Midwifery Program Research Articles

Verbal feedback for written assessment: evaluating a novel feedback communication strategy

Background/Aims Feedback plays a pivotal role in learning, but traditional written feedback often lack engagement and specificity, hindering learners' ability to effectively apply feedback. In midwifery education, the need for innovative feedback delivery mechanisms is pronounced. The aim of this study was to evaluate the integration of digital health technologies in feedback delivery in a midwifery programme. Methods A novel communication strategy was implemented in a midwifery programme in northwest England, where the benefits, challenges and future implications of leveraging digital health technologies for assessment feedback were assessed. Results Preferences were mixed, with 45.1% of learners favouring written feedback. Verbal feedback was perceived as more personal and motivating, and valued for its nuance, tone and ability to clarify complex points, although written feedback provided clearer, detailed information for future reference. Less experienced markers struggled with verbal feedback, while more experienced markers appreciated the quicker, more refreshing process. All markers found feedback templates helpful for ensuring equitable feedback. Conclusions This study scrutinised the significance of rethinking feedback delivery in midwifery education and indicates that digital health technologies present promising opportunities for reshaping the feedback landscape. Implications for practice Developing student confidence and competence in digital literacy remains a significant challenge. Higher education institutions can collaborate with healthcare providers to offer training in digital health technologies, helping midwives adapt to modern clinical environments.

The future of midwifery care and education in Belgium: A discussion paper

BackgroundAdvanced education of midwives acting during the first 1000 days in life is key in optimum care provision for intergenerational health and wellbeing. AimThis paper provides a comprehensive analysis of the current context of midwifery care and (inter)national trends in midwifery education. Gaps for optimizing midwifery education in Belgium are defined. ResultsSocietal, medical, and technological changes including medicalization of birth impact the midwife's profession and competency requirements. The World Health Organization demands adapted midwifery competency frameworks to meet these changes and achieve universal health coverage by 2030. While the European Union's directives address the recognition of professional qualifications of midwives, basic midwifery programs in Europe range from vocational to master's programs. In Belgium, basic midwifery programs are direct-entry bachelor programs; however, the program length varies according to the region. A horizon scanning by the Belgian Health Care Knowledge Center concluded that an extension and advancement of the current midwifery program are urgently needed to enable midwives to fulfil an autonomous role in accordance with national laws and international directives. DiscussionBasic midwifery education anno 2023 does not fit (1) the changes in women's health towards 2030; (2) the future demands regarding midwifery competence, and (3) the current and future demands for autonomy according to the legal frameworks. ConclusionAn extension and advancement of the basic midwifery programs are needed to sufficiently arm midwives to meet changes they are confronted with. Therefore, a debate involving all stakeholders concerned with the future of midwifery care and education is recommended.

Developing and validating a self-assessment tool for assessing confidence of nurse-midwives against competency domains of the International Confederation of Midwives, in India.

While midwives are recognized as primary care-providers for maternal and new-born care in many parts of the world, India is transitioning to professional midwifery. The pathway to midwifery in India has been through integrated nursing and midwifery education. Since 2018, India has introduced an 18-month post nursing midwifery education programme. To establish a baseline for midwives' competence and measure progress, there is a need for a quick, easy-to-administer and low-cost tool that can be used at scale to guide programme efforts. This paper describes the process of validation and testing of a tool to assess the confidence of practicing nurse-midwives as a proxy indicator for competence against the seven competency domains of the International Confederation of Midwives (2013). A total of 2198 nurse-midwives, providing maternal and new-born services at the time of the study, from 442 public and private hospitals across six states in India, responded to a self-administered questionnaire. The tool is psychometrically sound and can potentially be used in low-middle-income countries to measure confidence of midwives and nurse-midwives against international competence standards. It is suitable for quick large-scale programmatic assessments within a short time period, providing evidence to inform midwifery strengthening initiatives. The tool can be contextualized to suit specific country contexts. Since it was tested in India, where a distinct cadre of midwives is not yet established and nurse-midwives provide maternity care, the tool can be easily adapted for use in other countries in the South East Asia Region with similar contexts.

Educational needs of midwifery students in medical ethics: A qualitative study.

