate voluntarily, with the assurance that there would be no negative repercussions or penalties for declining to provide an evaluation.
Results
The three themes found were ‘recognising the importance, facing the gap’, ‘inconsistent mentorship experiences’ and ‘recommendations for improvement’. While the participants recognised the importance of leadership and management skills for their future careers, they often felt unprepared. Limited opportunities to practice their skills during clinical placement left them feeling rushed and inadequate. Although mentorship was acknowledged as crucial, the participants highlighted that it could be inconsistent because of variations in mentor styles and experience. To bridge this gap, the students recommended improvements: consistent learning opportunities for all, pairing with skilled mentors, extending clinical placements and incorporating pre-graduation leadership training.
Recognising the importance, facing the gap
The participants acknowledged the value of leadership and management skills but felt unprepared because of their limited practical experience. The majority acknowledged the importance of strong leadership and management competencies for professional development and recognised how these skills not only enhanced their professionalism and competence but also positively influenced team dynamics, leading to improved patient care. However, concerns were raised regarding their readiness, as many felt they lacked adequate clinical exposure and opportunities to refine their leadership and management skills. The limited duration of clinical attachment sessions posed a challenge, leaving students feeling rushed and inadequately prepared to assume leadership or management roles competently.
‘I understand the importance of leadership and management skills in midwifery, but I believe more practical experience is needed to fully develop these abilities. Longer clinical placements would allow for the application of theoretical knowledge and the enhancement of skills like delegation, decision making, and conflict resolution’.
‘Theoretical knowledge of leadership and management is well-covered, but practical application is essential. More exposure to varied clinical settings and leadership roles would better prepare us for future challenges’.
Inconsistent mentorship experiences
The participants recognised the importance of mentorship but emphasised the inconsistency in the quality and opportunities provided by mentors. All participants agreed on the pivotal role that mentors play in shaping them into better leaders and managers in clinical settings.
While participants were able to identify skills taught by their mentors, such as decision making, problem solving and communication, they highlighted a lack of opportunities to practice these skills during their clinical sessions.
‘It's disappointing when we learn valuable skills from our mentors but have limited chances to apply them in real-world clinical situations. We need more structured opportunities to practice these skills, such as delegating task or managing complex patient cases’.
Some participants expressed frustration at not being able to practice these skills at all during their placements. While certain participants benefitted from fruitful mentorship experiences, this was not universal.
‘I've been lucky to have a great mentor who's really helped me. But I know not everyone has that same experience. We need to improve mentorship programmes to ensure all students have equal learning opportunity’.
Being assigned to different clinical sites or having mentors with varying styles and approaches contributed to discrepancies in the mentorship experience among participants.
Recommendations for improvement
The participants proposed solutions to bridge the identified gaps in their mentorship and clinical attachment experiences. The participants recommended implementing consistent learning opportunities for all students to ensure that each individual could maximise their learning potential during the limited time available in clinical attachments. They emphasised the importance of being paired with reliable and skilled mentors who could effectively serve as role models, teachers and guides to facilitate the development of leadership and management skills. This suggestion arose from the experiences of some participants who encountered mentors lacking the ability to lead or teach the necessary skills expected of students.
‘Learning opportunities in clinical placements should be more consistent, so everyone gets the most out of their limited time there. Also, having mentors who are actually good at leading, guiding us and teaching the skills we need would be a huge help, instead of a randomly assigned staff member’.
The participants also suggested extending the duration of clinical attachment sessions to allow for establishing trust and rapport with the healthcare team and mentors. They believed that longer attachment periods would facilitate a smoother learning process and foster better interactions between students and healthcare professionals. Additionally, prolonged clinical attachments would enable students to familiarise themselves with the environment, making them more proficient in performing leadership and managerial tasks that require knowledge of the available facilities, resources and team members.
‘Longer clinical placements would be really helpful. Having more time to get to know the team and the environment would make it easier to step up into leadership roles so we can be well-prepared for the real world after we graduate’.
Given that leadership and management skills necessitate extensive exposure and practice, students stressed the importance of receiving adequate training before transitioning into registered midwives. They emphasised the need for these skills to be ingrained before graduation, recognising the critical role they play in future professional practice.
Discussion
Mentors serve as role models and offer guidance to mentees to develop their knowledge and skillset. Mentors should be experienced professionals who can guide midwifery students and newly graduated midwives in developing the necessary skills to become competent practitioners. In midwifery care, mentors play a crucial role in teaching valuable lessons on leadership and management (Sheehan et al, 2022).
Communication skills are particularly integral to midwifery care, as midwives are expected to effectively communicate not only with their team but also with children, women and family members (Almorbaty et al, 2023). Mentors should focus on teaching effective communication skills, placing strong emphasis on empathy, adaptability and awareness. Having empathy and understanding of the woman's and healthcare team's situation is crucial for maintaining a positive clinical environment. This benefits not only the leader but also the entire healthcare team, fostering optimal team dynamics, motivation and professional relationships that contribute to job satisfaction and professional growth (Sheehan et al, 2022). Establishing effective communication with women during care also fosters trust and rapport between a team leader and the woman, which positively impacts the quality of care and health outcomes.
It is essential for mentors to use engaging and innovative teaching methods that stimulate mentees to develop their leadership and management skills while maintaining their motivation to continuously improve (Sheehan et al, 2023). Mentors should take full accountability for their mentees' development and provide appropriate supervision to ensure that mentees can achieve independence (Anderson et al, 2022). Additionally, mentors should serve as platforms and reference points for mentees to seek guidance and clarification when doubts or misunderstandings arise. Tailoring teaching techniques to suit the individual needs of mentees is crucial. This requires effective communication between mentors and mentees to ensure that learning objectives are met by the end of the clinical attachment session. By fostering open dialogue and adapting teaching methods accordingly, mentors can effectively support mentees in their professional development (Amod et al, 2024).
