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Mentoring assistant practitioners – The radiographer’s perspective
Radiography (2010) 16, 223e229
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/radi
Mentoring assistant practitioners e The radiographer’s perspective Iain Colthart a,*, Margot McBride b, Maria Murray c a
NHS Education for Scotland, 5th Floor, Thistle House, 91 Haymarket Terrace, Edinburgh, EH12 5HD, UK University of Dundee, 11 Airlie Place, Dundee, DD1 4HT, UK c Society and College of Radiographers, PO Box 29434, Glasgow, G67 9AT, UK b
Received 22 December 2009; revised 17 February 2010; accepted 24 March 2010 Available online 24 April 2010
KEYWORDS Role development; Radiographer; Mentorship; Trainee assistant practitioner; Evaluation
Abstract Purpose: The aim of this study was to evaluate the experiences of diagnostic and therapeutic radiographers as they mentored trainee assistant practitioners undertaking an educational programme. The evaluation study describes the challenges and benefits the radiographers experienced as mentors as well as giving their insights into the introduction of assistant practitioners in their departments. Method: The mentors’ opinions were sought by a questionnaire which formed part of the evaluation of the respective diagnostic imaging and therapeutic educational programmes run by two colleges. Results: The response rate was 54% (22/41). Mentors described personal and professional benefits for themselves from undertaking this role. Although mentoring had provided a number of challenges including an increase in workload, the experience had also enhanced their teaching and mentoring skills and contributed to their Continuing Professional Development (CPD). Whilst the role was more time consuming than initially expected this had not impacted generally on their ability to undertake CPD or deliver patient care. In relation to the wider impact of the programmes some negative impact was reported on the speed of service delivery but not on the quality of practice. Mentors felt that the programmes had a positive effect on teamworking and had been beneficial for patient care. Some difficulties were noted in balancing the mentoring of trainee assistant practitioners and radiography undergraduates. Conclusion: The mentors strongly endorsed the educational programmes and their roles and responsibilities in their delivery. Protected time to carry out mentoring duties and establishing good communication with the colleges providing the theoretical teaching were identified as means of further improving the mentoring process. ª 2010 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: þ44 131 313 8091; fax: þ44 131 313 8001. E-mail address: [email protected] (I. Colthart). 1078-8174/$ - see front matter ª 2010 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2010.03.004
224
Introduction A scoping exercise was undertaken by NHS Education for Scotland (NES) in 2004 which examined role development for radiographers and support workers in Scotland. Its findings included the identification of a lack of pathways and educational opportunities and mechanisms for developing support workers to take on the role of assistant practitioner (AP).1 In response to this situation the then Scottish Executive Health Department (SEHD) commissioned the Scottish Qualifications Agency (SQA) to develop two Higher National Certificates (HNCs) in diagnostic imaging and radiotherapy to prepare support workers for the AP role. The HNCs were approved by the College of Radiographers (CoR) in June 2006 and initiated in January 2007. NES and the Scottish Executive Health Department jointly funded the HNC programmes. An evaluation was undertaken of the HNC programmes to assess their content and collect information on the shortterm impact of the programmes on radiography practice and current AP roles so that changes to these can be evaluated in the future. An integral part of the evaluation was capturing the views of the radiographers who had mentored the trainee assistant practitioners (TAPs). This paper reports on their mentoring experiences.
The educational programmes The HNCs were made up of 9 core common units, one workbased unit and 3 specialised units for diagnostic imaging and radiotherapy respectively and were undertaken by 34 TAPs at Stow (n Z 24) and Dundee (n Z 10) Colleges. The course required one day attendance at college and 2 days of work-based learning per week. The remaining time was spent in their normal role as a helper or assistant. The TAPs were supervised and mentored by Health Professions Council (HPC) registered radiographers for the work-based element of their training. All TAPs successfully completed the programmes which concluded in January (Stow) and February (Dundee) 2009 respectively. The 100% completion rate is regarded as exceptional for an HNC programme. The evaluation sought the views of a range of stakeholders, namely the TAPs, mentors, radiography managers and educationalists responsible for delivering the programmes. Mentors played an integral part in the programmes given the emphasis on work-based learning and furthermore the importance of their role in supporting the TAPs was highlighted in the feedback received in earlier monitoring reports. The mentors were able not only to give a close-up view of the TAP’s experience of the programmes but also the impact on them personally from undertaking this role.
