Safety first: Factors affecting preceptor midwives experiences of competency assessment failure among midwifery students

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.

The lived experience of being an undergraduate midwifery student in the neonatal unit

OBJECTIVE

The objective of this study is to examine the experience of undergraduate student midwives in the neonatal unit.

BACKGROUND

Clinical experience is an essential component of education for the development of competent midwives. Literature has highlighted the pivotal effects of precepting and how it contributes to student experience. Although there is a plethora of research examining undergraduate student midwives' experience, to our knowledge this is the first study exploring their experience in the neonatal unit.

DESIGN

Based in phenomenology, eight semi-structured interviews were conducted producing rich data.

METHODS

Following informed consent and ethical approval, post transcription, the data were coded using Colaizzi's (1978) framework.

RESULTS

Significant themes and sub-themes emerged such as course design, environmental experience, sources of stress and preceptor experience. The student experience very much depends on the preceptor, how busy the environment is and if appropriately staffed.

CONCLUSIONS

Based on these findings there are suggested recommendations including adjusting the timing and length of the placement and how to improve the environment based on the preceptor-student relationship. Also, suggestions on how consistency and communication can be improved are proposed.

Developing a consensus-based scoring rubric to enhance practice-based assessment of student nurses' clinical competence: A Delphi study

BACKGROUND

Concerns about reliability and validity of practice-based assessment of professional competencies are frequently reported in the literature. Difficulty in understanding competency statements or distinguishing different achievement levels has been found to be a major factor.

OBJECTIVES

To develop a consensus-based scoring rubric based on stakeholders' interpretations of level descriptors for student nurses' professional values competencies.

DESIGN

Two rounds of Classic e-Delphi.

SETTINGS

This study was conducted in a London based university using Bristol Online Survey website as a host.

PARTICIPANTS

100 stakeholders with vested interests in undergraduate pre-registration nurse education were purposefully invited to participate.

METHOD

Round one collected free-text interpretations of the United Kingdom Nursing and Midwifery Council professional values competency statements. Round two used a Likert scale questionnaire to measure the level of agreement to the level descriptor statements generated through round one. Responses were analysed through content analysis in round one and consensus measure in round two. A threshold of 70% agreement to determine consensus was set in advance.

RESULTS

In round one, 47 participants provided their interpretations of the competency statements. In round two, 51 participants completed the questionnaire. All 24 items achieved a strong consensus with 86%-100% of participants agreeing or strongly agreeing with the statements.

CONCLUSIONS

A Delphi study was successfully used to develop a consensus-based scoring rubric with clearly stated descriptors for professional values competency statements. This scoring rubric holds the potential to enhance practice-based assessment across all healthcare professional disciplines.

Validation of the MidACE tool - Students' perceptions of the Midwifery Academic role in clinical environments

BACKGROUND

Situating Midwifery Academics in clinical environments can have an important impact on students' clinical learning. Students' perceptions of this support role in the clinical environment using standardised measures has been under-investigated.

AIMS

To develop and test a tool that measures midwifery students' perceptions of the Midwifery Academic role on clinical learning and development of professional knowledge, skills and clinical capability.

METHODS

A staged process for tool development included draft item generation, review by expert panel for face and content validity and pilot testing with a convenience sample of undergraduate midwifery students. Dimensionality, internal consistency and test-retest reliability were evaluated.

RESULTS

Two hundred and seventy-nine midwifery students completed an online survey (74% response rate). Responses on the ten-item tool loaded strongly on one factor, explaining 69.6% of variance. Cronbach's alpha (0.94) and test-retest reliability (intraclass coefficient=.92; 95%CI .89-.95) were good. Most students agreed that the Midwifery Academic role supported the integration of midwifery theory and practice and critical self-reflection. Areas for improvement included working in partnership with preceptors; assessing students' development; and increased presence in the clinical environment.

CONCLUSIONS

This study established reliability and validity of the Midwifery Academic in Clinical Environments (MidACE) tool. Students perceived Midwifery Academics could contribute further to their professional knowledge, skills and clinical capability through a strong collaborative presence in the clinical environment.

Transparency of assessment decision-making when students are not meeting required levels of proficiency in clinical practice

This paper discusses the context of assessing nursing and midwifery students who are not meeting required levels of proficiency in clinical practice. The paper then outlines an action plan protocol designed to assist supervisors and assessors examine the credibility of their assessment decisions in these circumstances. Development of the protocol draws on a comprehensive review of evidence and original research showing the personal, professional and organizational pressures faced when a student is failing to achieve proficiency in clinical practice. The action plan protocol is suggested as one way of addressing the need to document concerns to enable students to ultimately self-regulate their learning and professional development.