Background: Ethics education is a basic part of midwifery education program. However, there is no evidence to show that ethics education has been able to meet the educational needs of midwifery students. Purpose: This study aimed to explore the educational needs of students for ethics in midwifery program with a focus on the course of history, ethics, and rules of midwifery. Research design and participants: The present study is qualitative descriptive content analysis research, exploring midwifery students' needs of ethics education in bachelor's degrees. We conducted in-depth semi-structured interviews with 11 undergraduate midwifery students, seven midwives working in hospitals and health centers, and seven midwifery faculty members in Urmia University of Medical Sciences. The participants were selected using a purposeful sampling method and invited to join the study from December 2021 to June 2022. The sampling continued until data saturation. Findings: Content analysis identified four categories and associated subcategories: 1. "The client's rights": respecting the dignity of clients, confidentiality, the client's right to choose and make decisions; 2. "Legal and ethical requirements of fertility": abortion, alternative treatment for infertility, domestic violence; 3. "Communication skills": communication with the client, communication with clients' caregivers and communication with colleagues; and 4. "ethical principles in research": compliance with ethical principles in the research process and ethical principles in publishing research findings. Ethical considerations: The study was approved by the Ethics Committee of Urmia University of Medical Sciences. Before filling the questionnaires, written informed consent was obtained from the participants. The participants were assured of the confidentiality of personal information. Conclusion: The educational needs of midwifery students can be met by providing theoretical and practical training on respecting the pregnant mother, communication skills, legal and ethical aspects of the reproductive period, and incorporating ethical principles in related courses.

Settler Midwifery: A Colonial Tool in Canada's Reproductive Healthcare System.

The land we call Canada is a settler colonial country where reproductive healthcare is used as a mechanism to control, subjugate, and erase Indigenous people and to advance the White settler state. Healthcare providers play an integral role in the healthcare system and contribute to Canada's colonization. In this piece, we critically analyze how settler midwifery is complicit with colonialism in reproductive healthcare by exploring the history of midwifery in Canada, midwifery education, and contemporary settler midwifery. European settlers omitted the history of Indigenous midwifery in Canada and to justify their erasure, they conceptualized Indigenous Peoples as uncivilized and their birthing practices as substandard. To establish a colonial healthcare system, settler midwives replaced traditional Indigenous birth attendants. When midwifery became regulated, midwives were required to train in formal post-secondary institutions that sustain colonial logics, systems, and practices. Midwifery education programs maintain colonialism by reinforcing medicalized Western practices and sustaining barriers to the growth of Indigenous midwifery. As a result, Western birthing practices are widespread among settler midwives and Indigenous Peoples face barriers to comprehensive and culturally sensitive care. To decolonize Canadian midwifery, we must dismantle stereotypes about Indigenous Peoples and their birthing practices in historical narratives, implement an anti-colonial approach to midwifery education, support Indigenous midwives in returning birth home, and improve the provision of culturally sensitive care. Settler midwifery in Canada is complicit in colonialism; building anti-colonial alliances can help support Indigenous midwives in leading a decolonial future for reproduction and birthing.

A qualitative study which aims to explore the factors influencing the delivery of both theory and practice of contraception and sexual health on pre-registration midwifery programmes in England

BackgroundPregnancy offers an opportunity to provide equitable access to contraception information and provision, and professional bodies advocate provision of contraception in the immediate postpartum period. This study examines the contribution...

Implementation of competency-based education for quality midwifery programmes in Africa: a scoping review

