Factors affecting quality of midwifery students learning in the workplace: Results of two ICM congress workshops

Barriers to clinical learning skills development among midwifery students and newly qualified midwives in Morocco: A qualitative study

Background

In Morocco, despite various initiatives to improve the quality of reproductive healthcare, the indicators remain unfavorable. To strengthen the skills of midwives and support the achievement of Millennium Development Goals (MDGs) 4 and 5 by 2030, Morocco has developed and implemented a competency-based training framework. However, there is a lack of information on the successful implementation of this program and its impact on the quality of student midwives' preparation for practice.

Objective

This study aimed to gain a deeper understanding and explore the barriers affecting the development of clinical learning skills among midwifery students and newly qualified midwives.

Methods

This study employed a descriptive, exploratory qualitative approach. Data were collected through nine focus group discussions with 30 midwifery students and 24 newly graduated midwives between April and June 2023 from six higher education institutions in northern and central Morocco. Inductive content analysis was used to analyze the transcribed discussions.

Results

The barriers varied between locations. Overall, the internship design was inadequate, and the clinical environment was insufficient. Participants highlighted limited opportunities to experience the full range of midwifery skills. However, most midwifery students and new graduates had deficient competencies in managing high-risk situations and emergencies.

Conclusion

This work provides an overview of the nature and extent of the challenges faced by many student midwives in Morocco, resulting in newly graduated midwives being poorly prepared for the full range of midwifery practice. These findings can inform various initiatives to strengthen midwifery education at the global, regional, and national levels.

Opportunities and challenges in clinical learning of midwifery students in public Universities of Tigray Region, Ethiopia, 2020: a qualitative study

BACKGROUND

Clinical learning focuses on real problems in the context of professional practice in which learners are motivated by its relevance and active participation. Studies showed that midwifery students were challenged by the absence of a variety of cases in non-teaching hospitals, overcrowded teaching hospitals, absence of objective-based evaluation methods, and lack of supervision from clinical instructors. If the theory learned in class was applied in practice, it is helpful to produce skillful and competent midwifery professionals. The aim of this study was exploring opportunities and challenges for midwifery students in the clinical learning environment.

METHODS

the study was conducted in public Universities of Tigray, Ethiopia. Phenomenology study design and purposive sampling technique were employed; four focused group discussions and five key informant interviews were conducted. Data were collected using an open-ended guide, transcribed verbatim, entered into ATLAS ti7 software, and translated. Then codes and themes were derived from the transcribed data, and finally analyzed thematically.

RESULTS

a total of 33 participants in which 28 in four focused group discussions and five key informant interviews participated in this study. Based on the result, midwifery students were getting opportunities to practice when they were assigned to non-teaching hospitals, working with close supervision, having smooth relationships with staff, receiving constructive feedback, and evaluated based on their skills. Whereas, they were challenged by aggressive staff, poor follow up, overcrowded teaching hospitals, low usage of skills lab, and short time for clinical practice.

CONCLUSION

Midwifery students have positive attitude, and were getting opportunities to practice while they were assigned to a very conducive clinical learning environment with supportive and skillful clinical instructors/ preceptors. However, they have negative attitude, and were challenged to work due to the poor attention given to midwifery students' clinical learning. It is recommended that midwifery students have to practice well in skills lab before they assigned for clinical practice so that the skills lab have to be strengthen with all necessary materials for clinical practice and clinical instructors have to be integrated to teaching hospitals so as to educate students while their hands-on.

When theory beats practice: the implementation of competency-based education at healthcare workplaces : Focus group interviews with students, mentors, and educators of six healthcare disciplines

BACKGROUND

Work-integrated learning constitutes a large part of current healthcare education. During the last decades, a competency-based educational (CBE) approach has been introduced to reduce the theory-practice gap and to promote continuous competency development. Different frameworks and models have been developed to support CBE implementation in practice. Although CBE is now well-established, implementation at healthcare workplaces remains complex and controversial. This study aims to explore how students, mentors, and educators from different healthcare disciplines perceive the implementation of CBE at the workplace. The six-step model of Embo et al. (2015) was used as a base: (1) competency selection, (2) formulating learning goals, (3) self-monitoring performance, (4) self-assessing competency development, (5) summative assessment of individual competencies, and (6) summative assessment of global professional competence.

METHODS

Three semi-structured focus group interviews were conducted with (1) five students, (2) five mentors, and (3) five educators. We recruited participants from six different educational programs: audiology, midwifery, nursing (associate degree and bachelor), occupational therapy, or speech therapy. We used thematic analysis combining an inductive and deductive approach.

