Midwifery Student Evaluation of Practice: The MidSTEP tool - Perceptions of clinical learning experiences

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.

Assessment of the psychometric properties of the italian version of the midwifery student evaluation of practice (MIDSTEP-IT): A validity and reliability study

BACKGROUND

Clinical learning is a crucial component of the midwifery education program, necessary to support the acquisition of professional abilities through the integration of theoretical and practical learning experiences. Evaluating Bachelor of Midwifery students' perception of their clinical learning experiences is important to improve midwifery educational programs.

AIM

the objective of this study was the translation, cultural adaptation, and validation of the Midwifery Student Evaluation of Practice (MidSTEP) in a group of Italian midwives' students.

METHODS

"Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice" guidelines were adopted to achieve the MidSTEP Italian version. Exploratory Factor Analysis was performed. Internal consistency for reliability was assessed using Cronbach's alpha reliability coefficient (α) and Omega coefficient (ω), while Intraclass Correlation Coefficients (ICC) were used to determine if the tool was stable over time.

FINDINGS

The Italian version of MidSTEP (MidSTEP-IT) has good internal consistency: considering the Clinical Learning Environment Scale, Cronbach's α was 0.839 (for the "Skill Development" subscale α was equal to 0.739 and for the "Philosophy of Midwifery Practice" subscale α was equal to 0.825) while considering the Midwifery Preceptor Scale, Cronbach's α was 0.920. Factor analysis does not fully reflect the factorial analysis of the original version.

CONCLUSION

The MidSTEP-IT had been proven to be a valid and reliable tool, easy and fast to administer, that could be effectively helpful for investigating and measuring the Italian midwifery students' perception of their clinical learning experiences, according to the setting and impact of mentors on their professional growth. It is an innovative tool, valuable in both clinical practice and research to highlight the importance of encouraging a supportive clinical learning environment and an efficient preceptorship.

Turkish validity and reliability study of midwifery student evaluation of practice (MidSTEP) tool

BACKGROUND

In midwifery education, clinical learning environments have a significant impact on students' acquisition of clinical competence and professional self-identity. The Turkish version of the MidSTEP can be used a measurement tool to assess midwifery students' perceptions of their clinical learning environment experiences and the positive effects of preceptor on the professional development of midwifery students.

AIM

This research was conducted to determine the Turkish validity-reliability of MidSTEP.

METHOD

This research, which was designed as a methodological study, was conducted with volunteer students studying in the first, second, and third years of midwifery at a university in Turkey. The MidSTEP consists of the Clinical Learning Environment Scale and Impact of the Midwifery Preceptor Scale, each with two subscales. The validity and reliability of the MidSTEP were assessed using Exploratory Factor Analysis, Cronbach's alpha, and Intraclass Correlation Coefficient.

PARTICIPANTS

In this study, 205 students were included in the research sample, considering that it may not be sufficient to reveal the factor structure when the number of scale items and the sample size is less than 200.

RESULTS

As a result of the factor analysis a 26 item measurement tool of two scales and each with two sub-dimensions was achieved. The Turkish version of the MidSTEP Tool matched the original scale in terms of the number of items and factor structure.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The Turkish version of the MidSTEP is a valid and reliable instrument. The measurement tool can confidently be used in undergraduate midwifery clinical education.

Midwifery professional placement: Undergraduate students' experiences with novice and expert preceptors

BACKGROUND

In recent decades, increased midwifery university places have been offered to address midwifery workforce shortages. As a result, more graduate midwives entered the workforce, in turn leading to more midwifery students precepted by novice midwives when on professional placement. It is not known whether this more junior midwifery workforce impacts student experience.

AIMS

To explore undergraduate midwifery students' experiences with novice and expert midwifery preceptors, and to identify the benefits and challenges of working with novice and expert preceptors, from the perspective of undergraduate student midwives.

METHOD

This study used a qualitative descriptive approach. Nineteen third/fourth-year Bachelor of Nursing/Bachelor of Midwifery (Honours) students attended six focus groups (ranging from 2 to 5 participants). Data were analysed thematically.