BackgroundImproving the quality of midwifery education to international standards is critical to prepare competent midwives. Despite the recognised impact of competent midwives, little is known concerning the implementation of Competency-Based Education (CBE), especially in Africa, where poor investment in quality midwifery education has been reported.ObjectiveThe aim of this study is to scope and synthesize the existing literature on the implementation of CBE for midwifery programmes and its sustainability in Africa.MethodsThe scoping review methodology outlined by Arksey and O’Malley framework was adopted to explore the extent of the literature on the implementation of CBE for midwifery programmes and its sustainability in Africa. This framework directed the scoping review methodology, with reference to PRISMA-ScR guidelines.ResultsA total sample of 72 studies were finally included in this scoping review. Reporting of the scoping review findings follows the PRISMA- ScR format. The study showed that of the 54 African countries as per the World Bank classification, after review of the full articles following the eligibility criteria for inclusion, literature on midwifery education programmes only spanned 17 African countries as at the time of this report. Of which, 11 are implementing CBE, 5 are still using Traditionally Based Approaches (TBA) while Problem-Based Learning (PBL) is the main teaching pedagogy used in Botswana. This review revealed that for the successful implementation of CBE, a CBE curriculum implementation process must be strictly observed. Evidence from the literature confirmed that CBE has not been sustained in Africa. There is still a struggle to fully integrate the major components of the competency-based midwifery programme due to inadequate support and an inadequate monitoring system.ConclusionsIt is expedient that CBE implementation should be planned concurrently with its sustainability for it to be effective. Adequate training and support should be continuously provided to faculties, institutions, policy makers, professional bodies, students and other stakeholders for successful implementation and sustainability.International Registered Report Identifier (IRRID)PRR1-https://doi.org/10.2196/47603.

Navigating Challenges and Opportunities in Nursing Education: Insights from Student Nurses at the National University of Lesotho

<i>Background:</i> Globally, student frustration and attrition rates are declining, underscoring the importance of investigating the academic and interpersonal challenges that students face after their first year. Objectives: exploring the experiences of National University of Lesotho student nurses on their course of education. <i>Method:</i> A qualitative phenomenological research design was used to conduct research at the National University of Lesotho. Data was collected using an unstructured interview guide in two focus groups comprising all student nurses who are enrolled in the nursing and midwifery programme from their second year into the programme. This study employed a stratified random sampling procedure to select its respondents. This study made use of thematic analysis. <i>Results: </i>The results demonstrated clinical weariness caused by a severe workload. The tasks and responsibilities assigned to the students, which they consider to be the duties of registered nurses, frequently leave them feeling overburdened. Variations in clinical supervision experiences include negligence; some experience sexual abuse; and some students find the clinical setting quite unpleasant and inappropriate. On the other hand, students expressed that they are empowered by the current nursing curriculum to face the clinical challenges. <i>Conclusion:</i> Despite appreciating the faculty's supportive and inspiring environment, students had conflicting emotions about the instructional approaches and learning environments. There were variations in both instructional quality and clinical supervision.

Revitalise and Revolutionise: A Student-Centred Curriculum

Given the unique challenges encountered by midwifery students, it’s imperative that the curriculum is tailored to their requirements, rather than constrained by institutional frameworks. During a curriculum review we had the opportunity to revitalize our BSc Midwifery programme. Alongside the 2019 Standards for pre-registration midwifery education1 we put into action a flexible personalised curriculum that suits the needs of modern midwifery students.

LGBTQIA+ healthcare content in pre-registration nursing and midwifery curricula: A cross-sectional study

BackgroundNurses and midwives are expected to provide inclusive care for LGBTQIA+ populations. However, there is a paucity of knowledge on how well-prepared nursing and midwifery graduates are for this aspect of their role. AimTo explore LGBTQIA+ content in pre-registration nursing and midwifery curricula in Australia. DesignCross-sectional study. SettingsAustralian higher education institutions offering 86 pre-registration nursing and midwifery programs. SamplePublicly available pre-registration nursing and midwifery course programs in Australia as presented in the online course handbooks of 25 randomly selected educational institutions. MethodsA LGBTQIA+ terminology matrix was developed to guide data extraction from subject titles, synopses, and learning outcomes. Explicit terms were those strongly associated with LGBTQIA+. Implicit terms were those indirectly associated with LGBTQIA+. Explicit and implicit LGBTQIA+ terms were analyzed for frequencies. Poisson regression was used to compare counts of LGBTQIA+ terms by course, subject, and university. ResultsAmong the 1093 subjects, no subject titles included explicit terms and 6 (0.55 %) titles included implicit LGBTQIA+ terminology. Explicit LGBTQIA+ terminology was identified in 54 (4.9 %) subject synopses and implicit terminology was found in 323 (29.6 %) subject synopses. Explicit LGBTQIA+ terms were identified in 14 (1.3 %) learning outcomes while implicit terms were found in 323 (29.6 %) learning outcomes. Group of Eight universities were more likely to use explicit and implicit LGBTQIA+ terminology than non-Group of Eight universities (p < 0.001; p = 0.035). Undergraduate programs included more LGBTQIA+ terminology than postgraduate programs (p = 0.019; p < 0.001). Core subjects were more likely to include LGBTQIA+ content than elective subjects (p < 0.001). ConclusionExplicit LGBTQIA+ terminology was minimal indicating limited overall content. The study results alert nursing and midwifery educators to take a targeted approach to teaching and learning with a LGBTQIA+ focus to support future nurses and midwives with quality knowledge and skills and ensure equitable and safe care for LGBTQIA+ people.