Mentoring There are a number of definitions of mentoring in the literature.2 A straightforward definition is “support offered by an experienced professional nurturing and guiding the novice”.3 This involves an experienced professional developing the career of their mentee. Mentoring is not the same
I. Colthart et al. as teaching and also distinct from other related activities of clinical supervision, appraisal and assessment.2 Practice education of other members of the healthcare team, which includes mentoring, is a pivotal and explicit role of a registered radiographer4,5 and evidence of ongoing Continuing Professional Development (CPD) relating to education may be required. It is recognised that the mentors in these programmes, by virtue of their role, could pursue accredited status from CoR which is a further opportunity to evidence CPD.6
Method Data was collected by a self-completion questionnaire drafted by the authors. A questionnaire was chosen as the most appropriate method to collect detailed information from mentors dispersed throughout Scotland. Prior to the questionnaire’s distribution in March 2009 it was reviewed for relevance and validity by an existing mentor. This limited piloting was deemed appropriate given the level of the evaluation and the radiography expertise of the authors. The questionnaire sought information on: the radiographer’s clinical role and that as a mentor; challenges and benefits resulting from mentoring; the impact of mentoring on them as individuals; the TAPs’ performances and their impact in their radiography departments; an overall assessment of the programmes and suggestions for improvements. As there was no central record of mentors available a list was drawn up from a variety of sources including a list provided by one of the colleges, those identified in the Service Level Agreements between NES and individual NHS boards at the outset of the programmes and by personal contact with radiography managers. A total of 42 were identified from these sources. Advice was sought from the National Research Ethics Service (NRES)7 on whether the evaluation would require ethical review from a NHS Research Ethics Committee given that it involved the participation of NHS staff. NRES classified the evaluation as an educational (service type) evaluation and not research per se which meant that ethical review would not be required. However it was recommended that approval to conduct the evaluation should be sought from local NHS boards’ research and development offices. This was duly done through NHS Research Scotland (NRS)8 a central body who co-ordinate research and development applications. NRS confirmed the project as service evaluation which would not require ethical approval.
Results Twenty two questionnaires were returned giving a response rate of 54% (22/41) with one questionnaire being returned as undeliverable. The respondents gave a valuable insight into the process and demands on them during their mentoring experiences.
Profile of mentors Mentors had been in their current clinical role for an average of 9.5 years ranging from 6 months to 40 years. The
Mentoring assistant practitioners mentor’s job titles are: radiographer (n Z 5); senior radiographer (n Z 7); specialist radiographer (n Z 1); superintendent radiographer (n Z 8); clinical specialist (n Z 1). The mentors predominately represented diagnostic imaging (n Z 21) with one from radiotherapy. The majority work full-time (n Z 15) with the remainder part-time (n Z 7). Respondents came from 7 out of 8 health boards receiving funding from NES and there was an almost even split with the mentors’ TAPs attending Dundee (n Z 10) and Stow (n Z 12) Colleges. Mentors had an average of 6 years experience in any mentoring role ranging from 1 year to 28 years. Four were exclusively mentoring TAPs with the remainder (n Z 18) mentoring a combination of TAPs and radiography undergraduate students. Given this experience the majority (n Z 15) felt prepared for mentoring on the AP programmes
Benefits of mentoring in terms of personal and professional development Almost all mentors (n Z 19) identified personal and professional benefits. Examples of personal benefits were enjoyment of working with the trainees, appreciation of feedback received from the TAPs, a sense of reward, pride and achievement in seeing their TAPs successfully complete the programmes. In professional development terms a number of benefits were identified which related to technical aspects of radiography and those associated with mentoring and teaching. Mentoring had meant that several had to reassess their theoretical and technical skills and update these as appropriate. In diagnostic imaging this entailed having to explain how equipment works and why a particular technique is used. Specific examples of updating knowledge and skills were positioning skills and having to understand more fully the technical aspects of digitisation and its impact on image production and interpretation. No particular examples were identified by the radiotherapy mentor. Teaching and mentoring skills were also recognised as having been enhanced by participating on the programmes. Interestingly one mentor indicated that different skills were required to mentor TAPs and radiography undergraduate students respectively. Mentoring had also given the mentors an understanding of the AP role, their scope of practice and an appreciation of the contribution they can potentially make.
Challenges for the mentors The major challenge reported by mentors (n Z 15) was the amount of paperwork associated with the programmes and in particular the number of assessments (n Z 80) which had to be completed by the students. Paperwork was described in one case as being “excessive and unwieldy” with a recommendation to revise the assessment forms. The number of practical assessments required also came in for criticism as being “laborious and repetitive”. Other individual challenges noted included: having to think as a student in explaining procedures and not just acting automatically; lack of protected time to mentor; dealing with other staffs’ perceptions and attitudes towards the introduction of APs.
225
Assistance in being a mentor The mentors identified two common areas when asked what would have assisted and supported them in their role. The first of these was the provision of protected time to undertake mentoring which would have allowed the mentors to devote more of their attention to this task. Limited or no protected time for the mentor’s educational role is at odds with many Scottish and UK policy drivers.9 The second area was a better understanding and knowledge of the content of the theoretical teaching which would have given the mentors more clarity in knowing what the TAPs had covered and importantly what levels of competence and performance were required. The relationship between the college and the clinical department is recognised as being important to the successful operation of work-based learning programmes.10 Both colleges however did provide a series of formal meetings with the mentors prior to the commencement and during the delivery of the programmes. The aim of these meetings was to discuss the academic content and the clinical delivery and assessment of their students. The college clinical co-ordinators also made regular visits to all of the radiology and oncology departments during the programmes. These visits included meetings with the mentors, radiography managers and TAPS in order to evaluate and assess their clinical experience.
