Action research to improve the pre-registration midwifery curriculum Part 3: can fitness for practice be guaranteed? The challenges of designing and implementing an effective assessment in practice scheme

Abstract

Objective: to design and implement a robust assessment scheme to more effectively identify student midwives' fitness for midwifery practice.Design: five inter-related action research cycles. Methods included: documentary analysis, interviews, observation, questionnaires, focus groups.Setting: a large university in England.Participants: student midwives, practising midwives and midwife teachers, childbearing women, course planning team and EME project team collaborators.Findings: whilst there was evidence that the majority of students are fit for midwifery practice by the end of the course, assessment schemes were found to be unreliable. In particular there was the potential for ‘borderline’ students to register as midwives if assessors were inadequately prepared for their responsibilities; assessment documentation was not ‘user’ friendly; evidence of competence was inadequately recorded or there was a lack of systematic monitoring by university teachers and examiners of the assessment in practice scheme.Conclusions and implications for practice: the gap between curriculum aspirations and actual implementation needs to close. The assessment matrix, developed as part of the national evaluation study, could usefully be used as a framework when designing assessment schemes. The difficulties for midwife assessors in each locality need to be identified and solutions incorporated into workable but robust strategies. University midwife teachers/lecturers have a responsibility to work in partnership with assessors and students to monitor assessment in practice schemes and, where local circumstances and confidence in reliability permit, grade and award credits for practice-based assessment of student capability.