Impact of women's feedback on midwifery student learning: A thematic analysis of students' reflections.

PROBLEM: Little is known about the educational impact of providing routine, online feedback from women on midwifery student learning and clinical practice. BACKGROUND: Feedback on students' clinical performance has historically been provided by lecturers and clinical supervisors. Women's feedback is not routinely collected or evaluated for impact on student learning. AIM: To evaluate the impact of women's feedback about continuity of care experiences with a midwifery student on learning and practice. DESIGN: Descriptive, exploratory qualitative study. METHODS: All second-and third-year Bachelor of Midwifery students undertaking clinical placement between February and June 2022 at one Australian university, submitted formative, guided written reflections on de-identified women's feedback they received through their ePortfolio. Data were analysed using reflexive thematic analysis. FINDINGS: Forty-four of the 69 eligible students (64%) submitted reflections on feedback received. Three themes emerged: 1) Confidence boosting, 2) Deeply integrating Midwifery Metavalues, and 3) Enhancing commitment to continuity. Three subthemes: connection, future practice and advocacy were identified. Women's feedback positively impacts student learning and places the woman in the educational feedback loop. CONCLUSION: This study is an international first evaluating the impact of feedback from women on midwifery students' learning. Students reported greater confidence in their clinical practice, a deeper understanding of their midwifery philosophy, and an intention to advocate for, and work in, midwifery continuity models after graduation. Routine feedback about women's experiences should be embedded into midwifery education programs.

Exploring the needs and experiences of educators in facilitating use of the Bass Model of Holistic Reflection.

Health professionals are required to reflect on practice to evaluate and improve care in rapidly changing health care environments. This study explored the professional development needs of educators facilitating development of reflective capacity in midwifery students using the Bass Model of Holistic Reflection. Thirteen midwifery academics at two Australian universities took part in the study conducted in three phases. Phase 1 identified the learning needs of educators described as 'understanding the building blocks of reflection'; 'practical application of the model, and 'assessment of reflective capacity'. Phase 2 involved an Intervention including development of a reflective practice tool kit and delivery of a two-day workshop. Phase 3 evaluated the experience of educators using the resources and four themes emerged: 1) 'Educators value a reflective practice toolkit'; 2) 'A toolkit builds confidence and trust in the model through promotion of deep personal reflection'; 3) 'Effective use of the model is key to achieving consistency in application by educators; and 4) 'Deeper understanding of the model promotes transformation of practice'. This paper confirms the importance of developing resources for educators, that support reflective pedagogy when implementing models of reflection into curricula.

Midwifery students' experiences and expectations of using a model of holistic reflection.

BACKGROUND: Reflective practice is a core professional competency and the hallmark of an autonomous, evidence-based midwife practitioner committed to lifelong learning. Despite this professional imperative little is currently known about how the development of reflective capacity is facilitated with midwifery students. AIM: This study aimed to determine (1) the extent to which a holistic, structured model of reflection develops reflective capacity in midwifery students; and (2) their perceptions of learning and teaching strategies that build reflective capacity. DESIGN: A qualitative cross-sectional design involving focus groups and thematic analysis. PARTICIPANTS: The Bass Model of Holistic Reflection was introduced to promote development of reflective capacity in midwifery students enrolled in entry to practice programs in two Australian universities. Students were provided with guidance on how to apply the model to their reflections. After using the model for at least one trimester twenty-seven (27) participants volunteered to participate in focus groups. FINDINGS: Four themes emerged 'safe space within a circle of trust', 'deep personal learning', 'consistency of application by skilled facilitators', and 'integration and connection'. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Use of a holistic model combined with integrative and structured reflective activities supports the scaffolded and developmental nature of reflection. Alignment of the model with a woman centred midwifery philosophy generates midwifery knowledge and reflects student expectations of their role as aspiring midwives. Midwives' attitudes regarding reflection influences students' perceptions of value. Quality of feedback provided by educators affects levels of student motivation and engagement with reflection.

Development and validation of the Australian Midwifery Standards Assessment Tool (AMSAT) to the Australian Midwife Standards for Practice 2018.