Impact of being a mentor A number of aspects were explored in relation to the impact on themselves as individuals of being a mentor on the programmes: workload; time required for mentoring APs; protected study time for CPD; patient care. The intention was to compare these aspects at the beginning of the programmes in 2007 and at the time of the evaluation (March 2009) in order to record any impact. Almost all mentors indicated that the beginning of the programmes had led to either an increase (n Z 15) or a larger increase (n Z 5) in their workload than they had anticipated (Fig. 1). Over time this had declined with nine mentors indicating their workload was showing an increase at the end of the programmes. Despite a larger workload for most at the beginning of the programmes there was a spread of time devoted to mentoring at this stage. Nine mentors reported spending more time then they expected at the outset, eleven about what they expected and two less than expected. At the end of the programmes (Fig. 2) only three mentors were spending more time than they had anticipated with most (n Z 14) devoting the amount of time they expected. Although there was some evidence of mentors devoting more time than they had anticipated to the programmes this did not appear to have had a detrimental effect on their protected time for CPD (Fig. 3). At both time periods the majority (n Z 16) reported that it had no effect with three mentors reporting a beneficial effect and just one a very detrimental effect. However the fact that the majority was reporting no impact should be treated with a degree of caution in that seven mentors commented they received no protected time for CPD as a rule.
226
I. Colthart et al. Comparison of Mentor Workload at Beginning and End of Programmes (n = 22) 16 14 12 10 8 6 4 2 0 Large Increase
Increase
No change
Large Decrease
End of Programme
Beginning of Programme
Figure 1
Decrease
Comparison of mentor workload at beginning and end of programmes (n Z 22).
In terms of their mentoring role impacting on their ability to deliver patient care, only one reported a detrimental effect with the majority reporting no impact (Fig. 4). The detrimental effect related to a slowing down of service. Four mentors agreed that it had had a positive effect. In assessing the overall impact on the mentors of taking part in the programmes it is informative to consider the views of the radiography managers (n Z 3) who took part in the evaluation. The managers reported that the impact of the programmes on mentors was “huge”. In one instance a mentor had made a large personal commitment to the TAPs by working on into the evening after hours to complete their own work. It would be difficult to envisage this level of personal commitment being repeated again.
Trainee assistant practitioner’s impact on the department The perceived wider impact of the programmes on four particular aspects of the diagnostic imaging and radiotherapy departments’ operations were gauged: number of procedures undertaken; efficiency; teamworking; the patient experience (Fig. 5). In terms of the number of procedures undertaken the majority of mentors indicated no impact (n Z 16) but there was evidence of a detrimental effect (n Z 4) but equally also a beneficial impact (n Z 2). Similarly there was an even distribution of opinion on efficiency in the department with a detrimental impact identified by 6 mentors, no
Comparison of Time Devoted to Mentoring at Beginning and End of Programmes (n = 21) 14 12 10 8 6 4 2 0 Much more than I expected
More than I expected
About what I expected
Beginning of Programme
Figure 2
Less than expected
Much less than I expected
End of Programme
Comparison of time devoted to mentoring at beginning and end of programmes (n Z 21).
Mentoring assistant practitioners
227
Comparison of Impact of Mentoring on Protected Time for CPD at Beginning and End of Programmes (n = 20) 16 14 12 10 8 6 4 2 0 Very detrimental
Detrimental
No impact
Beginning of Programme
Figure 3
Beneficial
Very beneficial
End of Programme
Comparison of impact of mentoring on protected time for CPD at beginning and end of programmes (n Z 20).
impact identified by 9 and a beneficial effect by 7. The limited detrimental effects on the number of procedures and efficiency reflected the previous health board monitoring reports where some negative impact was reported on the speed of service delivery but not the quality of practice. Whilst a relatively balanced range of impact was noted in the number of procedures undertaken and efficiency, more positive effects were evident in the other two areas. The largest positive effect was observed in teamworking with 15 mentors noting a beneficial outcome from the programmes. Similarly half of the mentors (n Z 11) felt the programmes had been beneficial for the patient’s experience in their department.
Impact on radiography undergraduates Anecdotal evidence suggests the introduction of the APs’ programmes may have implications for the training of radiography undergraduates who are on placement in the radiography department at the same time. The two groups both require clinical practice and mentoring time which may lead to competition for the same resources. Seventeen of the mentors reported mentoring radiography undergraduates at the same time as TAPs. The mentors were asked whether the time they had spent with the TAPs had affected the undergraduate’s training. Mentors who expressed an opinion were divided on this issue with eight thinking there was no effect and seven identifying some effects.