RESULTS

An overview of the predefined competencies was hard to find which complicated CBE implementation and resulted in a lack of consistency between the steps; e.g., the link between the selection of relevant competencies (step 1) and the formulation of learning goals based on these selected competencies (step 2) was absent. Furthermore, the analysis of the data helped identifying seven barriers for CBE implementation: (1) a gap between the educational program and the workplace, (2) a lacking overview of predefined competencies, (3) a major focus on technical competencies at the expense of generic competencies, (4) weak formulation of the learning goals, (5) obstacles related to reflection, (6) low feedback quality, and (7) perceived subjectivity of the assessment approach.

CONCLUSION

The present barriers to CBE implementation lead to a fragmentation of current work-integrated learning. In this way, theory beats practice when it comes to CBE implementation as the theory of CBE is not effectively implemented. However, the identification of these barriers might help to find solutions to optimize CBE implementation. Future research seems critical to optimize CBE so that theory can meet practice and the opportunities of CBE optimize healthcare education.

Structural empowerment of midwifery students following simulation-based training of management of obstetric emergencies

BACKGROUND

Having the ability of managing obstetric emergencies is the necessary capability for providing care during labor and delivery.Simulation is considered to be a valuable strategy for empowering midwifery students in managing emergencies. So, this study was conducted to determine the structural empowerment of midwifery students following the simulation-based training of management of midwifery emergencies.

METHODS

This semi-experimental research was conducted from August 2017 to June 2019 in the Faculty of Nursing and Midwifery, Isfahan, Iran. 42 subjects of the third-year midwifery students were included in the study through convenience sampling method (n = 22 in the intervention group, n = 20 in the control group). Six simulation-based educational sessions were considered for the intervention group. Conditions for Learning Effectiveness Questionnaire, was used at the beginning of the study, one week after it and one year later. Repeated measures ANOVA was used to analyze the data.

RESULTS

In the intervention group, the significant difference was observed between the mean score of the students' structural empowerment before and after the intervention (MD=-28.41, SD = 3.25) (p < 0.001), before and one year after the study (MD=-12.45, SD = 3.47) (p = 0.003), and immediately after and one year after the study (MD = 15.95,SD = 3.67) (p < 0.001). In the control group, no significant difference was observed. Before the intervention, there was no significant difference between the mean score of the students' structural empowerment in the control and intervention groups (MD = 2.89, SD = 3.50) (p = 0.415); but, immediately after the intervention, the mean score of structural empowerment in the students of the intervention group was significantly higher than those of the control group (MD = 25.40, SD = 4.94 ) (p < 0.001). One year after the study, there was no significant difference between the two groups in terms of the mean score of the structural empowerment (MD = 6.89, SD = 3.58 ) (p = 0.061).

CONCLUSION

Simulation contributed to the structural empowerment of midwifery students by providing the opportunity for personal and professional growth and strengthening of the formal and informal power in the area of midwifery emergency management but these benefits were not seen at one year.

Implementing midwifery services in public tertiary medical college hospitals in Bangladesh: A longitudinal study

BACKGROUND

A necessary precursor for quality maternity care provision is high quality education. The quality of care that students are exposed to during clinical education on maternity wards shapes their competencies and professional identities. In this study, we look at the introduction of midwives educated to international standards - with facility mentorship - deployed in tertiary level teaching hospitals in Bangladesh with the intention of improving the use of World Health Organization (WHO)-recommended birth practices.

AIM

To examine the outcomes of introducing midwifery services into tertiary level care facilities in Bangladesh, on the use of WHO-recommended birth practices.

METHODS

A retrospective review of patient register data was carried out to understand level of changes in use of WHO-recommended birth practices after the introduction of a midwifery service. Multivariate linear regression was applied using an interrupted time series analysis, with and without a delayed effect, to assess both level and trend change following the introduction of the midwifery service.

FINDINGS

A significant increase (p < 0.001) in use of WHO-recommended birth practices was found, both immediately following the midwives' introduction and after one year. Quality improvement was observed not only in births attended by midwives, but also in those attended by doctors and nurses.

CONCLUSION

By introducing quality maternity care provision through midwives in clinical sites, especially in tertiary-level care hospitals with large numbers of students, international standard midwives can improve the quality of clinical education in maternity wards, a critical priority for maternal health worldwide.

