The data were analyzed by two independent investigators and encoded (Student 1, Student 2, etc.). Next, fours themes were identified and named: differences between traditional clinical training and a mentoring programme; advantages and disadvantages of mentoring in clinical training of midwifery students; student-mentor relationship; and mentoring as an innovative and promising approach to clinical training for midwifery students. Below are quotations from students referring to each of the themes.
- Differences between traditional clinical training and a mentoring programme
According to students, there were considerable differences between mentor-led clinical training and a traditional clinical placement. Currently, degree courses in midwifery in Poland offer clinical training in groups of 4up to even 8 students supervised by one academic tutor. Mentoring, on the other hand, offers individualized clinical instruction involving the collaboration of two practitioners, an experienced midwife (mentor) and a student midwife. “The main difference between a traditional clinical placement and a mentoring programme is in the number of students supervised by a midwife. I had individual training supervised by an assigned mentor, a one-on-one instruction” (Student 1). Students emphasized that mentoring allowed them to do more: “I could perform the same activities several times which helped me to improve my clinical skills” (Student 4). “During a traditional placement usually we have no chance of working with the same midwife. Now, I had my own mentor and did everything just with her”(Student 7). Clinical instruction in groups does not seem to fully satisfy the criteria of effective clinical skills training and the students’ expectations: “During a traditional clinical placement, usually in a group of 4-6 students, we often didn’t have much to do, because there was not enough work for all of us” (Student 5). During a traditional clinical placement, with a relatively large group, it may be difficult for midwifery tutors to find enough tasks to occupy all students and allow them to show what clinical skills they have already mastered, but with a mentoring programme students do not feel the pressure to compete with their colleagues for a chance to care for a patient and demonstrate their midwifery skills. The mentor ensures that the mentee uses her time well, involves her in all activities on the ward, shares her knowledge and creates opportunities to practise clinical skills. “There was not a single moment when I was just sitting there doing nothing. I was kept busy all the time. When there were no other tasks, I just sat down with the mentor to discuss clinical problems” (Student 10). All students appreciated the opportunity to acquire and improve their clinical skills under the supervision of experienced mentors. “Very often I could plan some activity myself so my shift on the ward did not just consist of ‘obeying orders’ as it usually happens during a traditional clinical placement. Because I had my assigned mentor, I was able to plan and practise patient care under her supervision”(Student 3). One student observed that in her case other members of the therapeutic team approved of mentoring: “It seemed to me that the clinical staff responded better to the presence of one student with one mentor than to several students supervised by just one tutor” (Student 10).
- Advantages and disadvantage of mentoring in clinical training of midwifery students
Mentoring offers students an opportunity of reliable assessment of their actual clinical skills and feedback provided by a mentor identifies the strengths and weaknesses of the performance. ”Of course during my earlier clinical training I acquired clinical skills, but with mentoring, I could show to an experienced midwife how I do things and she would tell me if I did right”(Student 2). In students’ opinion mentoring considerably enhanced the quality of the clinical training they received which they hoped would be reflected in the quality of clinical care that would deliver. “In my opinion it’s a very effective method of instruction. An ideal method of clinical training as it develops your competencies as a midwife and allows you to actually perform some clinical tasks yourself and so it prepares you for your future career” (Student 4). All students agreed that the effective use of midwifery skills and making informed decisions was possible in a safe and supportive learning environment. “I felt cared for and needed, I was treated as a member of the therapeutic team and that is why I never felt stressed and was more confident” (Student 9). The students said that collaborative working with one assigned mentor led to a comprehensive, objective and fair assessment of their skills. “Each student learns at her own pace. Learning in a system where one student learns under supervision of one clinical tutor allows the student to acquire necessary knowledge at her own pace which facilitates the integration of theory and practice” (Student 3). “I felt that working all the time with the same mentor I’ll be fairly assessed” (Student 8). However, the participants observed that there were not enough of mentors. One student pointed out that as mentor-led clinical training is not available to all, those who were not able to participate in the mentoring programme, might feel they had not been given access to a better form of learning. “This is seems unfair to those students who could not participate in the programme and a get a chance of experiencing what mentoring is” (Student 12).
- The student-mentor relationship
The concept of mentoring in clinical training of midwifery students involves collaborative working of midwives and students. If a midwifery mentor treats a student midwife as a member of the therapeutic team, it increases the student’s sense of belonging to the hospital department: “I first met my assigned mentor before the clinical placement started which positively influenced my attitude and our relations” (Student 1). In students’ opinion good relations with other health care professionals help them to avoid mechanical memorizing of procedures and encourage critical thinking: “My mentor was always ready to answer all my questions. She explained the clinical problems I found difficult and encouraged me to perform some tasks independently” (Student 4). Students valued the relationship between a student midwife and an experienced practitioner who provided support and counselling and shared knowledge. “My mentor proved to be friendly and caring. I could always ask her about anything I was not quite clear about. During the clinical placement the mentor wanted to share with me her knowledge and I could practise any particular skill with her” (Student 1). “The mentor was focused on sharing her knowledge and giving instruction just to me, which greatly increased the number and range of tasks I could perform” (Student 6). Students emphasized how important it was to make clinical training a comfortable experience: ”I didn’t feel any pressure. It was all very friendly. I could talk to my mentor about any topic, we often joked. We really felt like partners” (Student 5). Students saw and appreciated their mentors’ involvement: “My mentor supported me during the performance of tasks and readily shared her knowledge” (Student 11). Students realized that their mentors wanted to develop in them the ability of critical thinking and making informed decisions. “My mentor worked just with me, not a larger number of students, she knew very well what tasks I could perform myself without being supported or supervised” (Student 2). Students felt that the mentoring relationship was based on mutual trust: “ I think there was a greater deal of trust. I felt my mentor genuinely wanted to help me, not just critically assess my performance” (Student 9).
- Mentoring as an innovative and promising approach to clinical training for midwifery students
Students confirmed that innovative forms of clinical instruction improve the quality of their placements: “With individualized instruction, it was easier for me to learn and get new skills. I was being prepared for emergency situations so that I knew what to do and what my role was” (Student 2). They also appreciated a closer, less formal relationship between the mentor and mentee: “This individual approach and friendly attitude were very important, because I felt there’s someone who really cared about my education” (Student 6). There was a general wish that all practical training would be mentor-led or that each midwifery student could have at least one chance of such individual mentoring: “Would it be possible for every midwifery student to have at least one opportunity of such individual clinical training during the 3-year course of study?” (Student 12). Students also perceived the potential effect of mentor-led clinical training on their future career. They thought newly qualified midwives would be better prepared to deliver clinical care, aware of their knowledge and skills and more confident: “My mentor showed me my strengths and weaknesses, thanks to the feedback she gave me I knew what I could do well and what needs further practice. My mentor set goals which I had to achieve and I learned a lot” (Student 5). However, students observed that because mentoring was not a common approach to clinical training, some health care professionals did not fully understand the concept which was new for them. “Mentors need more recognition of their role, to avoid such comments by other midwives who are not mentors as ‘How is it that you are a mentor?’, ‘Who needs it?’, ‘Is that some special student?’ ‘Why just one student, not a group?’” (Student 3) The participants observed that there were not enough of mentors. “There is lack of mentors and my mentor often said that she felt the mentor’s role was somehow underestimated and there were not enough training opportunities for mentors” (Student 1). They suggested that mentor training offered to hospital-based midwives could increase the number of midwives interested in mentoring for midwifery students.