Midwifery Students' Experiences of Bias in the Clinical Setting: Prevalence, Types, and Impact.

Exposure to bias in clinical learning environments may undermine students' confidence, cause emotional harm, impede learning, and potentially delay graduation. However, little is known about the prevalence of bias experienced by midwifery students in the United States. This cross-sectional, descriptive study aimed to quantify clinical midwifery students' experiences of bias based on 7 self-identified characteristics (gender identity, race or ethnicity, body size, age, sexual orientation, religion, and occupational background). Additionally, this research explored the impact of bias on student well-being, learning, and professional commitment. The survey consisted of 39 items addressing (1) prevalence and types of bias, (2) emotional impact and influence on clinical learning, (3) ways students coped, (4) whether anyone spoke up at the time bias occurred, (5) whether students reported bias to faculty, and (6) impact of bias on commitment to midwifery. The survey was distributed to midwifery students and recent graduates in 2022 via American College of Nurse-Midwives email discussion lists and social media. Participants were eligible if they were in a clinical rotation in an Accreditation Commission for Midwifery Education-accredited midwifery program between 2019 and 2022. Surveys were returned by 383 participants, with 301 meeting inclusion criteria. Most participants (66.5%) reported personally experiencing or witnessing bias against at least 1 of 7 personal characteristics. The most commonly reported biases were related to gender, occupational background, age, and race or ethnicity. Only half of the participants reported these occurrences to someone with academic authority, and nearly a third considered withdrawing from their educational programs. In this study bias was common and significantly impacted students. These results underscore the need for creative and bold interventions at personal, educational, and institutional levels to prevent and mitigate bias. Safeguarding clinical learning environments will enable students to thrive, graduate with confidence and competence, and thereby contribute to the diversification and strengthening of the midwifery profession.

History of Midwifery at Tuskegee: Vanguards of Midwifery Education.

Tuskegee, in Macon County, Alabama, has played an important role in Alabama's midwifery legacy and was home to 2 different midwifery education programs from the 1920s through the 1940s. In response to a 1918 state law requiring midwives to pass an examination to receive a practice permit in their county, stakeholders developed a four-week course for Black Alabamian midwives on the grounds of Tuskegee Institute at the John A. Andrew Memorial Hospital. In the 1940s, in the same location on the grounds of Tuskegee Institute, the Tuskegee School of Nurse-Midwifery educated Black nurse-midwives to improve Black maternal and neonatal outcomes in the South.

Assessment of professional empowerment among midwives in selected LAC: A multisite descriptive study

Objectiveto identify the perception of professional empowerment among midwives in selected Latin American countries (LA). Specifically, this study aimed to compare i) the global level of empowerment among midwives in different LA countries, ii) the scores according to the different dimensions of the scale, and iii) scores according to area the of expertise. DesignA quantitative, observational, analytical, cross-sectional and multisite study using an adaptation of the Perceptions Midwifery Empowerment Scale (PEMS). SettingsClinical, educational and managerial midwifery positions in 5 LA countries belonging to a Latin American Research Network in Midwifery. All the participating countries reported a similar profile regarding type of education, association and regulation procedures. ParticipantsA total of 1127 responses from midwives with different professional backgrounds were included in the study. FindingsA total mean score of 73.28 (74.23–72.03) points was reported. Chile reported the lowest score of empowerment compared to the other countries, while Argentina reported the highest. Midwives' perceptions of empowerment within their area of expertise, primary health care (PHC) was the area of reference, and gynaecology reported a significantly lower score. Midwives working in management were significantly more empowered compared with those in other areas. Midwives who had continuous education and postgraduate studies were the most empowered. Regarding the provision of woman-centred Care, Chile and El Salvador differed significantly from Argentina (reference), while Uruguay reported a significantly higher score in this dimension. Midwives working in hospital wards reported significantly lower scores compared to those working in PHC. Key conclusions and implications for practiceThis study suggests that midwifery programmes in the LA countries would benefit from prioritising professional empowerment, especially in the areas of hospital practice, where midwives' perceptions of empowerment were most limited.

