Exploring the impact of clinical placement models on undergraduate midwifery students

BackgroundLearning undertaken through clinical placements provides up to 50% of the educational experience for students in pre-registration midwifery courses. However little is known about of the impact various models of clinical placement have on the learning experiences of undergraduate midwifery students. Two clinical placement models have been employed for undergraduate midwifery students at Monash University, including the block placement model and the continuous two days per week model.ObjectiveThis project sought to explore the learning experiences of students in these two models of placement.MethodFocus groups were held on two campuses with a total of 17 students from different cohorts and programs.DiscussionNo one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model.ConclusionNo one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model.     

Do midwifery International clinical placements influence students’ practice and employment decisions?

AimThe aim of this study was to investigate whether an International two-week clinical maternity placement enhances, and is beneficial, to midwifery students’ future practice and employment decisions during the final year of an undergraduate degree.BackgroundInternational placements are common in undergraduate pre-registration nursing midwifery university curricula, with the emphasis on preparing students to work with diverse women in multicultural environments whilst incorporating cultural competence. However, little is known as to whether an International placement influences future graduate’s work place choice.MethodsUsing a qualitative approach, focus groups were undertaken with 16 final year midwifery students from a University in Western Australia who had experienced a two-week International clinical midwifery placement in Tanzania (Africa) or Manilla (Philippines). Data was analysed using thematic analysis.FindingsThe results of the study revealed eight over-arching themes that revealed an increase in midwifery student’s confidence; an awareness of the need to consolidate knowledge and skills, reinforcement of their own career aspirations, midwifery beliefs and trust in women and physiological birth.ConclusionThis study confirms the benefits of overseas clinical placements, which provide opportunities beyond developing cultural sensitivity. Midwifery students are challenged to develop not only practical competence, but confidence to trust in themselves and the process of physiological birth. These experiences validate theoretical learning and provide opportunity to reflect on the possibilities of future employment and decision making as a midwife.     

A complex and demanding situation – Midwifery preceptors and midwifery students’ experiences of teaching and learning prevention of severe perineal trauma

BackgroundMany high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described.AimTo describe midwifery preceptors and midwifery students’ experiences’ of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma.MethodsA qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis.Results“A complex and demanding situation with mutual need for feedback, reflection and safety” was the overall theme describing the conditions. Three sub-themes were identified. “Adapting to a unique situation” refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. “Hindering and limiting circumstances” describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. “A trustful and communicative relationship” describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part.ConclusionAn increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors’ confidence in teaching.     

The impact of three-dimensional visualisation on midwifery students’ application of knowledge of the third stage of labour to practice: Qualitative findings of a pilot randomised controlled trial

ProblemComplex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Online resources for midwifery education are limited.BackgroundFace to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Virtual and artificial realities have been shown to increase confidence in decision making during clinical practice.AimExplore the impact of using three-dimensional (3D) visualisation in midwifery education, on student’s application, when educating women about the birth of the placenta, and membranes.MethodsFace to face individual interviews were performed, to collect deep, meaningful experiences of students, learning about the third stage of labour.FindingsPrior clinical experiences impacted on student’s ability to articulate how they would discuss birth of the placenta and membranes, and the process of haemostasis with women.DiscussionThe narrative findings of this pilot study identified ways that students traditionally learn midwifery, through theory, and clinical practice. Interview narratives illustrated how midwifery students who had previous experiences of witnessing birth, had superior ability to discuss the third stage of labour with women. While students with limited birth experiences, found the 3DMVR assisted them in their understanding of the physiology of the third stage of labour.ConclusionIn an environment of increasing technological advances, clinical placements remain an essential component of midwifery education.     

Optimising the continuity experiences of student midwives: an integrative review

BackgroundIn several countries, midwifery students undertake continuity of care experiences as part of their pre-registration education. This is thought to enable the development of a woman-centred approach, as well as providing students with the skills to work in continuity models. A comprehensive overview of factors that may promote optimal learning within continuity experiences is lacking.AimTo identify barriers and facilitators to optimal learning within continuity experiences, in order to provide a holistic overview of factors that may impact on, modify and determine learning within this educational model.MethodsAn integrative literature review was undertaken using a five-step framework which established the search strategy, screening and eligibility assessment, and data evaluation processes. Quality of included literature was critically appraised and extracted data were analysed thematically.FindingsThree key themes were identified. A central theme was relationships, which are instrumental in learning within continuity experiences. Conflict or coherence represents the different models of care in which the continuity experience is situated, which may conflict with or cohere to the intentions of this educational model. The final theme is setting the standards, which emerged from the lack of evidence and guidance to inform the implementation of student placements within continuity experiences.ConclusionThe learning from continuity experiences must be optimised to prepare students to be confident, competent and enthusiastic to work in continuity models, ultimately at the point of graduation. This will require an evidence-based approach to inform clear guidance around the intent, implementation, documentation and assessment of continuity experiences.     

