Learning to be a midwife in the clinical environment; tasks, clinical practicum hours or midwifery relationships

Sharing midwifery philosophy through a positive learning environment prepares students for a future providing midwifery continuity of care: A mixed method study

BACKGROUND

Global and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students' access to placements within these models in Australia.

AIM

To evaluate Bachelor of Midwifery students' experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia.

METHOD

A mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken.

RESULTS

Sixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated 'work across the full scope of midwifery practice' and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. 'Experiences prepare me to be a change agent for maternity service reform' rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife.

CONCLUSION

A mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models.

Professional identity: Students' learning from the attributes and behaviours of midwives on clinical placement

BACKGROUND

Midwifery practice experience is an important component of education to develop an understanding of professional identity in midwifery students. The responsibility of supporting student development in the clinical setting is predominantly undertaken by clinical midwives. There is minimal literature relating to the professional identity development of midwifery students.

AIM

To explore midwifery student experiences of the positive attributes of clinical midwives who supported the professional identity development of midwifery students in the clinical practice setting.

METHODS

An Appreciative Inquiry approach guided this study. The setting was a university in Sydney, Australia. Participants comprised thirteen students from a postgraduate midwifery course. Data were collected via individual interviews and analysed thematically. Students had two to six months of placement in the clinical setting.

FINDINGS

Data analysis identified three themes, Putting the woman at the centre of care; Supporting a woman-centred environment and Focusing on student success.

DISCUSSION

Findings from this study revealed that extended time spent with a midwife enabled the student to observe and reflect on the nuances of midwifery practice that are not overtly shared with students. Students were able to observe a midwife's tacit way of being. This paper reveals the positive attributes and behaviours of midwives whose practice the students want to emulate.

CONCLUSIONS

Midwifery students' exposure to positive clinical midwife role models on clinical placement enables them to develop a greater understanding of professional identity.

Development of the essential learning outcomes for the midwifery student continuity of care learning model: A Delphi study

BACKGROUND

In Australia, midwifery students are required to undertake at least ten Continuity of Care Experiences (CoCE) during their education. The learning outcomes of this experience have never been explicit or standardised resulting in inconsistent assessment.

AIM

To develop and identify standardised learning outcomes for the CoCE.

METHODS

A modified Delphi survey was conducted with an expert panel. Intended learning outcome statements were developed, reflecting the learning objectives identified in a previous study. Bloom's taxonomy levels of thinking complexities guided the wording of the outcomes. Participants were asked to rank and rate their level of agreement with each statement over two survey rounds.

FINDINGS

Round one was completed by 32 participants, with 92.5% of the 40 statements reaching consensus. The second round was completed by 23 participants, with 70.7% of the 33 statements reaching consensus. Content analysis of participant comments from each round identified duplicates that were removed and informed refining the wording of some statements. A final set of 15 learning outcomes were agreed upon. The outcomes were broadly grouped within the themes of accountability, advocacy, and autonomy.

DISCUSSION

This study has identified agreed learning outcomes for midwifery students undertaking CoCE. The consensus agreement of experts reinforced the learning model enables the development of woman-centred practice that is underpinned by accountability, advocacy, and autonomy.

CONCLUSION

Purposeful learning outcomes for the CoCE have been developed, informing how the model can be embedded in curricula, guide student learning and assessment to standardise the pedagogy of the model to prepare future midwives.

Impact of women's feedback on midwifery student learning: A thematic analysis of students' reflections

PROBLEM

Little is known about the educational impact of providing routine, online feedback from women on midwifery student learning and clinical practice.

BACKGROUND

Feedback on students' clinical performance has historically been provided by lecturers and clinical supervisors. Women's feedback is not routinely collected or evaluated for impact on student learning.

AIM

To evaluate the impact of women's feedback about continuity of care experiences with a midwifery student on learning and practice.

DESIGN

Descriptive, exploratory qualitative study.

METHODS

All second-and third-year Bachelor of Midwifery students undertaking clinical placement between February and June 2022 at one Australian university, submitted formative, guided written reflections on de-identified women's feedback they received through their ePortfolio. Data were analysed using reflexive thematic analysis.

