Experiences Of Midwifery Students Research Articles

Through the looking glass; midwifery students' experience of ethical issues: A feminist explanatory case study

BackgroundThe ethical component in midwifery education is governed by international professional values, codes, and ethical principles. The aim of midwifery education is to encourage students to develop a lifelong commitment to ethical practice within their midwifery role and scope. However, little evidence is available on the experiences of midwifery students and how they navigate ethical issues in maternity systems. AimTo present a case study from a midwifery students' perspective that demonstrates observed ethical issues and to provide analysis of the ethical issues identified. DesignA Single explanatory case study design with a feminist lens applied. Explanatory case studies present the ‘how and why’ of a phenomenon and contributes to understanding phenomena in a holistic and real-life context. SettingThis project was set at a West Australian university from which pre-registration midwifery courses are delivered. ParticipantsA solitary case study is presented from a midwifery students' clinical placement. MethodsEthics were approved 2023-04805. Edith Cowan University HREC. The source of data for this case study was direct observation by the primary author (Priya, 2021) and the Joanna Briggs Methods for Case study reporting guide followed. Thematic analysis with a feminist lens was applied to the data. ResultsThree themes were generated ‘Through the looking glass; observing ethical issues’; ‘Whose body Is It? The Erosion of Maternal Consent’ and ‘Relational care versus defensive practice’. These themes explain the antecedents and consequences of the ethical issues identified by the midwifery student, the findings are supported by ethical theory and midwifery philosophy to highlight some of the underlying causes that contribute to ethical issues. ConclusionMidwifery students experience ethical distress when they observe ethical issues and are powerless to support birth people in a way that aligns with midwifery philosophy of relational, woman-centred care. Further research is required to better understand how midwifery students may be better supported to foster ethical care.

Birth Simulation and Birth Environment Experiences of Midwifery Students: A Semi-Experimental Study

Today, the frequency of use of simulation applications in the skill development part of midwifery education is increasing.This study was aimed to examine the effect of birth simulation used in normal birth training of midwifery students on satisfaction and self-confidence after training and birth environment experience. The semi-experimental type study was conducted in the midwifery department of a foundation university in Istanbul Turkey. This study was conducted with 54 students. The students were evaluated twice after a 15-minute simulation training after the theoretical training and a total of six days of birth environment experience two days a week. The data of the study, “Data Collection Form” and “Student Satisfaction and Confidence in Learning Scale (SCLS) were used. While the mean SCLS score was 54.57±6.10 after the students' theoretical training on normal birth and simulation application, it was determined that the SCLS average was 57.98±7.86 after the birth environment experience. According to the multiple regression analysis, it was found that the SCLS scores of the students who took the normal birth course with theoretical, simulation and birth environment experience were 0.52% higher than those who took the theoretical and simulation courses (p

Perinatal death witnessed by midwifery students during clinical practice and their coping methods: A qualitative study

ObjectiveThe aim of this study was to determine the perinatal death experience of midwifery students during clinical practice and their coping methods. DesignA qualitative, descriptive, phenomenological design was used. SettingsThe study was conducted with midwifery students. ParticipantsThe study was conducted with 14 midwifery students at a state university in northern Turkey between April and July 2023. MethodsPerinatal death experiences that students witnessed during clinical practice and their coping methods were analyzed using the individual in-depth interview technique. Data were analyzed using the thematic analysis method. The results obtained from the study were reported according to the COREQ criteria. FindingsAs a result of the analysis, four main themes: (1) the perception of the concept of death, (2) the first encounter with death, (3) methods of coping with death, and (4) students' suggestions were elicited from the data. Students who witnessed perinatal death were affected by this situation, experienced negative emotions, and resorted to different methods to cope with their negative feelings about death. ConclusionsMidwifery students who witnessed perinatal death were negatively affected emotionally and professionally; therefore, education and policy-oriented regulations are needed to cope with perinatal death.

Storytelling as an educational strategy for midwifery students: A qualitative study.

