Pre-registration Midwifery Curriculum Research Articles

Is the incorporation of the newborn examination in the pre-registration curriculum acceptable in clinical practice? A qualitative study.

The objectives of this qualitative study were to describe the experiences of currently practicing newborn examiner midwives who had accessed their training post registration; explore their views on the inclusion of newborn examination in the pre-registration curriculum and invite them to identify strategies to achieve practical implementation of the inclusion of the newborn examination in pre-registration in the practice setting. Data were collected through semi-structured interviews and analysed using Thematic Analysis with an inductive approach. Three main themes were identified; experiences of the role, views of the newborn examination being incorporated into the pre-registration midwifery curriculum and practical considerations. The findings from this study show that currently practicing newborn examiner midwives accept the need for inclusion of the newborn examination in pre-registration midwifery education in order to sustain the best service for mothers and babies. The findings also indicate a need for ongoing interprofessional learning, support and investment to maximise efficiency of the service.

Embedding evidence-based practice within the pre-registration midwifery curriculum

Clinical midwifery skills and understanding are continually changing in line with research evidence and service innovations. Evidence-based midwifery practice is essential to ensuring that the care provided to childbearing women is safe, effective and of the best quality to meet their individual needs. To deliver woman-centred care, evidence from research should be considered in conjunction with clinical experience and women's own preferences. One of the challenges for Higher Education Institutions that offer pre-registration midwifery education is to incorporate evidence-based practice across the curriculum so that student midwives see it as an integral part of their role, rather than as a separate concept. Midwifery students need the knowledge and skills to identify areas of practice in need of investigation, an understanding of how each stage of the research process works, and the skills to critique research studies to ensure that their practice is evidence-based.

Including the newborn physical examination in the pre-registration midwifery curriculum: National survey

Aims This study aimed to assess the scope of newborn infant physical examination (NIPE) education in programmes of pre-registration midwifery education. Methods An online questionnaire was sent to all lead midwives for education in the UK. Findings are reported in two parts: part A (the current paper) examines the education provision for the inclusion of NIPE in the midwifery curriculum. Part B (a subsequent paper) explores NIPE education as a post-registration module. Findings Of 58 education institutions, 40 (68.9%) completed the questionnaire. A quarter (25.0%) stated that NIPE training is included in their pre-registration midwifery programmes; 37.5% reported plans to implement it within the next 2–5 years and 30.0% had no plans to do so. Benefits for practice partners, commissioners, students and service users were identified. Challenges were noted, particularly in relation to resources and student support in practice. Conclusion Although barriers doubtless exist, the success of the few institutions that have incorporated NIPE into their curricula is evidence that this is not only possible, but has proven benefits.

Student midwives views on incorporating creative arts as a learning strategy

This paper reports select findings from an initial study seeking to ascertain student midwives views on incorporating creative arts as a learning strategy into pre-registration midwifery curriculum. Concern regarding the quality of midwifery practice in relation to supporting mothers has been at the forefront of national news. There has been increasing friction between what student midwives learn about practice and what they witness in practice. The findings offer insight into whether creative arts is a viable pedagogy to enable students to engage with the emotionality of midwifery practice. The paper concludes that creative arts should be considered an integrated pedagogy in midwifery education as it goes some way to address the divergence of the art and science of midwifery to ensure graduating students are fit for purpose.

Exploring maternal perinatal mental health using a blended learning package

This paper presents and discusses a collaborative midwifery curriculum development involving service users and academic staff, focusing on maternal perinatal mental health. An overview of contemporary drivers for service user involvement in midwifery care, practice and education and the significance of maternal perinatal mental health are highlighted to set the context for the educational development. The potential advantages and challenges of service user involvement in the pre-registration midwifery curriculum are outlined. The authors’ response to these challenges, through the process of initiating, implementing and evaluating a blended learning package is discussed. At the heart of this blended learning activity is the facilitated narratives of two service users, interspersed with student-focused reflective and analytical activity to develop an appreciation of a wide range of evidence, including practice experiences, theory and literature. This partnership approach to developing teaching materials for the pre-registration curriculum is advanced as a means to ensure the service user voice becomes central to the pre-registration midwifery curriculum.

Exploring the value of the tripartite assessment of students in pre-registration midwifery education: A review of the evidence

Many universities use a tripartite assessment within the pre-registration midwifery curriculum to grade student practice; we consider what the purpose and value are from an educational, formal and social perspective. By utilising research, policy documents and reflections from our experiences we explore the principles which underpin this judgement of student performance. After deliberation, we consider the increased presence in practice to have many benefits, but have evidence that it is not required educationally, to assess student practice, or to formalise the assessment process, since sign-off mentors are now better prepared to undertake this role. Thus, to support our increased partnership with practice, afforded by tripartite assessments, we offer an alternative.

Introduction of e-learning into the pre-registration midwifery curriculum

This article identifies the introduction of interprofessional e-learning into the pre-registration midwifery curriculum. It provides a personal reflection of the experiences of using e-delivery of the interprofessional teaching and learning pathway at Coventry university. E-learning is not new, yet, there has been a lack of information (research, literature and evidence) about e-learning and information technology and pre-registration midwifery education. This article provides insights into the modern midwifery curriculum, contextualizing the need for interprofessional education and identifying some of the challenges to the midwifery profession, educators and students inherent in this method of delivery. The article also suggests some solutions to the challenges and offers insight into possible technologies for delivery of the midwifery curriculum in the future.