FINDINGS

Forty-four of the 69 eligible students (64%) submitted reflections on feedback received. Three themes emerged: 1) Confidence boosting, 2) Deeply integrating Midwifery Metavalues, and 3) Enhancing commitment to continuity. Three subthemes: connection, future practice and advocacy were identified. Women's feedback positively impacts student learning and places the woman in the educational feedback loop.

CONCLUSION

This study is an international first evaluating the impact of feedback from women on midwifery students' learning. Students reported greater confidence in their clinical practice, a deeper understanding of their midwifery philosophy, and an intention to advocate for, and work in, midwifery continuity models after graduation. Routine feedback about women's experiences should be embedded into midwifery education programs.

Advocacy, accountability and autonomy; the learning intention of the midwifery student continuity of care experience

PROBLEM

The Continuity of Care Experience is a mandated inclusion in midwifery education programs leading to registration as a midwife in Australia. The practice-based learning experience has evolved over time, yet there remains no standardised learning intentions, objectives, or outcomes for the model.

AIM

To identify the key learning intentions of the Continuity of Care Experience by an expert panel to support the development of learning outcomes.

METHODS

A descriptive qualitative study with two focus groups were conducted with an expert panel (n = 15). Participants were midwifery education subject matter experts on the Continuity of Care Experience with backgrounds in academia, policy development, curriculum design, accreditation, or clinical education. The discussions were transcribed and thematically analysed.

FINDINGS

Three main themes and six sub-themes describe the learning intentions of the Continuity of Care Experience. The main themes were: (1) advocacy for women; (2) accountability of care; and (3) autonomy in practice.

DISCUSSION

The education model of continuity of care enables students to develop midwifery practice that involves advocating for women, being accountable for their care and being autonomous in practice. We have established that during the experience students practice in partnership with women and are exposed to the full scope of midwifery care. Importantly students learn holistic woman-centred practice.

CONCLUSION

The learning intentions of the Continuity of Care Experience reflects woman-centred practice. Having identified a common understanding of the learning intention, these can now be used to design learning, and assessment, through the development of measurable learning outcomes.

Examining the transformation of midwifery education in Australia to inform future directions: An integrative review

BACKGROUND

Integral to quality midwifery practice is the education of midwives. Like other countries, Australia faces ongoing challenges in delivering midwifery education programs. Reasons include escalating program costs, challenges in securing meaningful clinical experiences, subsumption of midwifery with nursing, and associated loss of identity in some institutions.

AIM

To critically examine the literature exploring the historical and current drivers, supports and impediments for entry-to-practice midwifery programs to identify strategies to strengthen midwifery education in Australia.

METHODS

A structured integrative literature review using Whittemore and Knafl's five-stage framework was undertaken; 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation of results.

FINDINGS

The literature search identified 50 articles for inclusion. The thematic analysis identified four key themes: i. a commitment to educational reform, ii. building a midwifery workforce, iii. quality maternity care through midwifery education, and iv. progressing excellence in midwifery education.

DISCUSSION

Extensive literature describes the evolution of midwifery education in Australia over the last 30 years. Through collaboration and amidst opposition, quality midwifery education has been established in Australia. Identification of midwifery as a distinct profession and transformative leadership have been integral to this evolution and must be grown and sustained to prevent a decline in standards or quality.

CONCLUSION

There is a need to address priorities in midwifery education and for the evaluation of midwifery programs and pedagogy. The provision and maintenance of quality education and practice require shared responsibility between education providers and health care services.

Implementing midwifery continuity of care models in regional Australia: A constructivist grounded theory study

PROBLEM/BACKGROUND

Strong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings.

AIM

To develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings.

METHODS

A Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants.

RESULTS

Three concepts of theory emerged: 'engaging the gatekeepers', 'midwives lacking confidence' and 'women rallying together'. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence; this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models.

DISCUSSION

The findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives' reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers.

CONCLUSION

Implementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits.

Medical interns; the neglected learners of the maternity ward learning environment

BACKGROUND

Clinical training during internship is an important part of medical education. The maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology internship to obtain competencies in this field. The present study was conducted to explain medical interns' manner of learning in the maternity ward.