Narratives can provide a framework to teach the concepts of patient-centered care to the students. This article describes the experiences of midwifery students from employing of purposive storytelling as a teaching strategy in the education program. This qualitative study used an in-depth interview method to collect the experiences of midwifery students engaged in a narrative medicine training program. The narrative-based teaching activities focused on three patients to teach four themes (clinical manifestations, treatment options, prevention strategies, and ethics), and related to MMR (maternal mortality rate) concept offered to students from Guilan University of Medical Sciences in 2022-2023. At the end of the course, all students were invited to provide experiences regarding the teaching method. Conventional content analysis was performed simultaneously with data collection. Four-dimension criteria (Lincoln and Guba) were used to evaluate the rigor of the findings. Data analysis led to the extraction of three main categories and eight sub-categories: effective learning (extended learning, a safe learning environment, and boosted motivation for midwifery role), challenges on the way of learning (contagious sadness, shattered cohesion, and executive monopoly), and challenges on the way of performance improvement (the necessity of interdisciplinary education and the inevitability of a strong foundation). Narrative-based teaching may improve the learning experience of students, but it is not possible to train all the course content by this method, and it should ideally be a supplement to other educational methods, such as lecturing.

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

BackgroundThe 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. AimThis study was conducted to evaluate the clinical practice experiences of midwifery students and their perceptions of midwifery preceptors. DesignA descriptive and cross-sectional study. MethodsThis 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. ResultsThe 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. ConclusionsUnderstanding 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.

Evaluation of the experience of midwifery students in the training of obstetrics emergencies using clinical simulation-based learning

Evaluation of the experience of midwifery students in the training of obstetrics emergencies using clinical simulation-based learning

Midwifery students' experiences: Violations of dignity during childbirth.

The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. Four key themes described the threats to women's dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth.

A blended learning perineal suturing programme for midwifery students: An evaluative descriptive study

AimThe purpose of this study was to examine midwifery students' views and experiences of learning perineal suturing skills through a blended learning approach. BackgroundEvidence suggests that not all midwifery students are gaining sufficient experience in perineal trauma and suturing to sufficiently prepare them to achieve competency in this skill at the point of registration. DesignThe blended learning approach included lectures, a bespoke ‘suture at home kit’, online reusable learning objects, and an optional face-to-face drop-in suture clinic. Midwifery students submitted a video demonstration of the skills acquired and then attended a clinical skills laboratory in preparation for a face-to-face competency assessment on campus. ResultsA qualitative descriptive evaluation research design study was undertaken from 22 participants. Deductive thematic analysis was selected to analyse the qualitative data.Two themes were identified. The first theme, 'learning at home', included sub-themes of 'deliberate practice' and 'the ability to make mistakes. The second theme, 'achieving competency', included sub-themes of 'equipment' and 'bringing it all together' ConclusionsThe blended learning approach of the programme applied to teach perineal suturing had a positive influence on midwifery students learning of the skill. The acquisition of knowledge using the suture at home kit gave the students confidence and prepared them for laboratory practice and assessment, and ultimately prepared them for practice placement. They identified other clinical skills suited to using an 'at home' simulation pack. The validation of the perineal suturing programme by midwifery students supports the need for a blended learning approach for this and other clinical skills. All participants expressed a positive view of the programme and found it beneficial for their learning. Midwifery students recognised that the suture at home kit gave them confidence, knowledge of the skill and preparedness for the clinical skills laboratory practice and assessment. They identified other clinical skills suited to using an 'at home' simulation pack. The positive experiences of midwifery students in this study to a blended-learning programme for perineal suturing education and training further validated the recognised need to develop and include online, and face to face learning approaches for this vital aspect of intrapartum care.

O30 - "Learning to learn": Commencing midwifery students' experiences of self-determined learning in an undergraduate midwifery program

Self-determined learning aims to develop learners who can be creative, reflexive, think critically, be collaborative and build self-efficacy and capability using a non-linear approach to learning. Supporting deeper learning aligns with midwifery education as it develops critical thinking and reflective skills rather than simply acquiring skills and knowledge. A deeper understanding applies the midwifery student's learning to new situations and potentially challenging circumstances. Some learners find the transition to innovative and non-traditional learning activities and assessments challenging. Students can be de-motivated or reluctant to engage and embrace the opportunities available, potentially leading to disengagement, poor performance or attrition from the program. Investigating commencing midwifery students' conceptions and experiences of self-determined learning aimed to determine appropriate support to ease this transition. To explore commencing midwifery students' experiences and perceptions of self-determined learning. A qualitative descriptive design was used. In-depth online interviews involved ten midwifery student participants. Data was analysed using thematic analysis with an inductive approach. Making the transition described becoming familiar with the new way of learning, including beliefs about self-determined learning. Trusting the journey encompassed making adjustments and developing the confidence to be vulnerable in the learning process. Recognising the value incorporates the advantages and the importance of becoming a capable self-determined learner and how this aligns with becoming the midwife the student aspires to be. After a transition period, self-determined learning encourages midwifery students to take responsibility for their learning. Midwifery students valued a holistic, relationship-based support system that included accessible resources and a safe and respectful learning environment. Developing self-determined learning capacity and capability facilitates transformation in the student, supporting midwifery graduates who are confident, capable, and embrace the challenges of future professional midwifery practice.