Comparison of the Impact of Mentoring on the Ability to Deliver Patient Care at the Beginning and End of Programmes (n = 20) 18 16 14 12 10 8 6 4 2 0 Very detrimental
Detrimental
No impact
Beginning of Programme
Beneficial
Very beneficial
End of Programme
Figure 4 Comparison of the impact of mentoring on the ability to deliver patient care at the beginning and end of programmes (n Z 20).
228
I. Colthart et al. Mentors' Perceptions of the Impact of the Programmes on their Departments (n = 22) 16 14 12 10 8 6 4 2 0 Very detrimental
Detrimental
Procedures undertaken
Figure 5
No impact Efficiency
Beneficial
Teamworking
Very beneficial
The patient's experience
Mentors’ perceptions of the impact of the programmes on their departments (n Z 22).
Those who thought there had been no effects were clear that both had been treated equally and that there were enough facilities and clinical experience to cater for both groups. Conversely those who intimated that TAPs had affected radiography undergraduates training cited general issues such as clinical tutor’s time being spread more thinly, logistical problems in moving staff around to accommodate both groups and competition for suitable patients to X-ray.
Overall impression of the programmes Mentors were asked if the programmes had achieved their objectives of preparing the trainees to work as APs. There was a strong endorsement of the programmes in meeting this fundamental aim with mentors being of the opinion that it had completely (n Z 6) or mostly (n Z 13) achieved this. The mentors themselves indicated strong levels of approval with most being either satisfied (n Z 16) or very satisfied (n Z 4) with their involvement in this role.
Discussion In considering the outcomes from this evaluation it is important to appreciate its strengths and limitations. The response rate of the mentors was good but they could not all be identified to be contacted. The evaluation predominately reflects the views of diagnostic imaging mentors due to the small numbers of radiotherapy TAPs involved in the programmes. In terms of the representativeness of the mentors they were drawn exclusively from mainland health boards. This evaluation is essentially a “snapshot” measure and planned ongoing future evaluation activity will enable NES to chart the impact of the programmes on this original cohort more fully over time. For example the now qualified APs “freeing up” time which will allow radiographers to carry out the more complex radiological and oncology
procedures. The evaluation relied on self-reporting which is not ideal but sought the views of a range of stakeholders to give a rounded perspective of the programmes. The evaluation has provided baseline information and has offered answers to a number of questions at the present time including the impact of the programmes on mentors. All participants in the evaluation endorsed the programmes as having met their fundamental objectives of equipping the trainees with the skills and knowledge they need to function as an AP. The hard work and dedication of the mentors was recognised as pivotal to the TAPs achieving their goals given that half of the education programmes were taught in the clinical environment. The mentors had found the numbers of clinical assessments demanding but nearly all identified benefits for themselves in terms of personal and professional development. The major impact for mentors was on workload with evidence of some underestimating the time that would be required to undertake this role. However the outcomes of devoting time to mentoring seem to have little impact on their own time for CPD and their ability to deliver patient care. In fact in both these areas there was a marginally more positive than negative effect and indeed undertaking the role had contributed to the mentors’ CPD. In looking forward the radiographers identified means of improving the mentoring process. In terms of identifying the wider impact of the APs it was too early to gauge changes in radiography practice at the time of the evaluation. This is in part due to the levels of supervision that the APs were working under and a lack of evidence at this relatively early stage. However the contribution of the APs to the work of the departments was recognised by the mentors. Benefits were identified in terms of improved teamworking and a better patient experience. Within some departments there was evidence of the TAPs impacting on radiography undergraduate students’ training and this is an issue which deserves further investigation.
Mentoring assistant practitioners
Conclusion The evaluation presents a balanced picture of the successes and challenges resulting from the radiographers’ assessments of their participation as mentors for the HNC programmes in diagnostic imaging and radiotherapy. The mentors were positive about their experience of mentoring on the programmes which they believed had benefitted themselves personally and professionally and successfully prepared the trainees to become APs. The mentors identified the provision of protected time and better knowledge of the theoretical teaching the TAPs were receiving at college as a means of improving their ability to carry out this role.
References 1. NHS Education for Scotland. Role development for radiographers, assistant practitioners and support workers: national scoping report. NHS Education for Scotland; 2004. 2. The College of Radiographers. Mentoring: guidance and advice. The College of Radiographers; 2009.
