Experiences of Clinical Assessment and the Competency Assessment Process in Midwifery Midwifery Lecturer and Doctoral Student Carmel Bradshaw Supervisors Dr Judi Pettigrew and Dr Mary Fitzpatrick

Background to the study Major changes in the delivery of undergraduate midwifery education in Ireland including: 2002, introduction of competency assessment framework for clinical assessment : Responsibility for clinical support, supervision and assessment of students devolved to the midwives. 2006, Direct route to midwifery (BSc in Midwifery) with the programme situated within the third level institutions 2007, Post Registration midwifery programme reduced from 2 years to 18 month programme within third level institutes

Clinical assessment in midwifery practice a practice based profession with students requiring assessment in clinical practice traditionally provided by clinical midwife managers and midwifery teachers, now provided by registered midwives Assessment of practice a key facet of under graduate programmes to ensure safety and competence at point of registration

Aims of research To explore midwifery students (BSc and Post Reg) experiences of clinical assessment utilising a competency assessment framework during their undergraduate programme To explore the perceptions of midwifery lecturers of clinical assessment from an educationalist perspective with a particular focus on the competency assessment framework culminating in ………..

An in depth exploration of preceptor midwives experiences of clinical assessment of undergraduate midwifery students with a particular focus on the change in their role and on the competency assessment framework in use.

Preceptorship/Preceptor A qualified and experienced midwife who has agreed to work in partnership with practitioner, colleague or student to assist and support them in the process of learning and adaptation to his or her new role (Morton-Cooper and Palmer, 2000) Note preceptorship in an Irish midwifery context applies to support of students only

2 Focus groups (BSc Midwifery students) June 2014 Ethical approval received April 2013 Analysis of data from focus groups using Burnard's (2006) framework of analysis Phase I Qualitative descriptive design to determine midwifery students and midwifery lecturers experiences of competency assessment process 2 Focus groups (Post Reg students) May 2013 2 Focus groups with midwifery lecturers Oct 2013

Themes Midwifery students Centrality of the preceptor to the experience of the student Components of the Competency Assessment Process Managing the staff and student role Midwifery Lecturers Role of the preceptor Components of the Competency Assessment Process Challenges of Competency Assessment

The Students Experiences of Competency Assessment

Centrality of the preceptor to the experience of the student Need for preceptor preparation and updates Consistency and continuity among preceptors The impact individual preceptors can have on the student’s learning and experience Unrealistic expectations of the students The need for feedback for preceptors Vetting of preceptors to assess suitability for the role

The impact individual preceptors can have on the student’s learning and experience “You may feel confident going in to work. But some reduce you to tears, you feel useless. I still don’t know what effect those experiences have on you” P8 “Midwives who could make or break you in a week” P14 “Preceptors who take an interest and wanted to teach students ..and then it is very easy, they are willing to work with you” P11

The need for feedback for preceptors and vetting of preceptors to assess suitability for the role “They (preceptors) should be put forward for preceptorship, the manager would have some idea what they are like, whether they are good teachers” P6 “Shouldn’t they be reprimanded when they are like that , there is no comeback on them when they are being intolerant” P6

Components of the Competency Assessment Process Task vs. holistic approach to assessment Consistent approach to assessment The importance of skills assessment in midwifery The number of competencies Integrating competency assessment into the clinical environment Written evidence to support practice The need for feedback

The importance of skills assessment in midwifery (and the tangibility of assessing skills) “It is all in the hands, your knowledge is all great but if you cant do it with your hands and be assessed with what you do with your hands there is nothing tangible for the midwife to see” P14 The number of competencies “There is a lot of competencies, quality would be better than quantity” P1

Written evidence to support practice “Preceptors don’t even agree. Sometimes they need something in and sometimes not, they pick something and pull it apart” P13 “The supportive evidence, you could copy that from a book. It doesn't show anything, doesn't prove anything, doesn't show you can communicate with anyone” P2

The need for feedback “What I found most annoying was no feedback, not good, not bad, nothing” P14 “People know if there is something bad going on with someone, they just kind of know” P3 and “Yeah they only hear when we are useless” P2

Managing the staff and student role Transition from staff nurse to student midwife Expectations of clinical staff of the Post Reg midwifery students Quality of supervision

Transition from staff nurse to student midwife “There is such variation and complications which we hadn't covered in college and it was really daunting as a student to be expected “ Go on there’s your women, get on with it”P6

Expectations of clinical staff of the Post Reg midwifery students “Oh my God, the safety aspect of it and I know they say we are here next door, come and ask us anything but you don’t want to be doing that all day” P6

Quality of supervision “As you progressed your experience was making it easier for you, not that the process had improved” P8 “You are not a nurse while you are here in practice you are a student of midwifery”P14 contrasting with “Because we are paid employees there is not much emphasis on teaching” P5

Phase 2 Data from phase 1 will be used to generate items for a questionnaire and as a basis for interviews with preceptor midwives to commence in 2014

References Burnard, P. (2006) A Pragmatic Approach to Qualitative Data Analysis In Newell R Burnard P (Eds) Vital Notes for Nurses: Research for Evidence Based Practice Blackwell Publishers, Oxford Morton Cooper A.,Palmer A (2000) Mentorship, preceptorship and clinical supervision: a guide to professional roles 2nd Ed Blackwell Scientific Publications Oxford Neary M (2013) Professional Development for Student Mentors Guide for: Mentors, Teachers, Lecturers and Professional Practitioners Inspire .ie Cork

Thank you for your attention. Questions?