Exploring midwifery students’ experiences of professional identity development during clinical placement: A qualitative study

BackgroundHealthy China 2030 has proposed to strengthen the investment in midwifery education to prepare more qualified midwives to address the shortage of midwifery workforce in China. The formation of a strong professional identity has been demonstrated to be a vital enabler for successfully transitioning from university to work. As midwifery is a practice-based profession, clinical placement is a key period for midwifery students’ professional identity development, where they can be part of the profession and exposed to professional behaviour and interaction in the real world. However, it has not yet been explored in terms of the professional identity development of midwifery students in China during clinical placement. AimTo gain insight into the professional identity development experiences of midwifery students in China during clinical placement. DesignA qualitative study using a descriptive phenomenological approach. MethodsSemi-structured interviews were conducted with fourteen final-year midwifery students who were undertaking clinical placement in four public hospitals in central China between March 2021 and May 2021. The transcribed data were analyzed following the Colaizzi’s phenomenological analysis method. ResultsA total of one category, two theme clusters and seven themes emerged. The overarching category “conflicting experiences of professional identity development” was identified from the interaction of two theme clusters, “positive experiences motivating professional identity development” and “negative experiences impeding professional identity development”. Four themes including “feeling the sense of accomplishment for facilitating smooth births”, “developing professional competence”, “positive role models of clinical mentors”, and “cooperative inter-professional relationships” fell into the theme cluster of “positive experiences motivating professional identity development”; while the other three themes including “high-intensity working state”, “emotional instability of birthing women”, and “feeling insufficient in professional competence” fell into the theme cluster of “negative experiences impeding professional identity development”. ConclusionsThe conflicting experiences of professional identity development among midwifery students might lead to the emergence of confusion and further decrease their retention intention in the profession. Thus, intervention strategies should be adopted to promote midwifery students’ professional identity development during clinical placement, so as to prepare confident and motivated midwives to provide high-quality maternal care and address the shortage of midwifery workforce in China.

EVALUATION OF THE IMPACT OF CLINICAL PRACTICE AND THE COVID-19 PANDEMIC ON STRESS EXPERIENCE IN STUDENTS

Aim: With this study, it was aimed to evaluate the clinical practice and the effect of the Covid 19 pandemic on the stress experience of midwifery students. Method: The research is a descriptive survey conducted in the midwifery department of a university. The universe of the study consisted of 294 students who were educated in the midwifery department and went into clinical practice. 268 students who agreed to participate in the study formed the sample of the study. The research was carried out using the participant introduction form developed by the researchers in line with the literature. The participant introduction form consists of 13 questions including sociodemographic data, stress status and information about covid-19. Results: The 4th graders' level of stress is higher than the students in other grades. The mean age of those who gave the stress level score a 5 is higher than the other stress level scores. 76.5% of the students stated that they experienced stress before going to clinical practice. There is a statistically significant relationship between the stress level and the distance from the clinical practice area to the living area. Conclusions: The stress level of students who practice in the clinical field is different. It is very important to provide new opportunities for students, to provide psychological support and to make students feel that we are with them.

Balancing it out: A grounded theory of how midwifery students at a faith-based university in Papua New Guinea provide care to women following stillbirth

Providing care to women following stillbirth affects the well-being of midwifery staff. In this grounded theory study, the authors used focus groups and individual interviews to explore the experiences of midwifery students at a faith-based university in Papua New Guinea. Balancing it Out is the process students used to balance social, cultural and professional factors to achieve their aim of providing the best possible care to women following stillbirth. Provision of holistic care to women following stillbirth and cross-sector health promotion are crucial to attain the best outcomes for women and the midwifery staff who provide their care.

Clinical supervisors’ experiences of midwifery students’ reflective writing: a process for mutual professional growth

ABSTRACT Structured reflective writing during clinical placement has been shown to be valuable for students’ learning and for their personal and professional development. The aim of this study was to examine clinical supervisors’ experiences of midwifery students’ daily written reflections on their practice at birthing units. A qualitative study was performed, and data were analysed using content analysis. In total 17 midwives working as clinical supervisors in the South of Sweden were interviewed using both focus groups and individual interviews. One main category ‘A process for mutual professional growth’, three categories and seven subcategories emerged from the analyses. The supervisors’ experience was that reflective writing facilitated individualized supervision and initiated a loop of reflection. The way students wrote their reflections affected the feedback and was an aid for the supervisor to be active and flexible. The process of using written reflections was considered as a tool for following the progress of the students and the process of learning but also developed the midwife in her supervisory as well as in her professional role. The supervisors called for more time allotted, better organizational support, and clearer instructions for how to write feedback.