229 3. The College of Radiographers. Radiography clinical supervision framework. The College of Radiographers; 2003. 4. Health Professions Council. Standards of proficiency e radiography. Health Professions Council; 2009. 5. The College of Radiographers. Code of conduct and ethics. The College of Radiographers; 2008. 6. The College of Radiographers. The Approval and accreditation of educational programmes and professional practice. Practice educator accreditation scheme. The College of Radiographers; 2006. 7. National Research Ethics Service, http://www.nres.npsa.nhs. uk/applications/apply/ethical-review-requirements [accessed17.2.2010]. 8. NHS Research Scotland, http://www.nhsgrampian.com/ nhsgrampian/nrscc.jsp?pContentIDZ6576&p_applicZCCC&p_ serviceZContent.show [accessed 17.2.2010]. 9. The College of Radiographers. A charter for protected study time in Scotland. The College of Radiographers; 2008. 10. The College of Radiographers. The approval and accreditation of educational programmes and professional practice in radiography. Clinical education and training: guidance and strategies for effective relationships between education providers, placement providers and learners. The College of Radiographers; 2006.
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/radi
Mentoring assistant practitioners e The radiographer’s perspective Iain Colthart a,*, Margot McBride b, Maria Murray c a
NHS Education for Scotland, 5th Floor, Thistle House, 91 Haymarket Terrace, Edinburgh, EH12 5HD, UK University of Dundee, 11 Airlie Place, Dundee, DD1 4HT, UK c Society and College of Radiographers, PO Box 29434, Glasgow, G67 9AT, UK b
Received 22 December 2009; revised 17 February 2010; accepted 24 March 2010 Available online 24 April 2010
KEYWORDS Role development; Radiographer; Mentorship; Trainee assistant practitioner; Evaluation
Abstract Purpose: The aim of this study was to evaluate the experiences of diagnostic and therapeutic radiographers as they mentored trainee assistant practitioners undertaking an educational programme. The evaluation study describes the challenges and benefits the radiographers experienced as mentors as well as giving their insights into the introduction of assistant practitioners in their departments. Method: The mentors’ opinions were sought by a questionnaire which formed part of the evaluation of the respective diagnostic imaging and therapeutic educational programmes run by two colleges. Results: The response rate was 54% (22/41). Mentors described personal and professional benefits for themselves from undertaking this role. Although mentoring had provided a number of challenges including an increase in workload, the experience had also enhanced their teaching and mentoring skills and contributed to their Continuing Professional Development (CPD). Whilst the role was more time consuming than initially expected this had not impacted generally on their ability to undertake CPD or deliver patient care. In relation to the wider impact of the programmes some negative impact was reported on the speed of service delivery but not on the quality of practice. Mentors felt that the programmes had a positive effect on teamworking and had been beneficial for patient care. Some difficulties were noted in balancing the mentoring of trainee assistant practitioners and radiography undergraduates. Conclusion: The mentors strongly endorsed the educational programmes and their roles and responsibilities in their delivery. Protected time to carry out mentoring duties and establishing good communication with the colleges providing the theoretical teaching were identified as means of further improving the mentoring process. ª 2010 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: þ44 131 313 8091; fax: þ44 131 313 8001. E-mail address: [email protected] (I. Colthart). 1078-8174/$ - see front matter ª 2010 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2010.03.004
224
Introduction A scoping exercise was undertaken by NHS Education for Scotland (NES) in 2004 which examined role development for radiographers and support workers in Scotland. Its findings included the identification of a lack of pathways and educational opportunities and mechanisms for developing support workers to take on the role of assistant practitioner (AP).1 In response to this situation the then Scottish Executive Health Department (SEHD) commissioned the Scottish Qualifications Agency (SQA) to develop two Higher National Certificates (HNCs) in diagnostic imaging and radiotherapy to prepare support workers for the AP role. The HNCs were approved by the College of Radiographers (CoR) in June 2006 and initiated in January 2007. NES and the Scottish Executive Health Department jointly funded the HNC programmes. An evaluation was undertaken of the HNC programmes to assess their content and collect information on the shortterm impact of the programmes on radiography practice and current AP roles so that changes to these can be evaluated in the future. An integral part of the evaluation was capturing the views of the radiographers who had mentored the trainee assistant practitioners (TAPs). This paper reports on their mentoring experiences.
The educational programmes The HNCs were made up of 9 core common units, one workbased unit and 3 specialised units for diagnostic imaging and radiotherapy respectively and were undertaken by 34 TAPs at Stow (n Z 24) and Dundee (n Z 10) Colleges. The course required one day attendance at college and 2 days of work-based learning per week. The remaining time was spent in their normal role as a helper or assistant. The TAPs were supervised and mentored by Health Professions Council (HPC) registered radiographers for the work-based element of their training. All TAPs successfully completed the programmes which concluded in January (Stow) and February (Dundee) 2009 respectively. The 100% completion rate is regarded as exceptional for an HNC programme. The evaluation sought the views of a range of stakeholders, namely the TAPs, mentors, radiography managers and educationalists responsible for delivering the programmes. Mentors played an integral part in the programmes given the emphasis on work-based learning and furthermore the importance of their role in supporting the TAPs was highlighted in the feedback received in earlier monitoring reports. The mentors were able not only to give a close-up view of the TAP’s experience of the programmes but also the impact on them personally from undertaking this role.
