The breast services team is celebrating the success of Karen Coates, their first colleague on the Mammography Associate apprenticeship scheme, who has achieved her qualification with distinction.
The 12-month Mammography Associate (MA) Level 4 apprenticeship course is hosted by the NBIA at Wythenshawe Hospital’s Nightingale Centre, part of Manchester University NHS Foundation Trust (MFT), and delivered by Health Education England.
Together with Karen, radiographer Gemma Ingram (who also has training and management responsibilities) plus trainer and mentor Katie Horton share their experience of the programme, and the benefits it can offer breast tnit teams.
Our breast services department is a large team, with around 76 staff including:
- Managers and admin staff
- Consultant and assistant practitioners/mammography associates
- Breast care nurses
Each week, the service has capacity for 180 two-week rule symptomatic appointments, around 50 follow ups and 15-20 family history appointments. Around 45,000 women each year are invited for screening using four mobile and two static satellite sites. Both Gemma and Katie have worked in the team for over a decade.
Gemma and Katie’s background
Gemma started as a radiographic assistant in 2007, took on an assistant practitioner role in 2008 and then completed a degree in diagnostic radiography. As a radiographer she is now developing her advanced practice, spends 30% of her time in a management role and is also the training team lead.
Katie joined the Trust straight after qualifying in 2011, and is a member of the training team and mentor to some of the trainees in the department. She trains assistant practitioners/mammography associates and radiographers in both screening and symptomatic clinics, carries out image assessments and quarterly image reviews with all staff members.”
Karen is a relative newcomer to the team, joining in February 2019. She explains: “I started off working in the breast unit as a chaperone and loved the patient contact.
“I found myself wanting to learn more and was really interested in the imaging side of things. I began asking more questions regarding the mammograms and this led to me shadowing a mammographer. Then a job was advertised and my consultant colleagues encouraged me to apply. I got the job which I was amazed at, as I had only worked for the breast unit for four months and I have never looked back since.”
Implementing the apprenticeship programme
The Trust encourages its services to use the apprenticeships provided through the national tax levy, which are shared out amongst the whole care group/directorate.
Gemma and her colleagues assessed the mammography associate apprenticeship to ensure it met their needs.
She said: “The course appeared to have more elements to learn than previous courses and more focus on policies, QA and physics etc.
“The 20% theory aspect has provided time for the candidates to learn all aspects of the role in more detail.
“Whilst we always encourage all staff to have a good knowledge of all aspects with a preceptorship document to evidence this, the fact that the apprenticeship course tests the candidate’s knowledge encouraged them to really learn and be aware of all they were doing.”
Gemma found several aspects of the apprenticeship programme helpful in developing Karen’s skills. These included the focus on consent, confidentiality, policies, practical work and ergonomics. The more reflective approach and more evidence of knowledge required ensured good learning across the whole role. There was also excellent communication and reassurance from the team in Manchester.
The mentor-mentee relationship
Gemma commented: “Karen has had consistent contact throughout the course with the providers, which has been helpful as she struggled with her confidence and had lovely staff to support and encourage her from both our Trust and MFT.
“The communication and dedicated catch up points were really good. In previous courses the interaction had been mostly towards the end of the course when the candidates were close to qualifying, but keeping abreast of numbers and performance has really helped keep Karen on track throughout. The trainers have also maintained good relationships with the course providers and have been able to effectively seek advice throughout.”
The training programme also offered an extension beyond 12 months, to accommodate Karen as a part-time trainee, working four rather than five days a week.
Karen says: “Knowing I had the extension of the programme to compensate for working part-time reduced the pressure and put you at ease as things can come up unexpectedly.”
“I just made sure I was organised when it came to my assignments. And I was also prepared to do some study in my own time at home, especially preparing myself for the Maths and English exam. I needed the qualifications to reach my End Point Assessment (EPA).”
Adapting to the Covid-19 challenges
Inevitably, the pandemic brought significant changes to the mammography associate apprenticeship programme, as Karen outlines.
“Before the pandemic, we were having regular visits to Manchester for our training days with the girls who were also on the course. It was great to chat and support each other. And knowing you’re not the only one that finds training difficult at times.
“I have really enjoyed learning a new skill and increasing my knowledge. I’ve learnt so much more about the patient pathway leading up to and after a cancer diagnosis. I feel my confidence levels have increased and I can support the patient better.
“Due to the pandemic, we stopped screening for over three months so this had a massive effect on my training and my confidence. Many of the staff were sent to join different teams to help staff on the Covid wards. There were also staff shortages due to people self-isolating so I had to assist in ultrasound many times. Working with full PPE was challenging at times especially during the heat wave.”