RESULTS

Three overarching themes were identified: 'Building relationships'; 'Teaching and learning'; and 'Improvements to professional placement'. Benefits and challenges existed with both novice and expert preceptors. Importantly, feeling welcomed and receiving critical feedback were identified.

CONCLUSION

The student/preceptor relationship is based upon feeling welcomed, and relatability, and is developed more easily with novice preceptors. Expert preceptors provide insightful and valuable feedback and are more able to actively teach. Novice preceptors' consolidation of practice can impact student learning opportunities. Including students in decision-making aids development of critical thinking. Allocation practices which address student learning needs will improve the student professional practice experience. Midwifery students benefit from working with midwifery preceptors of all experience levels. Translating the findings from this project into preceptorship training programs for midwives will improve student satisfaction and outcomes.

Development and testing of the Midwifery Perceptions and Assessment of Clinical Teaching (MidPaACT) tool

OBJECTIVE

Develop and test a tool to measure midwives' perceptions of their role in preceptoring midwifery students.

DESIGN

A multi method exploratory study design was used.

POPULATION

Preceptor midwives from three maternity units in south-east Queensland Australia.

METHODS

A three-phase process was used: item generation; expert review; psychometric testing including content analysis of qualitative responses. The survey was online or paper-based and included demographic details, the Clinical Preceptor Experience Evaluation Tool (CPEET) role subscale and draft tool. A focus group discussion explored the open-ended responses.

FINDINGS

A large sample of preceptors (n = 164, 64.2 % response rate) participated. Factor analysis revealed a two-factor structure with 24 items accounting for 40.2 % of variance. The mean total score of the Midwifery Perceptions and Assessment of Clinical Teaching (MidPaACT) tool was 103.31 (SD = 9.47). The scale was reliable (Cronbach's alpha 0.89) and valid. Test-retest reliability showed moderate to excellent temporal stability across the scale and subscales. Measures of concurrent validity showed little agreement with the CPEET tool. Qualitative analysis revealed the way midwives were taught as students had a powerful influence on their approach to teaching in practice.

CONCLUSION

This tool is specifically designed to assess midwifery preceptors' perceptions of their role in student learning in practice. Psychometric testing of the MidPaACT tool confirms its reliability and validity.

IMPLICATIONS FOR PRACTICE

Midwifery preceptors are a key influence on the development of students' capability as a midwife. Midwives' perceptions of their proficiency in student learning are under-reported. The MidPaACT tool provides a reliable and valid means of measuring preceptors' perceptions and identifying areas for future educational and workforce improvement.

Midwifery students' perceptions of clinical learning experiences and midwifery preceptors in Turkey

BACKGROUND

The clinical education environment presents a valuable opportunity for students to learn, acquire and develop the clinical skills essential for professional midwifery practice. The presence of competent and relevant preceptors plays a pivotal role in ensuring the success of midwifery students and fostering positive clinical experiences.

AIM

This study was conducted to evaluate the clinical practice experiences of midwifery students and their perceptions of midwifery preceptors.

DESIGN

A descriptive and cross-sectional study.

METHODS

This study was conducted with 205 students enrolled in the midwifery department of the Faculty of Health Sciences of a state university in Turkey. Data collection used a participant information form and the Clinical Learning Environment and Midwifery Preceptor Scales designed to assess factors affecting midwifery students' clinical learning. Data analysis was performed using the SPSS 22.0 program, employing methods such as the Independent Sample T-Test, One-Way Analysis of Variance and Tukey test.