MATERIAL AND METHODS

The present study was conducted using a qualitative approach with the inductive content analysis method. This study observed the maternity wards of teaching hospitals affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through observation and semi-structured individual interviews.

RESULTS

Two main categories and seven subcategories emerged from the analysis of the data. Inadequate participation in learning opportunities included the following three subcategories: the incongruousness of the learning opportunities with the educational goals, inadequate readiness for participation in learning opportunities, and the overlap between learning opportunities and diminished autonomous practice. Inadequate formal and structured education included the following four subcategories: inadequate learning support and direction, subordinate roles and aimless presence, the pale educational role played by the attendants and senior residents, and learning through the support of midwifery educators.

CONCLUSION

Participation in and access to learning opportunities in the maternity ward are very difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and in the company of training supervisors or competent educators to obtain the required competencies in pregnancy and childbirth.

Online learning and teaching approaches used in midwifery programs: A scoping review

OBJECTIVE

The objective of this scoping review was to map and identify existing literature that described online learning and teaching approaches used in midwifery education.

DESIGN

An extensive search of multiple databases and gray literature was undertaken following the JBI standards, using predefined selection criteria and following the PRISMA guidelines.

METHODS

This scoping review included studies published in English between 2010 and 2020 that explored the online approaches to learning and teaching for undergraduate midwifery students. The articles were reviewed by three reviewers and content analysis was undertaken.

RESULTS

Twenty-seven articles were included in the review. Results suggest that student engagement is one of the main components of effective teaching in online midwifery education. Online learning resources need to engage the student and promote two-way communication that facilitates and motivates learning.

CONCLUSIONS

Adequate training and support for academic staff and students is essential for the online delivery of midwifery education.

Continuity of care experiences: A national cross-sectional survey exploring the views and experiences of Australian students and academics

BACKGROUND

Continuity of Care Experiences (CoCEs) are a component of all entry-to-practice midwifery programs in Australia and facilitate an understanding of the central midwifery philosophy of woman-centred care and continuity of the therapeutic relationship. The aim of this research was to explore how CoCEs are viewed and experienced by students and academics across Australia.

METHODS

Students enrolled in Australian midwifery programs and academics who teach into these programs were invited to participate in a cross sectional, web-based survey. Data were analysed using descriptive statistics and free text responses were analysed using content analysis.

FINDINGS

Four hundred and five students and 61 academics responded to the survey. The CoCE was viewed as a positive and unique learning experience, preparing students to work in midwifery-led continuity models and developing confidence in their midwifery role. Challenges in recruitment, participation in care, and balancing the workload with other course requirements were evident in reports from students, but less understood by academics. Significant personal impact on finances, health and wellbeing of students were also reported.

DISCUSSION

The value of CoCEs as an experiential learning opportunity is clear, however, many students report being challenged by elements of the CoCE within current models as they try to maintain study-work-life balance.

CONCLUSION

Innovative course structure that considers and embeds the CoCE requirements within the curricula, in addition to a collective commitment from regulatory bodies, the maternity care sector and Universities to facilitate CoCEs for students may address some of the significant student impacts that are reported by this research.

Clinical outcomes for women who had continuity of care experiences with midwifery students

BACKGROUND

Pre-registration midwifery students in Australia are required to engage in a minimum of ten continuity of care experiences (CoCE). Students recruit and gain consent of each woman to provide CoCE under direct supervision of a registered health professional, usually a midwife. Clinical outcomes for women who had CoCE with a midwifery student placed in a continuity of midwifery care (CMC) or fragmented models are rarely reported.

AIMS

1. analyse clinical outcomes for women experiencing CMC with CoCE by students; 2. analyse clinical outcomes for women in a fragmented care model with CoCE by students; and 3. compare clinical outcomes according to women's primary model of care.

METHODS

Students undertaking a Bachelor of Midwifery program at one Australian university recorded clinical outcomes for women experiencing CoCE during pregnancy [n=5972] and labour and birth [n=3933] in an e-portfolio. A retrospective, cohort design compared student recorded maternal data with National Core Maternity Indicators and Queensland Perinatal Data.

RESULTS

Midwifery students providing CoCE reported better or equal clinical outcomes for women compared to population data. Women receiving CoCE had reduced likelihood of tobacco smoking after 20 weeks of pregnancy, episiotomy, and third and fourth degree tears.

