1. Workshop on Harmonisation of the Education for Nurses and Midwives 22 nd January 2013 Belgrade, Serbia Mervi Jokinen Practice and Standards Development Advisor RCM

2. Progress in modernising the EU Directive Rappoteur Mrs Vernegaud (IMCO) reports have been published and responded to This week there will be voting on the final proposal For midwives’ article 40; the education entry level will be at 12 years of general education Annex V Training programme reviewed in the next phase input format currently; competencies in the future?

3. The role of midwife Midwifery is an autonomous profession and should be recognised as such. The existence of Midwives’ articles in the Directive supports the differentiation of midwifery education, training and practice from that of nurses. The points raised in this position are to strengthen this autonomy and to have acknowledgment of contemporary midwifery practice. Universal agreement on the International Confederation of Midwives (ICM) definition of the midwife and scope of practice

4. ICM Definition “A midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.“ Furthermore it qualifies an important principle in the scope of practice "A midwife may practise in any setting including the home, community, hospitals, clinics or health units."

5. Proposal amendments; Article 40 a)full-time training of at least three years as a midwife, consisting of at least 5 000 hours of theoretical and practical training including at least 2300 hours in direct clinical training, which may also be expressed with the equivalent ECTS credits; (at least one third) b) full-time training as a midwife of at least two years consisting of at least 3 600 hours, which may also be expressed with the equivalent ECTS credits, contingent upon possession of evidence of formal qualifications as a nurse responsible for general care referred to in Annex V, point 5.2.2; c) full-time training as a midwife of at least 18 months consisting of at least 3 000 hours, which may also be expressed with the equivalent ECTS credits, contingent upon possession of evidence of formal qualifications as a nurse responsible for general care referred to in Annex V, point 5.2.2 and followed by one year's professional practice for which a certificate has been issued in accordance with paragraph 2.

6. Other proposals; Article 40 3. Training as a midwife shall provide an assurance that the person in question has acquired the following knowledge and skills: (a) adequate knowledge of the sciences on which the activities of midwives are based, particularly midwifery, obstetrics, gynaecology and neonatology; (b) adequate knowledge of the ethics of the profession and the professional legislation; (c)detailed knowledge of biological functions, anatomy physiology, psychology and pharmacology in the field of obstetrics and of the newly born, and also a knowledge of the relationship between the state of health and the physical and social environment of the human being, and of his behavior; (d) adequate clinical experience gained in approved institutions under the supervision of staff qualified in midwifery and obstetrics; (e) adequate understanding of the training of health personnel and experience of working with such.

7. Article 42 1. The provisions of this section shall apply to the autonomous activities of midwives as defined by each Member State, without prejudice to paragraph 2, and pursued under the professional titles set out in Annex V, point 5.5.2. 2. The Member States shall ensure that midwives are able to gain access to and pursue at least the following activities: (a) provision of sound information and advice on female reproductive health, including family planning; (b) diagnosis of pregnancies, assessing and monitoring normal pregnancies, carrying out the necessary examinations; (c) advising or prescribing on the examinations necessary for the earliest possible identification and diagnosis of pregnancies at risk; (d) establishing comprehensive parenthood and childbirth preparation programmes; (e) caring for and assisting the mother during labour and immediately after birth and monitoring the condition of the foetus in utero by the appropriate clinical and technical means; (f) conducting spontaneous deliveries including where required episiotomies, suturing and breech deliveries;

8. Article 42 (g) recognising the warning signs of abnormality in the mother or infant which necessitate referral to a specialist health professional and assisting the latter where appropriate; taking the necessary emergency measures in the doctor's absence, in particular the manual removal of the placenta, possibly followed by manual examination of the uterus; (h) examining and caring for the new-born infant; taking all initiatives which are necessary in case of need and carrying out where necessary immediate resuscitation; (i) caring for and monitoring the progress of the mother in the post-natal period and giving all necessary advice to the mother on infant care to enable her to ensure the optimum progress of the new-born infant; (j) carrying out treatment prescribed by doctors and prescribing the medicines necessary as part of the exercise of the midwife profession; (k) drawing up the necessary clinical and legal documents.

9. Foundation for midwifery studies Majority of member states have moved into setting the access to midwifery training at 12 years general education or equivalent Advanced skills learned in high school – Writing, literacy, numeracy, more self-directed studies and different study methods Complex social changes – do we require midwives to be more mature with some own life experiences Other autonomous health professions’ requirements Munich Declaration 2000 WHO European Region Safe and quality maternity/health care

10. Underpinning the contemporary midwife Influencing what kind of practitioner will be educated- a midwife who is able in thinking critically and reflectively about their practice and in decision making; using research and evidence Theory--practice gap CPD – Lifelong learning

11. Cognitive skills

12. Statement of overall structure: Mission/Vision or Aims Intended achievements: Objectives / Outcomes Curriculum organisation: Core and modular structure Educational requirement: Learning and teaching methods, assessments Practical and clinical experience, resources Support, feedback and environment Curriculum evaluation plan Curriculum design principles

13. Curriculum statement Curriculum statement aims to inform educators, practitioners and managers their role and activities in relation to the course and its outcomes. Setting the content to be covered, learning objectives, teaching methods, learning theory or methods used, feedback and assessment processes as well as the course structure and entry requirements with learner characteristics Syllabus or content of programme is list of topics to be covered

14. Activities in planning a bridging programme Explore and analyse the current education programme in Serbia for midwives, compare with future requirements and develop recommendations Evaluate or identify current competencies and assess the need for potential changes Curriculum statement developed Curriculum content built on Is there a requirement for training the educators with prepared education materials, supervision of clinical practice Develop evaluation programme

15. Discussion points Learning must be centred on practice; clinical practice is the grounding and the meaning behind all Theory and practice of midwifery in-depth knowledge of fetal, neonatal and adult physiology to understand and apply this knowledge to monitoring, educating, supporting and providing care to the woman, and complex skills in developing woman’s autonomy in that care Hours; theory/clinical split; ECTS; EQF Novice to expert (Benner’s theory)

16. Discussion points continued Knowledge is not static Reflection: applying knowledge learned by theory into reality of practice and think in action reflecting on action Life-long learning Problem solving/enquiry based learning methods (PBL/EBL) Outcome based education Competence and Skill clusters that make up competency –soft skills versus hard skills Health and Social care national and EU level

17. Midwives in Serbia?