RESULTS

The average total score on the Clinical Learning Environment scale was 31.08±2.16 out of a possible 32, while the average total score on the Midwifery Preceptors scale was 17.60 (SD 1.27) out of a possible 18. The mean total score of the Midwifery Preceptor Scale and the mean scores of the sub-dimensions of Skill Development and Midwifery Practice Philosophy were found to be statistically significantly higher in those aged 21 years and older than aged 20 years and younger (P < 0.05). The Midwifery Preceptor Scale total score, the Clinical Learning Environment Scale total score and Skill Development sub-dimensions mean scores of the second-year students were found to be statistically significantly higher than the first and third-year students (P <0.05). Furthermore, students who received education in larger groups and willingly chose and had a passion for the midwifery profession demonstrated significant positive perceptions regarding their clinical learning environment experiences and the impact of their preceptors on their professional growth.

CONCLUSIONS

Understanding the perspectives of midwifery students regarding the clinical education environment, preceptors and the teaching and learning process holds great importance for enhancing the quality of the clinical education environment and fostering the development of clinical competencies among midwifery preceptors.

The impact of clinical placement site, community clinic versus tertiary hospital, on midwifery students' clinical learning experience in Sierra Leone: a cohort study

BACKGROUND

In midwifery education, the clinical learning experience (CLE) is a critical component to gaining competency and should comprise greater than 50% of a student's education. Many studies have identified positive and negative factors affecting students' CLE. However, few studies have directly compared the difference in CLE based on placement at a community clinic versus a tertiary hospital.

METHODS

The aim of this study was to examine how clinical placement site, clinic or hospital, impacts students' CLE in Sierra Leone. A once 34-question survey was given to midwifery students attending one of four public midwifery schools in Sierra Leone. Median scores were compared for survey items by placement site using Wilcoxon tests. The relationship between clinical placement and student's experience were assessed using multilevel logistic regression.

RESULTS

Two-hundred students (hospitals students = 145 (72.5%); clinic students = 55 (27.5%) across Sierra Leone completed surveys. Most students (76%, n = 151) reported satisfaction with their clinical placement. Students placed at clinics were more satisfied with opportunities to practice/develop skills (p = 0.007) and more strongly agreed preceptors treated them with respect (p = 0.001), helped improve their skills (p = 0.001), provided a safe environment to ask questions (p = 0.002), and had stronger teaching/mentorship skills (p = 0.009) than hospital students. Students placed at hospitals had greater satisfaction in exposure to certain clinical opportunities including completing partographs (p < 0.001); perineal suturing (p < 0.001); drug calculations/administration (p < 0.001) and estimation of blood loss (p = 0.004) compared to clinic students. The odds of students spending more than 4 h per day in direct clinical care were 5.841 (95% CI: 2.187-15.602) times higher for clinic students versus hospital students. There was no difference between clinical placement sites in regards to number of births students attended (OR 0.903; 95% CI: 0.399, 2.047) or number of births students managed without a preceptor/clinician present (OR 0.729; 95% CI: 0.285, 1.867).

CONCLUSION

The clinical placement site, hospital or clinic, impacts midwifery students' CLE. Clinics offered students significantly greater attributes of a supportive learning environment and access to direct, hands-on opportunities for patient care. These findings may be helpful for schools when using limited resources to improve the quality of midwifery education.

Factors that enhance midwifery students' learning and development of self-efficacy in clinical placement: A systematic qualitative review

AIM

To conduct a systematic review and synthesis of qualitative studies to explore the significant factors that enhance midwifery students' learning experiences and development of self-efficacy in clinical placement.

BACKGROUND

Midwifery education programs leading to registration as a midwife require students to achieve academic, clinical, and professional competence. Clinical placement comprises a significant part of the program as students work and are assessed under the direct supervision of the Registered Midwife or preceptor. This learning and teaching partnership aims to enable the transfer of knowledge, skills, and behavior, i.e., competence, while providing the opportunity for students to become socialized into the midwifery practice culture. Against this background, characterized by the shortage of midwives, declining fertility rates, and a stressful environment, students learn to become a midwife and develop self-efficacy. Self-efficacy is the belief in one's ability to master challenges, which is described as a component in learning theories. There seems to be a need to identify factors that contribute to this development.

DESIGN

A qualitative systematic literature review.