Mentoring There are a number of definitions of mentoring in the literature.2 A straightforward definition is “support offered by an experienced professional nurturing and guiding the novice”.3 This involves an experienced professional developing the career of their mentee. Mentoring is not the same
I. Colthart et al. as teaching and also distinct from other related activities of clinical supervision, appraisal and assessment.2 Practice education of other members of the healthcare team, which includes mentoring, is a pivotal and explicit role of a registered radiographer4,5 and evidence of ongoing Continuing Professional Development (CPD) relating to education may be required. It is recognised that the mentors in these programmes, by virtue of their role, could pursue accredited status from CoR which is a further opportunity to evidence CPD.6
Method Data was collected by a self-completion questionnaire drafted by the authors. A questionnaire was chosen as the most appropriate method to collect detailed information from mentors dispersed throughout Scotland. Prior to the questionnaire’s distribution in March 2009 it was reviewed for relevance and validity by an existing mentor. This limited piloting was deemed appropriate given the level of the evaluation and the radiography expertise of the authors. The questionnaire sought information on: the radiographer’s clinical role and that as a mentor; challenges and benefits resulting from mentoring; the impact of mentoring on them as individuals; the TAPs’ performances and their impact in their radiography departments; an overall assessment of the programmes and suggestions for improvements. As there was no central record of mentors available a list was drawn up from a variety of sources including a list provided by one of the colleges, those identified in the Service Level Agreements between NES and individual NHS boards at the outset of the programmes and by personal contact with radiography managers. A total of 42 were identified from these sources. Advice was sought from the National Research Ethics Service (NRES)7 on whether the evaluation would require ethical review from a NHS Research Ethics Committee given that it involved the participation of NHS staff. NRES classified the evaluation as an educational (service type) evaluation and not research per se which meant that ethical review would not be required. However it was recommended that approval to conduct the evaluation should be sought from local NHS boards’ research and development offices. This was duly done through NHS Research Scotland (NRS)8 a central body who co-ordinate research and development applications. NRS confirmed the project as service evaluation which would not require ethical approval.
Results Twenty two questionnaires were returned giving a response rate of 54% (22/41) with one questionnaire being returned as undeliverable. The respondents gave a valuable insight into the process and demands on them during their mentoring experiences.
Profile of mentors Mentors had been in their current clinical role for an average of 9.5 years ranging from 6 months to 40 years. The
Mentoring assistant practitioners mentor’s job titles are: radiographer (n Z 5); senior radiographer (n Z 7); specialist radiographer (n Z 1); superintendent radiographer (n Z 8); clinical specialist (n Z 1). The mentors predominately represented diagnostic imaging (n Z 21) with one from radiotherapy. The majority work full-time (n Z 15) with the remainder part-time (n Z 7). Respondents came from 7 out of 8 health boards receiving funding from NES and there was an almost even split with the mentors’ TAPs attending Dundee (n Z 10) and Stow (n Z 12) Colleges. Mentors had an average of 6 years experience in any mentoring role ranging from 1 year to 28 years. Four were exclusively mentoring TAPs with the remainder (n Z 18) mentoring a combination of TAPs and radiography undergraduate students. Given this experience the majority (n Z 15) felt prepared for mentoring on the AP programmes
Benefits of mentoring in terms of personal and professional development Almost all mentors (n Z 19) identified personal and professional benefits. Examples of personal benefits were enjoyment of working with the trainees, appreciation of feedback received from the TAPs, a sense of reward, pride and achievement in seeing their TAPs successfully complete the programmes. In professional development terms a number of benefits were identified which related to technical aspects of radiography and those associated with mentoring and teaching. Mentoring had meant that several had to reassess their theoretical and technical skills and update these as appropriate. In diagnostic imaging this entailed having to explain how equipment works and why a particular technique is used. Specific examples of updating knowledge and skills were positioning skills and having to understand more fully the technical aspects of digitisation and its impact on image production and interpretation. No particular examples were identified by the radiotherapy mentor. Teaching and mentoring skills were also recognised as having been enhanced by participating on the programmes. Interestingly one mentor indicated that different skills were required to mentor TAPs and radiography undergraduate students respectively. Mentoring had also given the mentors an understanding of the AP role, their scope of practice and an appreciation of the contribution they can potentially make.
Challenges for the mentors The major challenge reported by mentors (n Z 15) was the amount of paperwork associated with the programmes and in particular the number of assessments (n Z 80) which had to be completed by the students. Paperwork was described in one case as being “excessive and unwieldy” with a recommendation to revise the assessment forms. The number of practical assessments required also came in for criticism as being “laborious and repetitive”. Other individual challenges noted included: having to think as a student in explaining procedures and not just acting automatically; lack of protected time to mentor; dealing with other staffs’ perceptions and attitudes towards the introduction of APs.
225
Assistance in being a mentor The mentors identified two common areas when asked what would have assisted and supported them in their role. The first of these was the provision of protected time to undertake mentoring which would have allowed the mentors to devote more of their attention to this task. Limited or no protected time for the mentor’s educational role is at odds with many Scottish and UK policy drivers.9 The second area was a better understanding and knowledge of the content of the theoretical teaching which would have given the mentors more clarity in knowing what the TAPs had covered and importantly what levels of competence and performance were required. The relationship between the college and the clinical department is recognised as being important to the successful operation of work-based learning programmes.10 Both colleges however did provide a series of formal meetings with the mentors prior to the commencement and during the delivery of the programmes. The aim of these meetings was to discuss the academic content and the clinical delivery and assessment of their students. The college clinical co-ordinators also made regular visits to all of the radiology and oncology departments during the programmes. These visits included meetings with the mentors, radiography managers and TAPS in order to evaluate and assess their clinical experience.
Impact of being a mentor A number of aspects were explored in relation to the impact on themselves as individuals of being a mentor on the programmes: workload; time required for mentoring APs; protected study time for CPD; patient care. The intention was to compare these aspects at the beginning of the programmes in 2007 and at the time of the evaluation (March 2009) in order to record any impact. Almost all mentors indicated that the beginning of the programmes had led to either an increase (n Z 15) or a larger increase (n Z 5) in their workload than they had anticipated (Fig. 1). Over time this had declined with nine mentors indicating their workload was showing an increase at the end of the programmes. Despite a larger workload for most at the beginning of the programmes there was a spread of time devoted to mentoring at this stage. Nine mentors reported spending more time then they expected at the outset, eleven about what they expected and two less than expected. At the end of the programmes (Fig. 2) only three mentors were spending more time than they had anticipated with most (n Z 14) devoting the amount of time they expected. Although there was some evidence of mentors devoting more time than they had anticipated to the programmes this did not appear to have had a detrimental effect on their protected time for CPD (Fig. 3). At both time periods the majority (n Z 16) reported that it had no effect with three mentors reporting a beneficial effect and just one a very detrimental effect. However the fact that the majority was reporting no impact should be treated with a degree of caution in that seven mentors commented they received no protected time for CPD as a rule.
226
I. Colthart et al. Comparison of Mentor Workload at Beginning and End of Programmes (n = 22) 16 14 12 10 8 6 4 2 0 Large Increase
Increase
No change
Large Decrease
End of Programme
Beginning of Programme
Figure 1
Decrease
Comparison of mentor workload at beginning and end of programmes (n Z 22).
In terms of their mentoring role impacting on their ability to deliver patient care, only one reported a detrimental effect with the majority reporting no impact (Fig. 4). The detrimental effect related to a slowing down of service. Four mentors agreed that it had had a positive effect. In assessing the overall impact on the mentors of taking part in the programmes it is informative to consider the views of the radiography managers (n Z 3) who took part in the evaluation. The managers reported that the impact of the programmes on mentors was “huge”. In one instance a mentor had made a large personal commitment to the TAPs by working on into the evening after hours to complete their own work. It would be difficult to envisage this level of personal commitment being repeated again.
Trainee assistant practitioner’s impact on the department The perceived wider impact of the programmes on four particular aspects of the diagnostic imaging and radiotherapy departments’ operations were gauged: number of procedures undertaken; efficiency; teamworking; the patient experience (Fig. 5). In terms of the number of procedures undertaken the majority of mentors indicated no impact (n Z 16) but there was evidence of a detrimental effect (n Z 4) but equally also a beneficial impact (n Z 2). Similarly there was an even distribution of opinion on efficiency in the department with a detrimental impact identified by 6 mentors, no
Comparison of Time Devoted to Mentoring at Beginning and End of Programmes (n = 21) 14 12 10 8 6 4 2 0 Much more than I expected
More than I expected
About what I expected
Beginning of Programme
Figure 2
Less than expected
Much less than I expected
End of Programme
Comparison of time devoted to mentoring at beginning and end of programmes (n Z 21).
Mentoring assistant practitioners
227
Comparison of Impact of Mentoring on Protected Time for CPD at Beginning and End of Programmes (n = 20) 16 14 12 10 8 6 4 2 0 Very detrimental
Detrimental
No impact
Beginning of Programme
Figure 3
Beneficial
Very beneficial
End of Programme
Comparison of impact of mentoring on protected time for CPD at beginning and end of programmes (n Z 20).
impact identified by 9 and a beneficial effect by 7. The limited detrimental effects on the number of procedures and efficiency reflected the previous health board monitoring reports where some negative impact was reported on the speed of service delivery but not the quality of practice. Whilst a relatively balanced range of impact was noted in the number of procedures undertaken and efficiency, more positive effects were evident in the other two areas. The largest positive effect was observed in teamworking with 15 mentors noting a beneficial outcome from the programmes. Similarly half of the mentors (n Z 11) felt the programmes had been beneficial for the patient’s experience in their department.
Impact on radiography undergraduates Anecdotal evidence suggests the introduction of the APs’ programmes may have implications for the training of radiography undergraduates who are on placement in the radiography department at the same time. The two groups both require clinical practice and mentoring time which may lead to competition for the same resources. Seventeen of the mentors reported mentoring radiography undergraduates at the same time as TAPs. The mentors were asked whether the time they had spent with the TAPs had affected the undergraduate’s training. Mentors who expressed an opinion were divided on this issue with eight thinking there was no effect and seven identifying some effects.
Comparison of the Impact of Mentoring on the Ability to Deliver Patient Care at the Beginning and End of Programmes (n = 20) 18 16 14 12 10 8 6 4 2 0 Very detrimental
Detrimental
No impact
Beginning of Programme
Beneficial
Very beneficial
End of Programme
Figure 4 Comparison of the impact of mentoring on the ability to deliver patient care at the beginning and end of programmes (n Z 20).
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I. Colthart et al. Mentors' Perceptions of the Impact of the Programmes on their Departments (n = 22) 16 14 12 10 8 6 4 2 0 Very detrimental
Detrimental
Procedures undertaken
Figure 5
No impact Efficiency
Beneficial
Teamworking
Very beneficial
The patient's experience
Mentors’ perceptions of the impact of the programmes on their departments (n Z 22).
Those who thought there had been no effects were clear that both had been treated equally and that there were enough facilities and clinical experience to cater for both groups. Conversely those who intimated that TAPs had affected radiography undergraduates training cited general issues such as clinical tutor’s time being spread more thinly, logistical problems in moving staff around to accommodate both groups and competition for suitable patients to X-ray.
Overall impression of the programmes Mentors were asked if the programmes had achieved their objectives of preparing the trainees to work as APs. There was a strong endorsement of the programmes in meeting this fundamental aim with mentors being of the opinion that it had completely (n Z 6) or mostly (n Z 13) achieved this. The mentors themselves indicated strong levels of approval with most being either satisfied (n Z 16) or very satisfied (n Z 4) with their involvement in this role.
Discussion In considering the outcomes from this evaluation it is important to appreciate its strengths and limitations. The response rate of the mentors was good but they could not all be identified to be contacted. The evaluation predominately reflects the views of diagnostic imaging mentors due to the small numbers of radiotherapy TAPs involved in the programmes. In terms of the representativeness of the mentors they were drawn exclusively from mainland health boards. This evaluation is essentially a “snapshot” measure and planned ongoing future evaluation activity will enable NES to chart the impact of the programmes on this original cohort more fully over time. For example the now qualified APs “freeing up” time which will allow radiographers to carry out the more complex radiological and oncology
procedures. The evaluation relied on self-reporting which is not ideal but sought the views of a range of stakeholders to give a rounded perspective of the programmes. The evaluation has provided baseline information and has offered answers to a number of questions at the present time including the impact of the programmes on mentors. All participants in the evaluation endorsed the programmes as having met their fundamental objectives of equipping the trainees with the skills and knowledge they need to function as an AP. The hard work and dedication of the mentors was recognised as pivotal to the TAPs achieving their goals given that half of the education programmes were taught in the clinical environment. The mentors had found the numbers of clinical assessments demanding but nearly all identified benefits for themselves in terms of personal and professional development. The major impact for mentors was on workload with evidence of some underestimating the time that would be required to undertake this role. However the outcomes of devoting time to mentoring seem to have little impact on their own time for CPD and their ability to deliver patient care. In fact in both these areas there was a marginally more positive than negative effect and indeed undertaking the role had contributed to the mentors’ CPD. In looking forward the radiographers identified means of improving the mentoring process. In terms of identifying the wider impact of the APs it was too early to gauge changes in radiography practice at the time of the evaluation. This is in part due to the levels of supervision that the APs were working under and a lack of evidence at this relatively early stage. However the contribution of the APs to the work of the departments was recognised by the mentors. Benefits were identified in terms of improved teamworking and a better patient experience. Within some departments there was evidence of the TAPs impacting on radiography undergraduate students’ training and this is an issue which deserves further investigation.
Mentoring assistant practitioners
Conclusion The evaluation presents a balanced picture of the successes and challenges resulting from the radiographers’ assessments of their participation as mentors for the HNC programmes in diagnostic imaging and radiotherapy. The mentors were positive about their experience of mentoring on the programmes which they believed had benefitted themselves personally and professionally and successfully prepared the trainees to become APs. The mentors identified the provision of protected time and better knowledge of the theoretical teaching the TAPs were receiving at college as a means of improving their ability to carry out this role.
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