Our previous Birthwrite article discussed the conceptual leap for student midwives when embedding evidence-based practice and research in midwifery. The article noted that the evidence-based practice and research skills that are core to midwifery curricula do not always remain with student midwives beyond qualification (Folliard and Sanders, 2022). We suggested this was because these skills are somewhat opaque, less tangible than hands on midwifery skills (Lee and Peacock, 2020), and not reliably modelled by the midwives with whom students and newly qualified midwives learn. So, how do we, as midwifery educators, ensure parity of esteem between these different types of midwifery skills?
With the daily challenges of busy workloads leaving little time for experienced midwives to actively engage with research (Toolhill et al, 2015), clinical and academic educators may find it difficult to effectively facilitate prioritising and mastering evidence-based practice and research skills. Supervising midwives need to assess students’ ability to translate theory into practice. This paper outlines some approaches that have been taken and focuses on whether there is an opportunity for collegiate learning, which capitalises on the privileged position of student midwives, who have dedicated time to specifically focus on these skills. The aim of this is to ensure that evidence-based practice and research skills are maintained beyond the point of registration and nurture a research-positive maternity culture with safe practice at its core.
Simulation approach for research in the clinical environment
Learning through simulation is a widely used and effective pedagogy for clinical skills, encouraging students to think flexibly and develop competence, safe practice and understanding, closing the gap between theory and practice (Harder, 2018; Weeks et al, 2019). Simulation also offers an opportunity to assess critical thinking (Chitongo and Suthers, 2019; Lee and Peacock, 2020). With the correct resources and support, facilitating the emulation of practical physical midwifery skills is achievable, and a similar approach can be used to model research knowledge.
Efforts have been made to embed evidence-based practice by increasing research exposure for student nurses and midwives through involvement in projects and undertaking research for their undergraduate thesis (Borrelli et al, 2020; Grönning et al, 2022). In the authors’ experience, students may independently seek research exposure through elective placements within specialist teams. However, this is often limited to students who seek these opportunities rather than being a universal expectation. The issue of how to excite every student to the power of translating research into practice remains.
The authors question whether students acknowledge evidence-based practice to be the integration of clinical expertise with critical appraisal of the best available clinically relevant evidence (Sackett, 1997) and suggest that joining these elements puts safe practice at the fore.
Relationships, coaching and mutual knowledge exchange
Previous reports (Francis, 2013; Kirkup, 2015) suggest a closer relationship between education and practice environments can place safety and quality at the centre of student learning. Through a positive relational framework, educators in the clinical and approved education institution environments can offer an opportunity for students to nurture skills and enrich learning (Dewar et al, 2020). Coaching is grounded in relationship-based knowledge acquisition, where students undertake focused learning with flexibility about the subject and the ability to interact with colleagues and practice supervisors (Tweedie et al, 2019). This enables a reflexive approach to future learning moments, with the breadth of exposure widening the range of practice students can emulate.
Coaching provides an opportunity for students to proactively seek underpinning evidence in relation to real-time practice, bring this back to supervisors and fellow students and prompt collaborative critical thinking. If students can identify links with research during clinical situations and actively promote research-focused discussion, this may bring evidence-based practice alive (Aglen, 2016). The relationship between the student and supervisor creates a partnership approach to embedding research in practice through reciprocal learning.
To facilitate students effectively, supervisors must recognise their own knowledge gaps and embrace coaching as a positive opportunity to work alongside the student without fearing criticism of their expert role. Although there is a need to acknowledge the hierarchy in placement learning, there is space in coaching for mutual knowledge exchange between coach and student. This provides an opportunity for midwives’ professional development, as they too benefit from this learning, which may address issues of incongruence between theoretical learning and practice (Panda et al, 2021). Coaching then enables multiple ways of seeing both sides of the teaching and learning relationship, with the resourcefulness and experiences of both parties embraced (Mezirow, 1991).
While coaching may provide a means to collaboratively embed evidence-based practice and research in the practice setting, all midwifery educators need to consider their role in this, including within the approved education institution. As previously discussed, approved education institutions have embedded research within curricula but also need to give attention to how the research content of theoretical learning is delivered, finding a way to ignite a research interest among students who might view this aspect of their midwifery education as dry (Aglen, 2016; Lee and Peacock, 2020).
In asking students and midwives to view research through a practical lens, we are encouraging the development of phronesis, or practical wisdom (Kinsella and Pitman, 2012), challenging the perception that practice and research knowledge are separate and enabling students to see evidence-based practice and research as a practical skill they can learn to apply.
Conclusions
Curiosity and criticality are skills that need to be fostered in student midwives in a meaningful way that is carried through into their practice. Educators must equip students with an untethered curiosity. The use of an evidence-based practice and research focus in the coaching model, linked with classroom learning, where research is celebrated and enlivened, may be an approach that holds merit, and would warrant further exploration and evaluation.