Embracing the continuity of care experience: A new Australian graduate entry master of midwifery course with a student caseload of 15 women per year

BackgroundWomen receiving continuity of midwifery care have increased satisfaction and improved outcomes. Preparation of midwifery students to work in continuity models from the point of graduation may provide an ongoing midwifery workforce that meets rising demand from women for access to such care.Aim of the paperThe aim of this paper is to describe an innovative midwifery course based on a continuity model, where students acquire more than 50 % of clinical hours through continuity of care experiences. Additional educational strategies incorporated in the course to enhance the CCE experience within the philosophy of midwifery care, include a virtual maternity centre, case-based learning and the Resources Activities Support Evaluation (RASE) pedagogical model of learning.DiscussionAustralian accredited midwifery courses vary in structure, format and philosophy; this new course provides students with an alternative option of study for those who have a particular interest in continuity of midwifery care.ConclusionA midwifery course which provides the majority of clinical hours through continuity of care may prepare graduates for employment within midwifery group practice models by demonstrating the benefits of relationship building, improved outcomes and the reality of an on-call lifestyle.     

‘Continuity of Care Experiences’ within pre-registration midwifery education programs: A scoping review

BackgroundMidwifery is based on the philosophy of woman-centred care. The continuity of care experience in pre-registration education programs exemplifies this philosophy. Wide variation in how education providers implement ‘Continuity of Care Experiences’ into their programs of study can challenge this valuable learning opportunity.AimTo provide a comprehensive analysis of the governance and empirical evidence of knowledge, practice and enablers to support continuity of care experiences within pre-registration midwifery education.MethodA scoping review of research, policy and professional documents pertaining to the continuity of care experience in pre-registration education programs was conducted with 46 articles meeting the inclusion criteria.FindingsSeveral factors were identified that support the implementation, facilitation and evaluation of the continuity of care experience within pre-registration midwifery education. These include: a woman-centred model of maternity care; enabling midwifery students and women to develop ‘relational continuity’; tripartite support models; optimising the sequencing of these experiences within the program and, woman-led evaluations of student performance. There was little consensus regarding the pedagogical intent and, therefore, an inability to clearly define and measure the learning outcomes of the continuity of care experience.ConclusionIn countries where the predominant model of maternity care is fragmented and not woman-centred, further research is required to understand the pedagogical intent of the continuity of care experience.     

Shared learning on an international clinical placement: Promoting symbiotic midwifery practice knowledge

AimThe aim of this study was to explore the experiences of shared learning between Australian and Balinese midwifery students during a two-week clinical placement in Bali Indonesia.BackgroundCultural safety in midwifery is a key concept that is underpinned by the provision of holistic quality midwifery care to all women. Therefore, culturally safe midwifery care identifies, protects and promotes women’s individual cultures and is a key concept that is fostered in midwifery education. To educate culturally safe midwives, international placements to resource limited countries have become more common within midwifery education programs.MethodsThis study used a qualitative research design with a convenience sampling design. The participants were enrolled in midwifery courses in a University in the Northern Territory of Australia (n = 9), a Balinese private midwifery school (n = 4) and a Balinese public midwifery school (n = 4). Thematic analysis was used to analyse the data.FindingsThe findings were categorised into major themes under the headings of “Learning together despite differences”; “Cultural differences”, “Communication, Resources”, and “Recommendations for future placements”.ConclusionThis study provides a valuable insight into how shared learning increases students’ midwifery knowledge and is fundamental in understanding cultural differences that could be applied to students’ clinical midwifery practice.     