Needs Assessment for the Development of a Leadership Course for Midwives: a Qualitative Study.

Midwives play a vital role in the attainment of Sustainable Development Goals related to the health and well-being of mothers and newborns. Strengthening the leadership and management capacities of midwives is pivotal to the fulfillment of their mandate beyond assisting in birth and delivery. The study explores the perspectives of midwives about professional education and practice, which are aimed to serve as bases for developing a leadership course for midwives to enhance their roles in public health. The study employed a descriptive-qualitative design. Using a semi-structured questionnaire, online focus group discussions (FGDs) with midwives from the academe, professional organization, and clinical practice were conducted. Through directed content analysis, the gathered information was analyzed to include the participants' insights on midwifery competencies, teaching methods and assessment strategies, supplementary courses and training, and factors affecting midwifery practice. A total of eleven (11) participants contributed to the FGDs, which included midwives from the academe (dean, faculty), professional organization (board member of the Professional Regulation Commission), and clinical practice (public and private institutions). Notably, participants shared their perspectives regarding the similarities/differences in the terminal competencies of midwifery programs. The demands of outcomes-based education, coupled by the shift to online learning due to the pandemic, pushed the need for modifications in program delivery for the students. Results highlighted the need for supplementary courses and capacity building on leadership and management, research, and interprofessional collaboration. Midwives shared factors that affect their professional practice, which include insufficient training, inadequate manpower, and differences in expectations/standards in task performance. The findings indicate the need to develop capacity-building courses for midwives to enhance their contribution towards universal health care. The results of this study also highlight the importance of understanding and improving the competencies of midwives across the building blocks of the health system, which include health service delivery, human resources for health, health information systems, health financing, health governance, and health regulation. Notably, key concepts recommended for the Leadership Development Course for Midwives include: leadership and management, research, and interprofessional collaboration.

Altruistic values among students of Nursing, Midwifery, Physiotherapy, and Health Psychology: a cross-sectional study

Aim – to study the altruistic values of o group of nursing, midwifery, and physiotherapy students, and how these values evolved throughout academic years and across study programs. The study used a descriptive correlational design. The data were collected from students in the bachelor’s degree programs in nursing, midwifery, and physiotherapy, and in the master's degree program in health psychology (students in this program have completed bachelor’s degrees in nursing, midwifery, or physiotherapy). The Faculty of Natural Sciences at the University of Shkodra “Luigi Gurakuqi”, Albania offers bachelor’s degree programs in nursing, midwifery, physio­therapy and a professional master's degree in health psychology. During the academic year 2022-2023, the number of active students was 756. A total of 457 students participated in this study: 175 from the nursing program, 130 from the midwifery program, 107 from the physiotherapy program, and 45 from master program. Data were collected from December 1, 2022, through January 31, 2023, with an online questionnaire. Two tools were used in this study: a demographic questionnaire and the Altruism Scale used by Űmmet and colleagues. The mean score on the Altruism Scale was 2.9±0.78. A one-way ANOVA revealed that there was a difference in mean altruism score between at least two groups (F (3, 452) = [3.232], p=0.02). Tukey’s HSD Test for multiple comparisons found out that the mean value of altruism was different between the bachelor students in nursing and bachelor students in physiotherapy (p=0.011, 95% CI = [0.0498, 0.5448]). Compared to others, bachelor students in nursing had higher level of altruism and bachelor students in physiotherapy had lower level of altruism. Conclusions: The results showed that it is precisely the feeling of altruism that people have, which made them choose nursing as a profession. Since altruism is so important for the nursing profession, topics related to altruism should be included in nursing curricula.

