A previous article in this series (Power et al, 2018) discussed ‘Becoming a midwife’, an innovative e-module that was introduced at the University of Northampton to support student midwives' employability, social awareness and preparedness for professional practice on qualification. The e-module encouraged students to reflect on the knowledge and understanding gained through the module's ‘e-tivities’, supported by the Changemaker Hub (Box 1). Students were asked to consider how employability skills, attitudes and behaviours were enhanced in preparation for preceptorship applications by reflecting on personal and peer performance when creating a CV, devising a Changemaker Project and in a simulated interview situation, while considering the professional, legal and ethical issues relating to practice.
Carter et al (2017) found that critical thinking skills promoted safe, effective midwifery practice. This key skill should be integrated into the pre-registration midwifery curriculum to nurture new generations of critically-aware midwives. The first e-tivity in the module was to complete an employability skills self-assessment tool. One of the skills identified by the tool was ‘advocacy when opposed’, which is essential for practising midwives. This is identified in the Nursing and Midwifery Council (NMC) Code, which states that midwives must ensure that:
‘[Service users'] rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.’
It is important that women understand the risks and benefits of the interventions and care they receive, and it is the midwife's duty to have candid conversations to support women in making an informed decision.
Another key attribute found by the tool was the ability to identify opportunities for positive change. It is important that midwives are innovative and proactive in meeting the increasingly complex needs of women and families in their care. As the co-ordinators of care where interprofessional working is indicated, the physical and emotional demands of the role increase (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010). The Midwifery 2020 vision recognises that continuity of carer improves the quality, safety and satisfaction with maternity services (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010; Power, 2016). There may be some resistance to this change; however, student midwives should be encouraged during their training and as preceptor midwives to be advocates for service improvement.
A well-drafted CV is crucial for applications as it documents academic credentials, accomplishments and skills (Middleton, 2014; Career Services at the University of Pennsylvania, 2019), in the hope of impressing employers and securing an interview. Alice, a third-year student midwife, drafted her CV using the online tool and submitted it to the Changemaker team for feedback. She found the recommendations useful in shaping a professional CV from the original draft and in preparing for future job applications. Although many NHS midwifery positions are posted on the NHS Jobs website, which does not require a CV to be uploaded, it does allow the applicant to type the same information into fields that will self-populate onto applications, so this e-tivity was helpful.
Should an applicant be successful in securing an interview, they must be as well-prepared as possible, especially for midwifery posts, where competition is high (Power et al, 2016). Despite the national shortage of 3500 midwives (Royal College of Midwives (RCM), 2016), and although statistics in England show that approximately 2500 midwives are trained each year, the workforce only increases by around 100 midwives per year in real terms. This is because an almost equivalent number are leaving the profession each year, due to retirement, long-term sickness and a lack of flexible working (RCM, 2016). In preparation for preceptorship interviews, Alice used the interview simulator from the Changemaker Hub, which gave her the opportunity to practice answering generic interview questions.
Students were also asked midwifery-specific questions to give them an opportunity to research contemporary midwifery issues (Power and Briody, 2016). Students conducted mock interviews in pairs to practise, and were asked to engage with peer observation and feedback. Mock interviews improve performance and confidence and are therefore useful learning opportunities (American National University, 2016); that said, it should be acknowledged that mock interviews do not always predict performance in real interviews as the stressors of a real-life interview are difficult to reproduce (Ayres, et al, 1998). Constructive feedback can be invaluable in enhancing students' progression, as this identifies individuals' strengths and future learning needs. This discussion should aim to have a positive impact on students (NMC, 2008). Alice felt that the role-play exercise was valuable because both students had an understanding of the expectations of the role (American National University, 2016), meaning that the feedback was meaningful and productive. Alice found giving feedback challengin, because although her partner gave a strong presentation, they lacked confidence in some areas and would have benefitted from greater reference to national policies and guidelines. Alice, in turn, received constructive feedback that included working on her verbal communication skills to ensure that she gets her point across clearly in an interview scenario, and revising her knowledge of the Code (NMC, 2018a), to develop confidence in spontaneously articulating how it informs practice. Clear communication is essential for effective midwifery practice (NMC, 2018a; Care Quality Commission, 2019); therefore, developing this skill in the module was an opportunity for positive change.
Changemaker Project: breaking down language barriers
Changemaking is about ‘spotting a social or environmental problem and having the skills and grit to do something about it’ (University of Northampton, 2019). One e-tivity tasked students with developing a midwifery-focused Changemaker Project that would have a social impact on students themselves, their peers and the community. The Code (NMC, 2018a) recognises that reasonable steps should be taken to meet the language needs of non-English speaking women to make care equitable (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010). In 2011, the top three spoken languages of women cared for by Alice's clinical placement provider were English, Polish and Gujarati. The current caseload of women in her local community are from other Eastern European and Asian countries (Qpzm LocalStats UK, 2011). Alice's group therefore wanted to explore ways to break language barriers, as translation services were either no longer funded or were unreliable—to the detriment of women and their families (Newall and Phillimore, 2012). Recommendations arising from the group discussion were to employ bilingual midwives to meet the needs of the local community. These midwives would form a core team with a caseload of women to whom care would be delivered in the antenatal, intrapartum and postnatal periods. If bilingual midwives were not available, NHS-funded courses could be made available to midwives, including British Sign Language.
Student midwives must complete a three-year pre-registration programme of study. Evidence of this learning must be demonstrated and fitness to progress is approved collaboratively by mentors in the clinical area and the approved educational institution (NMC, 2009). Currently, students are required to work 40% of their placement with their allocated sign-off mentor (NMC, 2008); however, new standards for student supervision will require the student to be supported by practice supervisors, who will provide feedback to practice assessors. The assessor's role will be to periodically observe the student's progress, communicate with practice supervisors, and liaise with academic assessors to evaluate and recommend students for progression (NMC, 2018b). Students may have negative experiences if the mentor lacks confidence, or feedback is not given in a timely manner in an appropriate environment. This is often due to time constraints in clinical areas (Elcock and Sharples, 2011). As a result, one e-tivity asked students to discuss what makes a good mentor. Common themes agreed in groups were someone who was approachable, able to openly share information and knowledge, and honest when giving feedback.
Lessons learned
Midwives are committed life-long learners who are constantly refining their practice as a result of reflection that is integrated into the revalidation process (NMC, 2018c). In order to develop and improve practice, it is important that midwives are critical thinkers who reflect in and on practice. This module encourages a culture of reflection in the pre-registration midwifery programme at the University of Northampton to prepare students for qualification and beyond. In conjunction with the Changemaker Hub, students have the opportunity to prepare for job applications by creating CVs and improving interview techniques, which will be invaluable for ‘standing out from the crowd’ in a highly competitive field. The peer observation and feedback activity prepares them for their role as practice supervisors to ensure their practice is in line with the Code by ‘sharing skills, knowledge and experience where appropriate’ and reflecting and acting upon feedback to improve practice (NMC, 2018a: 9).