Midwifery students' perceptions and experiences of learning in clinical practice: a qualitative review protocol.

This systematic review aims to investigate and synthesize qualitative evidence related to midwifery students' perceptions and experiences of learning in clinical practice. Midwifery students are required to develop strong competencies during pre-registration education for future practice. Clinical placements provide a good opportunity for students to build essential practice capacities. Understanding the perceptions and experiences of midwifery students in clinical practice helps develop effective midwifery clinical educational strategies. A qualitative systematic review is therefore proposed to improve midwifery clinical education. This proposed review will consider qualitative studies that have explored midwifery students' perceptions and experiences of learning in clinical practice in all degrees. The search will be limited to English-language published and unpublished studies to the present. This review will follow the JBI approach for qualitative systematic reviews. A three-stage search will be conducted to include published and unpublished literature. Databases to be searched include PubMed, Science Direct, Web of Science, CINAHL, PsycINFO, American Nurses Association, Google Scholar, ProQuest Dissertation & Theses, and Index to Theses in Great Britain and Ireland. Identified studies will be screened for inclusion in the review by two independent reviewers. Any disagreements will be resolved through discussion. Data will be extracted using a standardized tool. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into a set of findings that can be used to inform midwifery education. PROSPERO CRD42020208189.

Mentoring in the clinical training of midwifery students - a focus study of the experiences and opinions of midwifery students at the Medical University of Warsaw participating in a mentoring program

BackgroundThe current system of clinical training for midwifery students in Poland is in need of considerable revision to adapt it to the global standards and the expectations of healthcare providers, healthcare users and student midwives themselves. Aim of this study was to report the experiences of midwifery students participating in a mentor-led clinical training program and their opinions of mentoring as a novel training method.MethodsA qualitative descriptive study that used a focus group was undertaken in the period from October 2017 to June 2019. The participants were 12 s- and third-year midwifery students at the Medical University of Warsaw who at various times during the study period had their clinical training in the Department of Obstetrics, Solec Hospital in Warsaw, Poland. All students had previous experience of clinical training other than clinical mentorship. At the end of the study, a focus group interview was conducted with all 12 participants. Five questions were selected to guide the focus group discussion: Did you get any valuable learning experience during your clinical training? How did this clinical training differ from your previous clinical training? What was your experience of one-on-one mentoring? Did the mentoring program meet your expectations? What do you think could be changed to make the proposed mentor-led clinical training more effective?ResultsFour themes were identified. The study demonstrated that mentoring was perceived by the participants as an innovative and effective method of clinical training for midwifery students. All students positively evaluated the quality of the mentor-led clinical training which allowed improving their clinical skills and building new competencies. Students believed they could effectively use their clinical skills and make informed decisions in a safe and supportive clinical learning environment. They felt that their inclusion in the therapeutic team contributed to better patient care.ConclusionsThe use of innovative forms of clinical training at undergraduate level improves its effectiveness and in the future should be reflected in a high-quality maternity care. Mentoring has its advantages for both, mentor and mentee, but the main goal is to develop and improve professional competencies of the junior partner.

Effects of team-based learning about postpartum haemorrhage on learning outcomes and experience of midwifery students in Indonesia: A pilot study.

AimThis pilot study aimed to evaluate the effects of team‐based learning about postpartum haemorrhage on the learning outcomes and experience of midwifery students in Indonesia.DesignOne‐group pre‐test–post‐test study.MethodsThis study enrolled 64 midwifery students as participants from an Indonesian health polytechnic school. This group attended two team‐based learning class sessions (90 min weekly for 2 weeks) on postpartum haemorrhage. Student learning outcomes and experience were assessed quantitatively.ResultsThe mean knowledge score (0–100) was significantly higher at post‐test (mean = 85.9, SD 9.8) than at pre‐test (mean = 61.4, SD 12.9) (p < .001). There was a significant difference in the mean clinical reasoning score (12–60) between post‐test (mean = 35.4, SD 5.8) and pre‐test (mean = 21.3, SD 7.9) (p < .001). Most students (98.4%) engaged in classroom activities.