Education of postpartum hemorrhage management clinical skills among midwifery students in Malawi: A qualitative study

BackgroundUnskilled health professionals in healthcare systems are contributing to the high numbers of maternal mortality in Malawi. It is therefore essential that midwifery students acquire postpartum hemorrhage management clinical skills, especially in view of high maternal mortality, with postpartum hemorrhage being the leading cause. However, there is limited evidence on how the teaching is conducted with regard to students’ learning of postpartum hemorrhage management clinical skills. PurposeThis study aimed to describe the current teaching of postpartum hemorrhage management clinical skills in undergraduate nursing and midwifery program in Malawi. MethodsThe study applied a qualitative exploratory descriptive design. Data were collected through ten individual interviews with lecturers and three focus group discussions with twenty-four students in a midwifery education program in Malawi. The data were analyzed using thematic analysis. ResultsTwo themes emerged from the data analysis: (1) there are various teaching and learning approaches for postpartum hemorrhage management in use and (2) unpreparedness of midwifery students in postpartum hemorrhage management for patient care. ConclusionThe present study demonstrated that teaching of postpartum hemorrhage management clinical skills in an undergraduate nursing and midwifery programme in Malawi focuses on theoretical knowledge rather than practical skills, leaving midwifery students unprepared for postpartum hemorrhage management during clinical practice. The findings from the present study may provide knowledge guiding revision of the curriculum for the undergraduate nursing and midwifery programme in Malawi to consider global standards of midwifery education; enhance the lecturer to student ratio to provide the students with appropriate supervision; and to employ innovative teaching and learning strategies that promote peer education and skills practice among midwifery students. In addition, to conduct more research related to various teaching approaches in nursing and midwifery educational programs and among qualified midwives in Malawi. Statement of significancePostpartum hemorrhage management education in undergraduate nursing and midwifery programme in Malawi focuses more on theory than clinical skills. Improving midwifery students' acquisition of postpartum hemorrhage management clinical skills is needed to ultimately help lower Malawi's maternal mortality ratio.

Augmented reality simulation-based training for midwifery students and its impact on perceived knowledge, confidence and skills for managing critical incidents

ProblemEmergency obstetric management is essential in midwifery training to prevent fetal and maternal morbidity. Repeating this management in practice is often not possible. Sustainable confidence in these procedures is usually achieved in the first few years of practice. BackgroundSimulation training complements hands-on learning and improves practical skills, benefiting both students and patients. Research on obstetric emergency simulation training have demonstrated this, but the use of digital simulation approaches, such as augmented reality (AR), is under-researched. AimTo investigate whether AR simulation training influences midwifery students' subjective perceptions of knowledge, confidence and practical skills in emergency situations. MethodsA descriptive exploratory study was conducted using a pre-post design. AR scenarios were developed on the topics of 'preparing emergency tocolysis', 'preparing a pregnant woman for caesarean section' and ‘resuscitation of newborns'. The AR simulation was conducted in the fourth to fifth semester of the midwifery programme. A questionnaire was developed for students (N = 133) to self-assess their competence in the categories of knowledge, confidence and practical skills. ResultsStudents rated their competence significantly better in the post-survey than in the pre-survey (p=<0.05). Simulation has an impact on self-assessment of professional knowledge, confidence and practical skills in emergency situations. It enhances students' procedural knowledge and practical skills in complex contexts, complements subject knowledge and builds confidence. ConclusionThe results provide initial evidence that AR simulation is an effective learning strategy for emergency management preparedness. Future studies should validate the effect with control cohorts and measure competence through practical examinations.

Developing an evaluation framework for an online midwifery programme: a practical participatory approach

