Midwifery students' experiences of objective structured clinical examinations: A qualitative evidence synthesis.

OBJECTIVES: To identify and synthesise the evidence of midwifery students' views and experiences of Objective Structured Clinical Examinations (OSCEs). DESIGN: A qualitative evidence synthesis was undertaken using Thomas and Harden's synthesis methods and reported according to the ENTEREQ guidelines. DATA SOURCES: PubMED, CINAHL Plus, Embase, ERIC, PsycINFO, Social Science Citation Index (via Web of Science) and Scopus were searched from inception to 19th February 2020 and an updated search was performed on 12th May 2021 to identify qualitative and mixed method studies, reporting qualitative data of undergraduate midwifery students' views and experiences of OSCEs. REVIEW METHODS: Studies were independently screened by title and abstract according to a predetermined inclusion and exclusion criteria. Full text review was then conducted independently by two authors. Studies providing qualitative data on undergraduate midwifery students' views and experiences of OSCEs during their midwifery registration education programmes were included. Quality appraisal was performed using the Critical Appraisal Skills Programme (CASP) tool. Data synthesis was performed using Thomas and Harden's thematic synthesis method. RESULTS: Eleven studies were identified and included. Thematic synthesis identified 13 descriptive themes which translated into four analytical themes that represented midwifery students' views and experiences of OSCEs: the preparation phase, the assessment phase, the feedback phase and the translation phase. CONCLUSIONS: This synthesis offers insight into undergraduate midwifery students' views and experiences of OSCEs and how they are experienced across four phases. This is determined to be a useful structure to guide midwifery educators and researchers in their consideration of the student experience of OSCEs in the future. Midwifery students in this synthesis reported high levels of nervousness, anxiety, and stress during the OSCE process. The findings reveal that there are a number of controllable factors impacting on midwifery students' feelings of safety in the assessment environment, and that these should be addressed to maximise the advantages that the OSCE has to offer in terms of learning and preparation for clinical practice.

A blended learning perineal suturing programme for midwifery students: An evaluative descriptive study.

AIM: The purpose of this study was to examine midwifery students' views and experiences of learning perineal suturing skills through a blended learning approach. BACKGROUND: Evidence suggests that not all midwifery students are gaining sufficient experience in perineal trauma and suturing to sufficiently prepare them to achieve competency in this skill at the point of registration. DESIGN: The blended learning approach included lectures, a bespoke 'suture at home kit', online reusable learning objects, and an optional face-to-face drop-in suture clinic. Midwifery students submitted a video demonstration of the skills acquired and then attended a clinical skills laboratory in preparation for a face-to-face competency assessment on campus. RESULTS: A qualitative descriptive evaluation research design study was undertaken from 22 participants. Deductive thematic analysis was selected to analyse the qualitative data. Two themes were identified. The first theme, 'learning at home', included sub-themes of 'deliberate practice' and 'the ability to make mistakes. The second theme, 'achieving competency', included sub-themes of 'equipment' and 'bringing it all together' CONCLUSIONS: The blended learning approach of the programme applied to teach perineal suturing had a positive influence on midwifery students learning of the skill. The acquisition of knowledge using the suture at home kit gave the students confidence and prepared them for laboratory practice and assessment, and ultimately prepared them for practice placement. They identified other clinical skills suited to using an 'at home' simulation pack. The validation of the perineal suturing programme by midwifery students supports the need for a blended learning approach for this and other clinical skills. All participants expressed a positive view of the programme and found it beneficial for their learning. Midwifery students recognised that the suture at home kit gave them confidence, knowledge of the skill and preparedness for the clinical skills laboratory practice and assessment. They identified other clinical skills suited to using an 'at home' simulation pack. The positive experiences of midwifery students in this study to a blended-learning programme for perineal suturing education and training further validated the recognised need to develop and include online, and face to face learning approaches for this vital aspect of intrapartum care.

Perineal management: Midwives' confidence and educational needs.

OBJECTIVE: The overall aim of this study was to collate information to inform the updating of a perineal management educational programme for midwives. This paper explores midwives' confidence and educational needs in managing the woman's perineum during the second stage of labour, focusing on future quality initiatives to improve midwives' experiences and expertise in the prevention of perineal trauma during birth. DESIGN: A mixed-methods sequential exploratory design was used. PARTICIPANTS AND SETTING: Midwives and clinical midwife managers assisting with births in the labour ward of a large urban university stand-alone maternity hospital in the Republic of Ireland with approximately 9,000 births per year participated in the study. MEASUREMENTS: A questionnaire and two focus groups were used to collect the data. FINDINGS: Fifty-two midwives from a total of 64 eligible labour ward midwives completed the questionnaire, a response rate of 81.2%. Midwives indicated that perineal management workshops did not cover prevention of perineal trauma, and mainly focused on suturing and repair of the perineum. The majority of midwives (85%) indicated that they would like further education on the prevention of perineal trauma. Higher levels of confidence in making a decision to perform an episiotomy, infiltrating the perineum and at performing an episiotomy were reported in experienced midwives. Midwives want improved and additional education in the management of women's perinea during the second stage of labour and made various recommendations regarding the content, format, timing and frequency of the workshop. Suggestions for further education included techniques for preventing perineal trauma during labour and birth and how to perform an episiotomy. KEY CONCLUSIONS: This study provides key insights into midwives' confidence and educational needs in relation to managing the woman's perineum during the second stage of labour. The findings from this study demonstrates the appetite of midwives for additional education in the area of perineal management, particularly prevention strategies. IMPLICATIONS FOR PRACTICE: Midwives play an essential role in reducing the rates of perineal trauma through regular education. It is therefore important that midwives keep up to date with the best available evidence. Updating existing perineal management educational programmes that are tailor made to midwives' needs could not only improve clinical skills and perineal protection techniques but also midwives' confidence in decision making. The overall aim is to reduce perineal trauma in women having a spontaneous vaginal birth.