Action research to improve the pre-registration midwifery curriculum--Part I: An appropriate methodology.
OBJECTIVE
To improve the pre-registration midwifery curriculum locally and influence national policy and guidelines for these programmes.


METHODS
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.


METHODS
A large university in England.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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 license to practise.
Fraser
D M
DM
Academic Division of Midwifery, School of Human Development, University of Nottingham, A Floor, Medical School, Queens Medical Centre, Nottingham NG7 2UH, UK. diane.fraser@nottingham.ac.uk
D003479:Curriculum / Q000592:standards*; D004739:England; D006801:Humans; D008008:Licensure, Nursing; D008880:Midwifery / Q000193:education* / Q000592:standards*; D016294:Models, Nursing; D015402:Nursing Education Research; D019982:Organizational Case Studies; D012107:Research Design; D013338:Students, Nursing; D013663:Teaching / Q000379:methods / Q000592:standards