PurposeThis paper aims to generate knowledge about relevant evaluation topics that align with and represent the unique character of the midwifery programme for students living in the rural and remote areas of Scotland.Design/methodology/approachThe first two central concepts of Practical Participatory Evaluation (P-PE) framed the research design: the data production process and (2) the knowledge co-construction process. The data were collected using a semi-structured approach via online discussions, dialogues and email-based consultation among programme stakeholders. A structural analysis was performed: the units of meaning (what was said) were extracted, listed and quantified in units of significance (what the texts were talking about), from which the key topics for evaluation emerged.FindingsA community of 36 stakeholdersengaged in the discussions, dialogues and consultations. The stakeholders identified 58 units of significance. Fifteen subthemes were constructed in five main themes: student profile, student well-being, E-pedagogy, student journey/transition from being a nurse to becoming a midwife and learning in (an online) geographically remote and isolated area. The themes, or topics of evaluation, are dynamic functions and underlying mechanisms of the commonly used evaluation measures student progress and student evaluation.Research limitations/implicationsThis P-PE is a single-site study, focusing on a unique programme consisting of a specific group of students living and studying a specific geographic area, affecting the transferability of the findings.Originality/valueIn collaboration with stakeholders, parameters to evaluate the uniqueness of the programme in addition to higher education institution routinely collected data on student progress and satisfaction were systematically identified. The themes highlight that if student progress and satisfaction were the only evaluation parameters, knowledge and understanding of the contributing factors to (un)successfulness of this unique online midwifery programme could be missed.

Effect of moral case deliberation on midwives' knowledge and practice regarding respectful maternity care.

Although there have been reports of misbehavior and disrespectful maternal care by healthcare providers worldwide, there are few intervention studies aimed at promoting respectful care, particularly among midwives. The aim of this study was to examine the effect of Moral Case Deliberation (MCD) on the of midwives' knowledge and practice in the field of respectful maternity care. This semi-experimental study involved 46 midwives working in the maternity departments of two hospitals affiliated with Bushehr University of Medical Sciences in 2023. The two hospitals were randomly divided into control and intervention groups. All midwives from both hospitals were included in the study. The Dilemma Method of MCD was implemented for midwives of intervention hospital. The Midwives' Knowledge and Practice of Respectful Maternity Care scale was used for data collection. It was administered both before and two weeks after the intervention. Data were analyzed using SPSS (version 20). The study was approved by ethics committee of Bushehr University of Medical Sciences in Bushehr, Iran (ethics code: IR.BPUMS.REC.1402.017). All participants provided written informed consent. The intervention group showed a significantly greater increase in knowledge scores from pre-test to post-test compared to the control group (p < .001). The intervention group had a significantly higher mean change score in practice self-assessment and practice peer evaluation, from pre-test to post-test, than in the control group (p < .001). MCD based on the dilemma method can improve practice in the field of respect-oriented midwifery care by increasing knowledge and potentially changing attitudes. The Dilemma Method of MCD improved midwives' knowledge and practice regarding respectful maternity care. This method can be included in the midwifery care quality improvement program to promote respectful maternity care. It is necessary to develop methods for wider dissemination of MCD in the cultural context of Iran.

Assessment of the Midwifery Education Program at the University of British Columbia – A Survey of Graduates and Midwife Mentors

The Midwifery Program at the University of British Columbia is the only academic centre for midwifery education in British Columbia. The program consists of arts and science courses, midwifery theoretical and clinical courses, problem-based learning tutorials, laboratory simulations, clinical experiences in community midwifery, and a semester of interprofessional placements in a local or global setting. As university based midwifery education is new to British Columbia, critical evaluation of the curriculum is essential. Between 2005 and 2010, we examined the curriculum annually from the perspective of new graduates (n=34) and their mentors (n=21) to inform curriculum renewal and development. Overall graduates felt well prepared for clinical practice after graduating, and highly valued their clinical placements. Both graduates and midwife mentors reported competence with most clinical skills, and senior midwives noted the graduates’ fluency with both the hospital and home setting. Need for improvement was noted with respect to suturing and venipuncture. There were some discrepancies in the assessment of competencies. While all graduates felt well or adequately prepared to recognize and manage when a normal birth changes to abnormal, not all mentor midwives agreed. Conversely, midwife mentors felt that graduates were prepared in the area of client communication and counseling, yet graduates felt less confident in this area. Over the years, the Midwifery Education curriculum has evolved to address feedback received via the yearly curriculum evaluation. The academic calendar has been modified to allow students and faculty more time for preparation, integration and reflection during the introductory year, to facilitate the consolidation phase in the core clinical courses, and to facilitate senior research projects. Courses on counseling, pharmacology for midwives, lactation consultation, global maternity care, and anatomy labs have been added to the curriculum. The program continues its effort to enhance theoretical and clinical teaching by offering regular preceptor workshops.