CONCLUSIONS

Clinical outcomes for women in fragmented models of care and receiving CoCE by undergraduate, pre-registration midwifery students are equal to or better than State data across 12 variables. CoCE should be offered to all women early in their pregnancy to ensure optimal benefits. Acknowledging midwifery students' potential to make positive impacts on women's clinical outcomes may prompt more health services to reconceptualise and foster CoCE.

Midwifery students experience of continuity of care: A mixed methods study

BACKGROUND

Continuity of Care Experiences are a mandated component of Australian midwifery programs leading to registration. Despite research evidence of the benefits of Continuity of Care Experiences for student learning and for women, there is limited evidence on the personal impact of this experience to students. Additionally, there is limited guidance on how to best support students to successfully complete this valuable component of their program.

OBJECTIVE

To identify the emotional, psychological, social and financial costs of undertaking the Continuity of Care Experience component of a midwifery program and to provide information which may lead to educational strategies within CoCE aimed to improve student support and alleviate challenges.

DESIGN

Using surveys and diary entries, a convergent parallel mixed methods approach was used to collect qualitative and quantitative data concurrently. Descriptive statistics were used to analyse financial cost, and clinical, travel and wait times. A constant comparative analysis was used for qualitative data about student's Continuity of Care Experiences. Integrative analysis was used to reconstruct the two forms of data.

SETTING

Two Australian universities offering Bachelor of Midwifery programs.

PARTICIPANTS

Seventy students completed the demographic survey and 12 students submitted 74 diaries describing 518 episodes of care. There was a response rate of 18% recorded.

FINDINGS

Analysis identified four themes: perception of Continuity of Care Experiences; personal safety; impact on self and family; and professional relationships. The mean time spent per completed experience was 22.20 hours and the mean cost was $367.19. Although students found Continuity of Care Experiences to be a valuable learning experience, they identified numerous factors including time, money, and personal circumstances that impacted on their ability to successfully meet the requirements.

IMPLICATIONS FOR PRACTICE

Continuity of Care Experiences are a highly valuable, but often challenging component of midwifery education in Australia. Using a model of social interdependence, students, educators and maternity care providers may engage better with the process and philosophies of CoCE.

Learning to be a midwife: Midwifery students' experiences of an extended placement within a midwifery group practice

AIM

To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice.

METHODS

Focus groups were conducted with fifteen third - year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia.

RESULTS

Four main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice.

DISCUSSION AND CONCLUSION

Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned 'how to be a midwife'. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital.

IMPLICATIONS AND RECOMMENDATIONS

Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates' capabilities and competencies 3-5 years post registration should be conducted.

Identifying the priorities for midwifery education across Australia and New Zealand: A Delphi study

PROBLEM

In countries where education programmes are assessed as meeting international standards there is limited knowledge about the challenges facing midwifery education.

BACKGROUND/AIM

The positive impact of quality midwifery education on maternal and newborn health is acknowledged by the World Health Organisation. However, there is limited research identifying the issues faced in providing quality midwifery education. The aim of this study was to identify the challenges and determine priority projects to strengthen midwifery education across Australia and New Zealand.

METHODS

A two-round Delphi study with experts in midwifery education was undertaken.

FINDINGS

In round one, 85 participants identified an initial 366 issues for midwifery education. Through thematic content analysis these were categorised into 89 statements reflecting five major themes: In round two, 105 midwifery experts from Australia n=86 (79%) and New Zealand n=23 (21%) rated the 89 statements in order of priority. Across the combined data (Australia and New Zealand) a total of 19 statements gained consensus of ≥80%.

DISCUSSION

Five priority themes were identified including; (1) enabling success of First Peoples/Māori midwifery students; (2) increasing the visibility and influence of midwifery within regulation, accreditation and university governance; (3) determining how best to deliver the clinical practicum component of programmes; (4) reviewing midwifery programmes to enhance design, content and delivery; and (5) ongoing education and support for the midwifery workforce.

CONCLUSION

In Australia and New Zealand, it is imperative that collaborative work is undertaken to design and action identified projects addressing these priorities.