BACKGROUND: The Australian Midwifery Standards Assessment Tool (AMSAT) was developed against the Competency Standards for the Midwife in 2017 to enable consistent assessment of midwifery student performance in practice-based settings. The AMSAT requires revision and re-validation as the competency standards have now been superseded by the Midwife Standards for Practice 2018. OBJECTIVE: This research revised and validated the AMSAT to assess performance of midwifery students against the Midwife Standards for Practice 2018 and assessed its sensitivity. DESIGN: A mixed-methods approach was used in a two-phase process. Phase one involved the re-wording of the AMSAT and behavioural cue statements in an iterative participatory process with midwifery academics, assessors and students. The tool was field-tested in different assessment environments in phase two. Completed assessment forms were statistically analyzed, whilst assessor surveys were analysed using descriptive statistics and qualitative content analysis. FINDINGS: Analysis of AMSAT (n=255) indicates the tool as: internally reliable (Cronbach alpha>.9); valid (eigenvalue of 16.6 explaining 67% of variance); and sensitive (score analysis indicating increased levels of proficiency with progressive student experience). Analysis of surveys (n=108) found acceptance of the tool for the purpose of summative and formative assessment, and in the provision of feedback to midwifery students on their performance. CONCLUSION: This study demonstrates that the re-developed AMSAT is a valid, reliable and acceptable tool to assess midwifery students' performance against the Australian Midwife Standards for Practice This user-friendly tool can be used to standardize midwifery student assessment in Australia and enable continued benchmarking across education programs.

Developing reflective capacities in midwifery students: Enhancing learning through reflective writing.

BACKGROUND: Practice-based or clinical placements are highly valued for linking theory to practice and enabling students to meet graduate outcomes and industry standards. Post-practicum, the period immediately following clinical experiences, is a time when students have an opportunity to share, compare and engage critically in considering how these experiences impact on their learning. Reflective practice has merit in facilitating this process. AIM: This project aimed to optimise the learning potential of practice-based experiences by enhancing midwifery students' capacity for reflective practice through writing. METHODS: Design-based research was used to implement an educational intervention aimed at developing reflective practice skills and enhance reflective writing. The Bass Model of Holistic Reflection was introduced to promote the development of reflective capacity in midwifery students. Academics and midwifery students were provided with guidance and resources on how to apply the model to guide reflective writing. Students' written reflections completed before (n=130) and after the introduction of the intervention (n=96) were evaluated using a scoring framework designed to assess sequential development of reflective capacity. FINDINGS: The pre-intervention scores ranked poorly as evidence of reflective capacity. All scores improved post-intervention. CONCLUSIONS: The introduction of a holistic structured model of reflection resulted in improved scores across all five components of reflective writing; self-awareness, sources of knowledge, reflection and critical reflection, evidence informed practice and critical thinking. While further work is required the results show that the implementation process and use of the Bass Model enables students to demonstrate their capacity to reflect-on-practice through their writing.

Development of a Model of Holistic Reflection to facilitate transformative learning in student midwives.

BACKGROUND: Reflective practice is considered an essential aspect of personal and professional development, and critical reflection is considered the cornerstone of being an accountable and autonomous practitioner. Tertiary education should lay the foundations of lifelong learning by ensuring students develop into critically reflective and reflexive practitioners, who demonstrate self-awareness and an ability to reflect on personal values and beliefs and their impact on the wider healthcare system. This level of reflective practice is essential to effect change at both an individual and societal level. Reflection should therefore be embedded into education programs as a learning, teaching and assessment strategy. AIM: The aim of this paper is to describe a structured Model of Holistic Reflection embedded within an Australian Bachelor of Midwifery Program. The paper firstly outlines the theoretical and conceptual underpinnings of the newly developed model. Secondly describes the six integrated and inter-dependant phases of the model. DISCUSSION AND CONCLUSION: The aim of developing the Holistic Reflective Model was to produce a sound educational tool to assist midwifery students to progressively build reflexivity and reflective practice. Furthermore, provide midwifery academics with an educational resource to facilitate development of reflective and critical thinking skills in students. The specific intention was to promote deep personal and transformative learning across an entry to practice program. This paper highlights a number of ways the model can be embedded within the curriculum to support the scaffolded development of critical reflection and reflexivity required to facilitate transformative learning. While evaluation is required the model may have transferability to other disciplines.

Promoting retention, enabling success: Discovering the potential of student support circles.

Retention of students is critical to education programs and future workforce. A mixed methods study evaluated student engagement within a Bachelor of Midwifery program and connection with career choice through participation in student support circles. Centred on the Five Senses of Success Framework (sense of capability, purpose, identity, resourcefulness and connectedness) and including four stages of engagement (creating space, preparing self, sharing stories, focused conversations), the circles support and develop student and professional identity. Of 80 students 43 (54%) provided responses to a two item survey assessed against a five point Likert scale to determine utility. Using a nominal group technique, student's voices gave rich insight into the personal and professional growth that participation in the student support circles provided. Evaluated as helpful to first year students in orientating to university study and early socialisation into the profession, the circles appear to influence the development of a strong sense of professional identity and personal midwifery philosophy based on the relational nature of the midwife being with woman rather than doing midwifery. This suggests that student support circles positively influence perceptions and expectations, contributing to a shared sense of purpose and discipline connection, for enhancing student retention and future workforce participation.