Impact of High Patient Volume on Midwifery Education in Kampala, Uganda

Abstract

PurposeThe purpose of this study was to understand the barriers to midwifery education within a high‐volume hospital in Kampala, Uganda. Our aim was to determine students’ and midwives’ perceptions of the educational process in the context of a setting with high patient volume.Research QuestionWe hypothesized that when compared with students, practicing midwives view high patient volume as a greater barrier to education.SignificanceDespite advances in maternal care, maternal and infant mortality in sub‐Saharan Africa have continued to lag behind the rest of the world. With an ongoing rise in pregnancies in this region, urgent attention is needed to better train, educate, and retain student midwives.MethodsWe conducted a cross‐sectional survey‐based study to identify challenges to midwifery education among students and midwives based at Mulago National Referral Hospital in Kampala. We surveyed 60 midwives and 51 midwifery students. Likert‐scale responses were dichotomized and chi‐square tests were used to examine differences in perceptions between students and midwives.ResultsWe identified notable and significant differences in perceptions between midwives and midwifery students when examining the impact of patient volume on education and practice. These differences persisted across multiple questions relating to the educational process. When compared with students, a larger proportion of midwives felt that high patient volume impaired education relating to midwifery knowledge (33% vs 12%, P < .01) and clinical skills (43% vs 4%, P < .01), and contributed to high stress levels (75% vs 35%, P < .01).DiscussionWhile there is ample research on educating midwives within a broader global context, limited research has explored how midwifery training is impacted by high patient volume. Student midwives may view high patient volume as an educational opportunity, while practicing midwives consider high patient volume a barrier to teaching. This difference may relate to a greater perceived responsibility for patient care by midwives. Our findings suggest that excessive patient volume may be impairing midwives’ ability to effectively teach their students the midwifery model of care while balancing their high patient workload. Additional research is urgently needed to identify how to support midwifery practice in health care environments with high patient demand.