METHOD

A systematic database search was conducted to identify primary peer reviewed qualitative literature published between 2000 and 2021 that has explored what enhances midwifery students' learning during their clinical placement. The databases searched included CINAHL (EBSCO), Medline (Ovid), Embase (Ovid), PsycINFO (Ovid), JBI Joanna Briggs Institute (Ovid), SveMed+ , and Web of Science. The search yielded a total of 354 results, of which 22 met the inclusion criteria. The relevant findings from the 22 studies were thematically analyzed and presented in the results.

RESULTS

The analysis revealed two descriptive themes - 'A nurturing relationship' and 'Predictability in the learning process, contextual factors. In addition, one analytic theme emerged - 'Gaining access to and belonging in an enabling educational and working culture'.

CONCLUSION

The relationship with the preceptor is a prerequisite for midwife students learning process and achievement of self-efficacy. A learning culture appears to be the fertile ground in which midwife students thrive and where they develop the self-efficacy needed to meet the demands of clinical placement.

Learning through relationships: The transformative learning experience of midwifery continuity of care for students: A qualitative study

BACKGROUND

Midwifery curricula in Australia incorporate 'Continuity of care experiences' (CoCE) as an educational strategy based on an assumption that midwifery students will learn skills and knowledge about woman-centred care that they may not learn in the typical fragmented care system. However, exactly what skills and knowledge they are expected to 'learn' and how these can be assessed have never been specifically identified.

AIM

To explore midwifery students' continuity of care learning experiences within pre-registration midwifery education.

METHODS

Focus groups were conducted with first, second and third year Bachelor of Midwifery students (n = 12), who were undertaking CoCE in rural and regional tertiary hospitals in NSW, Australia.

FINDINGS

The overarching theme, 'Learning through relationships', was made up of three interrelated themes: Meeting women and making connections, Being known, and Understanding holistic care.

DISCUSSION

The findings from this study contribute to understanding the educational effects of CoCE. The CoCE relationship provided safety and freedom to learn which was seen as foundational for midwifery students' vision of their future practice and can be seen as a self-determined transformational approach to learning.

CONCLUSION

This study adds insight into midwifery students' experience of CoCE, and demonstrates that transformative learning occurs through developing a relationship with both the woman and the midwife. For midwifery to develop as a profession and maintain its focus on woman-centredness, it is important that this aspect of midwifery education remains embedded within midwifery program philosophies and learning outcomes.

A pilot study: Transitioning into a new graduate midwife - perspectives about a unique student-led practice

OBJECTIVE

To explore midwifery students' (and as new graduates') experiences and level of satisfaction about a student-led midwifery model of care.

METHODS

This was a qualitative study to elicit rich descriptive data from the participants. Thematic analysis was used. The students were interviewed at the end of their final year of study and they were subsequently interviewed at the end of their graduate year.

RESULTS

Two overarching themes were identified from the qualitative findings from the first and second interviews including the students building and sustaining important relationships and transitioning from a student to new graduate.

CONCLUSIONS

The midwifery students valued the opportunity to spend one year in a student-led model of care so that they could build and sustain important relationships with women and their team including the mentor midwife as new graduates. The students developed confidence by being respected by midwives and enabled them to advocate for women.

Evaluation of the Midwifery Student Evaluation of Practice (MidSTEP) tool using Rasch analysis

PROBLEM

Quantitative feedback from students about their clinical learning experiences is used to inform program quality, but the extent to which tools are reliable, valid and refined receives less attention.

AIM

To evaluate the psychometric properties of the Midwifery Student Evaluation of Practice (MidSTEP) tool using Rasch analysis.

METHODS

The Midwifery Student Evaluation of Practice tool was completed by Bachelor of Midwifery students (n = 901) attending seven universities in Australia and New Zealand. The tool consists of the Clinical Learning Environment Scale (16 items) and Impact of the Midwifery Preceptor Scale (10 items), each with two subscales. Rasch analysis was conducted on all subscales separately using the partial credit model of RUMM2030. Response format, item fit, dimensionality of the scale and its targeting were assessed.