Student caseloading: embedding the concept within education

This final article in a series of three papers examines how the initiative of student midwife caseloading at Bournemouth University (BU) forms a central strand of our undergraduate pre-registration midwifery curriculum. It offers a model for other midwifery education providers to consider and possibly replicate. Following the initial success of our student caseloading scheme, steps were taken to embed it at the strategic and operational levels within our wider educational provision. It now forms an essential and integral part of the theoretical and practice elements of the pre-registration midwifery programme, underpinning the philosophy of approach, facilitation of learning and assessment of competence throughout the curriculum. This strand has been an evolutionary process that has developed from a purely practice-based initiative to a comprehensive educational component throughout all three years of midwifery education. Its development can be traced from the beginning of student caseloading in 1997 to BU's current and contemporary educational provision.

Student midwife caseloading - a new approach to midwifery education

Student midwife caseloading was pioneered by Bournemouth University (BU) in 1996. Following a successful pilot study and further refinements of the process, it was introduced as a core element of our undergraduate pre-registration midwifery programmes in 1999. This is the first of a series of three articles in which the ideas, initiative and success of establishing this groundbreaking project are considered. The founding of the concept, the process and practicalities of setting up the scheme and the lessons learnt are documented and discussed in this primary article. The importance of effective planning, positive collaboration and effective communication have underpinned and facilitated this seminal change from traditional student placements. The second and third articles will explore how student caseloading works in practice and is sustained to form a fundamental educational strand throughout the BU pre-registration midwifery curriculum; enhancing accountability and autonomy of our students and future practitioners of midwifery.

Action research to improve the pre-registration midwifery curriculum Part 2: case study evaluation in seven sites in England

Objective: to identify factors which facilitate and inhibit the effectiveness of current pre-registration midwifery programmes.Design: the case study part of an action research project.Setting: seven case study institutions in England.Participants: student midwives, midwives, midwifery managers/supervisors of midwives, midwife teachers, collaborators in the study.Findings: it emerged, following a synthesis of all data, that the pre-registration midwifery curriculum should have five key outcomes: students should feel confident and competent as midwives; students must have achieved the statutory requirements for registration; students should be committed to undertaking the whole role and responsibilities of a midwife; students must be equipped to take responsibility and accept accountability for their actions; students must recognise the need for career long learning. Whilst overall these new programmes were considered to be effective in preparing students for their role as midwives, there was variability in the degree to which these five key outcomes were achieved by the case study students.Implications for practice: there needs to be agreement as to what constitutes fitness for practice at the point of registration; assessment schemes, particularly those relating to practice capabilities, need to be valid, reliable and robust with the benefit of the doubt being given in favour of childbearing women when students are ‘borderline’; fitness for purpose requires clarification to avoid employers having unreal expectations of new qualifiers which may result in attrition due to excessive stress; review of curricula should take account of the importance of personal qualities and learning strategies which enable students to cope with complexity, uncertainty, decision making and ‘being a midwife’ before course completion.

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

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.

Action research to improve the pre-registration midwifery curriculum – Part 1: an appropriate methodology

The purpose of this first of three papers is to discuss the rationale and appropriateness of an action research approach to bring about curriculum improvement. This abstract relates to the study as a whole. The abstracts for the subsequent two papers relate to the specific parts of the study they describe.Objective: to improve the pre-registration midwifery curriculum locally and influence national policy and guidelines for these programmes.Design: action research provided the framework for the study where a multi-method approach was largely qualitative to attempt to capture the context and complexity in which the midwifery programme operates. The study comprises a synthesis of two separate but interwoven research projects: a national study about the effectiveness of midwifery education (the EME project) and an evaluation and re-design of the three year pre-registration midwifery programme in a large multi-sited university in England.Setting: a large university in England.Participants: the EME project 39 case study students, their teachers, practice-based mentors/assessors, preceptors and supervisors of midwives or managers; 50 students from the local university's midwifery programme, their teachers and practice-based mentors/assessors from six sites; 41 women who gave birth to their babies in a large teaching hospital in the East Midlands; and a professional network of experienced midwives whose role is to advise the statutory body regulating midwifery programmes in England.Findings: overall the three-year, pre-registration route into midwifery was found to be an effective preparation for contemporary midwifery practice as judged against a model of a competent midwife at the point of registration. However, there was evidence to suggest that not all students are equipped to practise competently and confidently in contexts of uncertainty and change in the National Health Service. Factors which emerged as influencing curriculum effectiveness related to: recruitment and selection; curriculum structure, appropriateness; and robustness of assessment schemes; the preparation of and support for assessors; and the role of the midwife teacher in assessment in practice settings.Conclusion and implications for practice: diagnosing problems and initiating actions as a collaborative process formed an important part of designing and implementing an ‘ideal’ curriculum in constrained health and higher education contexts. The need for on-going dialogue, critical reflection, and research to facilitate and assess learning more effectively in the ‘caring’ professions emerged as necessary to ensure that only competent practitioners have a licence to practise.

Delphi technique: one cycle of an action research project to improve the pre-registration midwifery curriculum

Facilitating a unified interpretation of new or re-designed curricula can be problematic in multi-sited universities. This paper discusses the use of the Delphi technique when implementing an innovative pre-registration midwifery curriculum. It formed one of the action research cycles of the author’s doctoral study and was used in an attempt to seek the views of all midwife teachers and achieve a critical mass consensus. The most important issues that emerged from the Delphi process were grouped into four categories. These four categories (the teacher’s base site, communications, staff development and administration issues) formed the agenda for a staff away day.The outcome of the process was the generation of a list of priorities and actions for curriculum implementation and the identification of ways in which staff development needs might be met more effectively. An unexpected, but equally important, outcome was the way it helped with team building and agreement on positive actions for its further development.