Gemma did find some positives in the situation. “A good continuation of studies was maintained throughout. We were able to provide more time for the 20% theory during the suspension of screening to maximise the practical training when we were able to resume, and Karen attended lectures online from home.
“I was able to carry out the visual assessment as part of Karen’s EPA. I had advice around how to complete the documents and provide the kind of examples required.
This was very convenient and minimally disruptive and I feel Karen felt less stressed with it not being a stranger observing her.”
Mentoring makes a significant difference
Reflecting on her decision to get involved in the mammography associate apprenticeship programme as a mentor, Katie says: “I was interested in becoming a mentor as I find it rewarding to share my experience with new members of staff and watch them develop into competent, confident members of the team. I’ve previously mentored new staff members but Karen is the first in an apprenticeship post.
“The mentoring role involves working with the apprentice from learning how to perform a mammogram through to working confidently and independently. We have monthly progress meeting. We discuss what has gone well and any areas that we feel might need some support.
“When the apprentice completes 100 images we will carry out an image review. We look at image quality, technique and repeat rates in that set of images. This gives both the mentor and trainee an idea of how they are progressing and allows us to identify any training needs. It allows for positive feedback and constructive criticism and identifies areas of strength or weakness. We repeat this process throughout the apprenticeship until the trainee reaches 500 images.
“A major part of the mentoring role is to provide support and encouragement to the apprentice and work with them to help them get the best out of their training. I try to be approachable and accommodating to each individual trainee and recognise that they learn differently.”
Would you recommend mentoring?
Karen said: “I’d encourage people to take up a mentoring position as it is a rewarding and fulfilling role. The only thing to be aware of is that that the mentor plays a more active role in the apprenticeship than we have previously experienced. The mentor will need to set aside a bit more time than they might be expecting.”
Karen agrees that the mentor role is key to supporting a mammography associate apprentice: “Katie was amazing and always professional. She adapted the training to my preferred learning methods, this really helped me as a trainee. I also had a dedicated mentor, Lyndsay Kinnear, from the team in Manchester. I could always contact her for help and support especially on the academic side of things. Both my mentors helped me unlock my potential and boosted my confidence levels when they were low. They were always on hand to help when I needed it either in person, on email or via phone.”
Looking to the future
What’s next for Karen herself and for the mammography associate apprenticeship?
Karen says: “If in the future if I would like to progress to a band 5 the mammography associate qualification has put me on the ladder to achieve this.
“My next step would be to perfect my technique and continue to build my confidence. I will be starting work on follow up mammograms and family history clinics. I aim to be involved in Quality Assurance and Health Promotion. During my training I was adamant I didn’t want to progress on to anything else. But you can never say never!
Gemma added: “We have just appointed an assistant practitioner/mammography associate and will be looking at the apprenticeship route for her training. The main limitation is sharing the apprenticeship levy between the whole care group. We have three staff members who have gone through the apprenticeship route since 2019 within the Breast Unit.”
Do you have any advice for those considering the apprenticeship?
Gemma said: “Go for it! Our apprenticeship candidates have enjoyed the course and felt supported throughout. The communication between the providers, trainees and the training team is excellent. The providers are extremely understanding and patient whilst you adapt to the new approach to learning and give detailed advice around what they need from you as a department.
“Be aware of the additional theory commitment to meet the requirements of an apprenticeship scheme. This is definitely an advantage to the individual but can be planned for around training clinics etc. Candidates also need Maths and English level 2 so if you have candidates within your Trust that may be interested in progressing, make them aware that this would be a requirement.”
Katie has enjoyed her mentoring role, and benefited from supporting Karen. She said: “Overall, I feel that the apprenticeship programme has been a success. It provides the trainees with a good depth of knowledge and prepares them really well for their role. I’ve really enjoyed mentoring Karen. She has been a lovely trainee and I feel that we have both gained from this experience.”
Would you recommend the programme?
It’s also a thumbs up from Karen, who is keen to encourage any potential mammography associate apprentices. “I would definitely recommend the programme. It was great to have not just the practical side of learning how to get a good mammogram and learning how to adapt your technique to achieve this. But having the off-the-job-learning too was brilliant as I have learnt so much which has increased my knowledge. I have visited the path labs, MRI, MDT observed in ultrasound, followed a lady through her journey from referral from her doctor to diagnosis, surgery and her aftercare treatment and many more
“I was one of the oldest on the first apprenticeship and lacked confidence and doubted my ability. But it now proves it doesn’t matter how old you are if you work hard, you’re determined and you put your mind to it, with all the training and support around you. You can achieve all your goals, if I can do it, so can you so just go for it! I am so thankful for everyone involved in my training. I am over the moon and still can’t believe it sometimes that I have qualified.”