BSc nursing & midwifery students experiences of guided group reflection in fostering personal and professional development. Part 2

Reflective practice is a learning strategy supporting preregistration nursing and midwifery students in meeting everyday clinical practice challenges. This paper reports on a development and innovation evaluation using a qualitative approach exploring students’ experiences of guided group reflection organised during fourth year undergraduate internship. Data were collected through student feedback and interviews using a descriptive approach. Three categories emerged from the findings; beginnings for reflective learning, engaging in reflective learning and being a reflective practitioner. Students reported that guided group reflection provided positive opportunities for enhancing confidence. Students demonstrated understanding of reflection and valued reflective time within the closed group structure, which fostered personal and professional development. Findings support the benefits of the established collaborative guided group reflection structures. Guided group reflection is described as a valuable learning strategy on the journey of becoming a nurse in an ever-demanding health care practice world.

‘The rollercoaster’: A qualitative study of midwifery students’ experiences affecting their mental wellbeing

ObjectiveMidwifery student mental wellbeing is an important consideration for the sustainability of the profession, however it has seldom been the subject of empirical research. Previous studies of the lived experience of midwifery students have focused on the impact of transition experiences and student satisfaction, rather than specifically on mental health and students’ views on support for their mental wellbeing. DesignA qualitative descriptive study using semi-structured interviews. SettingA midwifery undergraduate programme in one university in the South of England. Participants20 BSc midwifery students. FindingsTwo inductive themes were developed from our analysis. The theme of ‘the rollercoaster’ encapsulated students’ experience over the length of the course, characterised by multiple culture shocks of being in different worlds, from one clinical placement to the next, from university to clinical placement. This experience was emotionally taxing. The theme of ‘being noticed, feeling connected’ encapsulated midwifery students’ views on what could help them enjoy their training. They wanted to be seen as individuals by at least one educator, they wanted opportunities to connect with their peers and they wanted the support available to them to be consistent. ConclusionsListening to students’ insights into the lived experience of being a midwifery student can enable midwifery educators to improve the way courses are designed and support structures are put in place. The importance of having consistent contact with peers and educators cannot be underestimated. Implications for practiceThe emotional demands of midwifery training must be acknowledged. Educators should identify ways in which they can provide students with consistent individualised support and regular opportunities to meet with their peers.

The Effect of Reflective Learning on Childbirth Care Competence of Midwifery Students

Background: The skills of midwives in childbirth care competence are still inadequate. This problem is influenced by limitation experience of midwifery students of childbirth care in the field of practice area. That condition related to the proportion of midwifery students and case of childbirth woman was an imbalance. Midwifery students must prepare this competence in an education with childbirth care experience from practice in the laboratory and in the field of practice. Reflective learning is an appropriate learning method that uses experience as the basis of learning to improve childbirth care competence of midwifery students. Objective: This study is to analyze the effect of reflective learning implementation in childbirth care practice to improve students’ competence. Method: This research uses quasi-experimental design with non-equivalent control group design. The respondents were midwifery students in the fourth semester who had experienced the theory of childbirth care. There were totally 64 samples, 34 samples for treatment group and 30 samples for control group. Data were analyzed by using unpaired t test, Mann Whitney U and linear regression. Results: The respondents were homogeny in motivation and grade point of average (GPA). The improvement of childbirth care competency is influenced by treatment of 19.064 with R2 = 57.7%. Conclusion: The implementation of reflective learning in childbirth care practice affected the improvement of students’ competence.

Midwifery students’ experiences of problem solving based interprofessional learning: A qualitative study

BackgroundInterprofessional learning is identified as one of the most innovative ways to encourage students of different disciplines to communicate with each other in interprofessional teams. A review of existing studies identified that inter-professional learning with nursing and midwifery students learning together had not previously been reported. AimThis qualitative study sought to explore perceptions and experiences of midwifery students from interprofessional learning with nursing students. MethodsThis study was an exploratory qualitative study employing focus groups. Participants were 30 female students in the fourth year Bachelor of Midwifery at one university in Iran who undertook the surgical training course in midwifery in their seventh semester by inter-professional learning based on problem solving. Data were analysed according to the six steps of the concurrent thematic analysis method. FindingsOne main theme of challenging approach in learning emerged and two sub-themes 1) being challenged in a simulated clinical situation and 2) demonstrating professional knowledge. ConclusionInterprofessional learning by challenging students of various professions during shared interprofessional learning can be followed by positive outcomes such as improved critical thinking, interprofessional communication, teaching–learning motivation and independent learning.