RESULTS

Rasch analysis confirmed the internal construct validity of the Clinical Learning Environment and Impact of the Midwifery Preceptor subscales, with no evidence of mis-fitting items, local dependency or multidimensionality. The 4-point response scale was found to be appropriate, and internal consistency reliability of each subscale was good.

DISCUSSION

Results provide support for the reliability and validity of the Midwifery Student Evaluation of Practice tool. The four subscales can confidently be used in undergraduate midwifery clinical education. The use of Rasch analysis is consistent with growing awareness in health and education of the need to apply more advanced, sophisticated psychometric techniques to ensure measures are suitable for their intended use.

TWEETABLE ABSTRACT

Midwifery students clinical learning experiences should be measured using robust tools. MidSTEP is reliable and valid.

Who is Being Screened for Intimate Partner Violence in Primary Care Settings? Secondary Data Analysis of a Cluster Randomised Trial

OBJECTIVES

To assess sociodemographic differences in postpartum women screened for intimate partner violence and who disclosed to their Maternal and Child Health nurses.

METHODS

Secondary analyses of survey data from women participating in a cluster randomised trial. The trial tested a nurse-designed, enhanced violence screening model-versus routine screening among eight community nurse clinics in Melbourne, Australia. Self-completion anonymous surveys were sent to all clinic attendees who had given birth in the previous eight months. We measured intimate partner violence with the Composite Abuse Scale and other sociodemographic variables. Multivariable logistic regression was used to analyse characteristics of screened versus unscreened women and those who did or did not disclose.

RESULTS

91 clinics (163 nurses) participated in the trial. 2621/10,472 (25%) women responded to the survey. Notable characteristics, such as level of intimate partner violence (AdjOR 1.14, CI 0.94-1.40), parity (AdjOR 1.13, CI 0.94-1.35), education (AdjOR 1.20 CI 0.91-1.58) and being born in Australia (AdjOR 0.94, CI 0.86-1.03) made no significant difference to screening. However, nurses were significantly less likely to screen women with a lower income than those with a higher one (AdjOR 0.59, CI 0.40-0.87) with a dose response relationship. Women on the lowest levels of income were significantly more likely to disclose abuse (AdjOR 3.06, CI 1.02-9.17), indicating missed opportunities for nurses to provide timely care.

CONCLUSIONS FOR PRACTICE

Despite being required to screen all women, nurses are almost twice as likely to screen more affluent women, who would be less likely to be experiencing or disclose intimate partner violence.

Prepared and motivated to work in midwifery continuity of care? A descriptive analysis of midwifery students' perspectives

BACKGROUND

Internationally, midwifery education and maternity services are evolving to promote midwifery continuity of care. It is unclear whether current Australian midwifery education programs are graduating a midwifery workforce prepared and motivated to work in this way.

AIM

To discover how well midwifery students in Australia feel they have been prepared and motivated to work in midwifery continuity of care when they enter practice.

METHODS

A pragmatist approach was used. Participants were final year midwifery students at one Australian university participating in the Midwifery Student Evaluation of Practice (MidSTEP) project over three consecutive years. Descriptive analysis of selected scaled and free text responses was undertaken to ascertain how students' clinical practice experiences had influenced their learning, development and career aspirations.

RESULTS

Exposure to midwifery continuity of care had profound impact on students' learning, enabling them to provide woman-centred midwifery care whilst increasing confidence and preparedness for practice. The majority were motivated to work in midwifery continuity of care upon graduation. A small minority of participants felt unprepared to work in midwifery continuity of care, attributing this to their family commitments, a sense of needing more experience or unsupportive workplace cultures.

SUMMARY

Midwifery continuity of care experiences are highly valued by midwifery students and positively influence confidence, preparation and motivation for beginning practice. It is necessary to review education standards to ensure quality, consistency, and adequacy of these experiences throughout pre-registration midwifery education. This will assist in generating a midwifery workforce prepared and motivated to deliver the goals of maternity service reform.