A literature review to determine midwifery students’ perceived essential qualities of preceptors to increase confidence and competence in the clinical environment

BackgroundMidwifery students’ experiences with preceptors in the clinical environment plays an integral role in developing the confidence and competence of students. As up to 50% of the midwifery program is taught in the clinical environment, an analysis of the preceptorship role in the context of midwifery student confidence and competence may be important to inform future practice and policy.AimTo discover, whilst on clinical placement, what is required by preceptors to suitably equip midwifery students to develop confidence and competence in the clinical environment.MethodsA search of the literature was undertaken using health and midwifery related electronic databases of PubMed, CINAHL, Intermid, SCOPUS and Web of Science. Grey literature, and reference lists from studies were also part of the thorough search process.FindingsAfter critical reading of the 15 included studies, there were a number of themes identified as the preceptor qualities that contributed to student confidence and competence. Those themes include ‘belongingness’, ‘hands on experience/skill development’, ‘students’ development of professional identity’ and ‘preceptor characteristics that impact student learning’.DiscussionStudent confidence and competence can be dependent on the preceptor who supports them. There are preceptors who enable students to flourish in their confidence and competence, and there also appears to be preceptors who do not possess these qualities, which requires further enquiry.ConclusionAs the evidence appears to find that trained preceptors are optimal for student confidence and competence, further enquiry is warranted to inform policy and practice around the concept of preceptorship training for midwives.     

Using Rasch analysis to identify midwifery students’ learning about providing breastfeeding support

AimTo report on a study measuring midwifery students’ self-reported abilities in teaching and supervising breastfeeding mothers. Abilities were assessed at two time intervals, before and after completing a maternal and infant nutrition topic with simultaneous clinical opportunities to consolidate their skills.MethodA convenience sample of midwifery students in an Australian university completed a pre- and post-intervention survey to assess their self-rated ability to teach and supervise breastfeeding mothers. Rasch analysis was used to gain conjoint estimates of students’ self-reported abilities to teach and supervise breastfeeding mothers across 37 items with varying complexity of care needs. Rasch analysis was used to determine validity and reliability of the 37-item tool, to develop a hierarchical linear scale reflecting difficulty of breastfeeding supportive activities, and to determine student learning between the two time points.ResultsFrom 95 responses, 34 of the 37 items met the requirement for unidimensionality. Outcomes identified that midwifery students’ self-efficacy measures for breastfeeding support abilities can be reliably estimated. A hierarchical scale for learning these clinical skills has been generated to inform curricula development and learning processes. While there was an overall increase in the ease of difficulty of 21 items in the survey at time point two, eight items were identified as becoming more difficult.ConclusionThe findings of this study challenge midwifery educators to reconsider the educational activities provided for midwifery students’ that aim to develop the requisite skills to provide effective breastfeeding support, including the provision of specific clinical opportunities to learn from breastfeeding women.     

Clinical outcomes for women who had continuity of care experiences with midwifery students

BackgroundPre-registration midwifery students in Australia are required to engage in a minimum of ten continuity of care experiences (CoCE). Students recruit and gain consent of each woman to provide CoCE under direct supervision of a registered health professional, usually a midwife. Clinical outcomes for women who had CoCE with a midwifery student placed in a continuity of midwifery care (CMC) or fragmented models are rarely reported.Aims1. analyse clinical outcomes for women experiencing CMC with CoCE by students; 2. analyse clinical outcomes for women in a fragmented care model with CoCE by students; and 3. compare clinical outcomes according to women’s primary model of care.MethodsStudents undertaking a Bachelor of Midwifery program at one Australian university recorded clinical outcomes for women experiencing CoCE during pregnancy [n = 5972] and labour and birth [n = 3933] in an e-portfolio. A retrospective, cohort design compared student recorded maternal data with National Core Maternity Indicators and Queensland Perinatal Data.ResultsMidwifery students providing CoCE reported better or equal clinical outcomes for women compared to population data. Women receiving CoCE had reduced likelihood of tobacco smoking after 20 weeks of pregnancy, episiotomy, and third and fourth degree tears.ConclusionsClinical outcomes for women in fragmented models of care and receiving CoCE by undergraduate, pre-registration midwifery students are equal to or better than State data across 12 variables. CoCE should be offered to all women early in their pregnancy to ensure optimal benefits. Acknowledging midwifery students’ potential to make positive impacts on women’s clinical outcomes may prompt more health services to reconceptualise and foster CoCE.