Midwives' experiences of completing written feedback: The emotions, challenges and solutions

AIM

Written feedback is a valued learning tool for midwifery students, providing information on clinical performance with the aim to improve future practice. One aim of this study was to explore the experiences of midwives in completing written feedback in the clinical setting.

DESIGN

This qualitative study is situated within a hermeneutic phenomenological framework.

METHODS

Data were collected through focus groups and individual interviews, then transcribed and subjected to thematic content analysis.

RESULTS

Three interconnected themes of Emotions, Challenges and Solutions were identified. Midwifery participants experienced strong emotional reactions (anxiety, guilt, frustration) around the completion of written feedback in the clinical setting due to four challenges (lack of time, continuity, clarity of feedback content and direct supervision), which resulted in solutions being employed to offset or minimise problematic written feedback.

CONCLUSIONS

Completing written feedback in the clinical setting was a challenging experience for participants in this study, affecting their ability to do so in some cases. This is concerning as the literature is supportive of the positive impact written feedback has on the growth and potential of students.

Effective Clinical Teaching Practice and Associated Factors Among Midwifery Educators in Public Universities of Ethiopia: Institution-Based Cross-Sectional Study

BACKGROUND

Although effective clinical teaching realistically improves learners to be competent, in Ethiopia only 31.6% of midwifery graduates have passed the national proficiency standard for graduation. Likewise, research evidence is lacking on effective clinical teaching practice of midwifery educators in Ethiopia.

OBJECTIVE

This study aimed to assess effective clinical teaching practice and associated factors among midwifery educators in public universities of Ethiopia.

METHODS

Institution-based cross-sectional study was conducted in April 2019 on 424 midwifery educators selected by simple random sampling technique. Data were collected through email by using a semi-structured, pretested, self-administered questionnaire, entered into Epi-data version 4.2, and analyzed by SPSS version 23. Bivariate and multivariable logistic regression analyses were done to test the association. The odds ratio at 95% confidence interval (CI) and P-value <0.05 were used to ascertain statistical significance.

RESULTS

Only 178 (47.3%) of participants had effective clinical teaching practice. Clinical teaching experience (AOR= 4.72; 95% CI=1.97, 11.29), training on higher diploma in teaching profession (AOR=2.78; 95% CI=1.61, 4.82), clinical teaching workshop (AOR=4; 95% CI=1.98, 8.05), students per clinical unit (AOR= 3.71; 95% CI= 1.66, 8.26), giving objectives of clinical learning for students (AOR= 4.74; 95% CI=2.43, 9.25), using performance-based assessment tool (AOR =1.82; 95% CI=1.04, 3.16) and having good interest in clinical teaching (AOR=8.63; 95% CI=2.91, 25.56) were factors positively associated with effective clinical teaching practice.

CONCLUSION

Less than half of midwifery educators of Ethiopian Public Universities had effective clinical teaching practice. The educators' clinical teaching experience, training, and adherence to clinical teaching standards were identified to affect effective clinical teaching positively. Therefore, educators should adhere to the standards for effective clinical teaching and receive training on effective teaching.

Learning experiences of final-year student midwives in labor wards: A qualitative exploratory study

INTRODUCTION

Clinical placements are an integral part of midwifery education and are crucial for achieving professional competencies. Although students' experiences on placements have been shown to play a meaningful role in their learning, they have received scant attention in the literature. The aim of this paper is to describe the learning experiences of final-year student midwives in labor wards within the Brussels metropolitan region, Belgium.

METHODS

A qualitative exploratory study was conducted using two focus groups (N=20). Data analysis included: transcription of audio recordings, thematic content analysis with coding into recurrent and common themes, and broader categories. Discussions among researchers were incorporated in all phases of the analysis for integrity and data fit.

RESULTS

Data analysis identified the following categories as determining student learning experiences in labor wards: 1) managing opportunities, 2) being supported, and 3) dealing with the environment. Overall, respondents were positive and enthusiastic about their learning experiences, although some felt tense and unprepared. Students expressed concerns about differences in learning opportunities between placements and found it challenging to achieve all competencies. Student learning experiences were enhanced when they had placements for longer periods with the same supportive mentors.

CONCLUSIONS

Factors related to students' functioning, the healthcare professional, midwifery education and hospital environment affected their learning in labor wards. The combination of a more persevered preparation of students and mentors, together with a student-centered organization of placements, is crucial to create a positive learning experience for midwifery students in labor wards.