Mentors must exercise caution to avoid spoonfeeding mentees or fostering over-reliance, as this can hinder mentees' independence and development of autonomous leadership and management skills (Gularte-Rinaldo et al, 2023). Over-reliance on mentors may lead to mentees staying in their comfort zones, resulting in wasted time during clinical placements.
Clear roles and goals should be established early in the mentor-mentee relationship, to allow both parties to devise strategies to optimise their learning and teaching experiences in the limited time available for clinical attachment session (Amod and Mkhize, 2024). Mentors should remain accessible to mentees to address any confusion and provide opportunities for reflection and discussion on progress or concerns (Anderson et al, 2023). This proactive approach allows misunderstandings to be addressed early, preventing potential future setbacks. While the mentor's role is undeniably significant in facilitating the mentee's learning experience, it is equally crucial for students to proactively seek knowledge beyond their mentorship. This supplementary education enhances their understanding and prevents them from relying solely on one source, optimising their preparation time (Arundell et al, 2024). Both mentor and mentee should identify learning objectives and critically assess strengths and weaknesses. This self-analysis provides a foundation for planning how to address learning gaps during clinical placement, using available resources effectively (Shamoradifar et al, 2022).
Challenges impacting mentorship effectiveness
The midwifery students' feedback identified several challenges that align with issues commonly faced by mentors. Mentors have subjective perspectives shaped by their unique experiences in the clinical setting, which may lead to variation in their teaching approaches. Factors such as interactions with patients, the midwifery team and available resources can influence the style of leadership and management taught to mentees (Gray and Downer, 2021).
Mentors may also differ in their motivation for undertaking mentorship responsibilities. Whether a mentor is driven by a personal desire to teach, is assigned based on a recommendation or is randomly assigned will influence their approach (Gray and Downer, 2021). These differences may have positive or negative impacts on mentees.
Mentors' motivation should be appropriately aligned with students' knowledge, to prevent overwhelming them (Amod and Mkhize, 2024). The present study's participants highlighted that they encountered mentors who lacked the necessary skills or knowledge to effectively model leadership and management. It is crucial for mentors to honestly assess their capabilities before taking on the role, as their guidance significantly impacts students' growth in these areas. Both mentor and student should be open to teaching and learning, while maintaining professionalism and avoiding judgment, discouragement or intimidation based on differences in academic background, understanding or learning pace (Amod et al, 2024).
Another common obstacle associated with mentorship is differences in expectations. Mentors may have expectations for students that misalign with the students' objectives, hindering their learning progress (Gray and Downer, 2021). For instance, two students in the present study reported that did not have the chance to practice leadership and management skills during their clinical attachment session because their mentor misunderstood the purpose of their attachment. A communication gap in regards to learning objectives in the clinical placement session between the mentor and students led to a misunderstanding of roles. The mentor believed the final-year students were there primarily to assist staff with tasks, rather than to focus on developing leadership and management skills. Consequently, the students spent their time performing routine tasks, such as medication administration, alongside healthcare workers. The students felt the healthcare workers viewed them as final-year students who had already learned the necessary skills and should concentrate on adapting to the clinical work environment. It is crucial to clarify goals and roles at the outset of the clinical attachment to ensure an effective learning experience for students throughout the session (Arundell et al, 2024).
Another challenge mentioned by the majority of participants related to the limited duration of clinical attachment sessions. During the leadership and management module, midwifery students spent 1 month learning theoretical aspects of leadership, such as leadership and management styles, responsibilities and scope of practices. For the following 3 months, the students were sent for clinical placements in the hospital to develop their skills. During this period, the students found that it took time to familiarise themselves with the clinical setting and orientate themselves with the environment, healthcare team and facilities. The orientation phase typically lasted weeks, and building trust and rapport with the healthcare team and mentor required proper introduction, initiation and an effort to demonstrate dedication to learning and contributing to the team (Gularte-Rinaldo et al, 2023). This process usually took over a month, especially for students who were new to the clinical setting, compared to those with previous clinical experience at the same location, leaving less than 2 months of placement to develop their skills.
Implications for practice
Developing leadership and management skills necessitates extensive practical, hands-on experience. This requires considerable effort and interaction with key individuals in the clinical setting to truly advance skills such as conflict management, resource allocation and critical thinking (Palimbo et al, 2023). Participants expressed concerns about balancing other academic responsibilities, assignments, module responsibilities and examinations, which diverted their attention from actively practicing and achieving their learning objectives related to leadership and management skills.
Future practice should incorporate standardised mentorship programmes and extended clinical placements to enhance midwifery students' readiness for leadership and management roles. This will improve their clinical exposure, skill development and understanding of healthcare environments. Additionally, incorporating innovative and formal leadership and management training into midwifery education can equip students with the necessary skills to excel in these roles.
Limitations
This study relied on self-reported data from students, which may be prone to recall bias, and focused solely on the perspectives of students. Future studies could include the perspectives of mentors or clinical educators. Further research is needed to explore the factors influencing mentor effectiveness and to develop strategies to enhance mentorship experiences.
Conclusions
Although midwifery students recognised the significance of leadership and management in their journey to becoming competent and adaptable midwives, they expressed a need for additional learning opportunities and exposure under the guidance of assigned mentors. This is essential to ensure a comprehensive and productive clinical learning experience. Furthermore, students emphasised the importance of having mentors capable of addressing their learning needs and trained in leadership and management. This would enable students to effectively replicate and apply their knowledge and skills in real-world scenarios.