How well does pre-service education prepare midwives for practice: competence assessment of midwifery students at the point of graduation in Ethiopia.
BACKGROUND
Midwifery support and care led by midwives is the most appropriate strategy to improve maternal and newborn health. The Government of Ethiopia has recently improved the availability of midwives by scaling up pre-service education. However, the extent to which graduating students acquire core competencies for safe and effective practice is not known. The purpose of this study was to evaluate the quality of midwifery education by assessing the competence of graduating midwifery students.


METHODS
We conducted a cross-sectional study to assess the competence of students who completed basic midwifery education in Ethiopia in 2013. We interviewed students to obtain their perceptions of the sufficiency and quality of teachers and educational resources and processes. We assessed achievement of essential midwifery competencies through direct observation, using a 10-station Objective Structured Clinical Examination (OSCE). We calculated average percentage scores of performance for each station and an average summary score for all stations. Chi-square test, independent sample t test, and linear regression analysis were used to assess the statistical significance of differences and associations.


RESULTS
We assessed 484 graduating students from 25 public training institutions. Majority of students rated the learning environment unfavorably on 8 out of 10 questions. Only 32 % of students managed 20 or more births during training, and just 6 % managed 40 or more births. Students' overall average competence score was 51.8 %; scores ranged from 32.2 % for manual vacuum aspiration to 69.4 % for active management of the third stage of labor. Male gender, reporting sufficient clinical experience, and managing greater numbers of births during training were significant predictors of higher competence scores.


CONCLUSIONS
The quality of pre-service midwifery education needs to be improved, including strengthening of the learning environment and quality assurance systems. In-service training and mentoring to fill competence gaps of new graduates is also essential.
Jhpiego, Addis Ababa, Ethiopia. tegbar.yigzaw@jhpiego.org.
Tegbar
T
Yigzaw
Jhpiego, Addis Ababa, Ethiopia. firew.ayalew@jhpiego.org.
Firew
F
Ayalew
Jhpiego, Paris, France. young-mi.kim@jhpiego.org.
Young-Mi
YM
Kim
Jhpiego, Addis Ababa, Ethiopia. mintwab.gelagay@jhpiego.org.
Mintwab
M
Gelagay
Jhpiego, Addis Ababa, Ethiopia. daniel.dejene@jhpiego.org.
Daniel
D
Dejene
Jhpiego, Addis Ababa, Ethiopia. hannah.gibson@jhpiego.org.
Hannah
H
Gibson
Ministry of Health, Addis Ababa, Ethiopia. aster1621@gmail.com.
Aster
A
Teshome
Vrije Universiteit, Amsterdam, Netherlands. j.e.w.broerse@vu.nl.
Jacqueline
J
Broerse
Medical Centre Leeuwarden, Leeuwarden, Netherlands. jelle.stekelenburg@online.nl.
Jelle
J
Stekelenburg
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education / Q000592:standards*; D003430:Cross-Sectional Studies; D003479:Curriculum; D004521:Educational Measurement; D005002:Ethiopia; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D008880:Midwifery / Q000193:education* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D017678:Sex Distribution; D013338:Students, Nursing / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult