As autonomous, accountable practitioners, midwives are required to continually update their clinical knowledge and skills in order to provide high quality, safe and effective care (Nursing and Midwifery Council (NMC), 2012; NMC, 2015a; Jokhi, 2014). Post-registration education and practice (prep) is a set of NMC standards and guidance designed to support midwives in providing this level of care. Midwives renew their registration every 3 years by signing a Notification of Practice (NoP) and submitting an annual Intention to Practise (ItP) form to their named supervisor of midwives. Prep standards have two distinct requirements: midwives must provide evidence of a minimum of 450 hours of practice plus the equivalent of 35 hours of continuing professional development (CPD) or learning activity in the previous 3 years in order to maintain their professional registration (NMC, 2011). The NMC ensures midwives are complying with the standards by the NoP and may ask midwives to provide written evidence of their learning activity by means of audit. Under the current guidance, while the learning activity must be relevant to practice, there is no such thing as approved prep (CPD) learning activities (NMC, 2011), it is up to the individual to choose an activity they feel is relevant to practice and provide written evidence of its positive influence on their practice.
Revalidation: All change?
Revalidation is being introduced at the end of 2015 and aims to increase public confidence in nursing and midwifery by promoting a culture of professionalism and accountability. The NMC is currently consulting on revising CPD requirements and exploring whether it should be more prescriptive in identifying suitable CPD activities. The main changes from the current requirements are the increase of CPD hours from 35–40 hours (20 of which should involve interaction with others) and 5 reflective accounts based on the collection and reflection on feedback on practice from women and peers, CPD and the revised Code (NMC, 2015b).
In preparation for the introduction of revalidation, the NMC, as part of its Revalidation Evidence Report (2014), asked nurses and midwives what CPD activities they undertook and the responses included traditional activities such as workshops and conferences (84% of respondents); reading and reviewing relevant publications (81% of respondents); mandatory training (non-clinical) (65% of respondents) and group or practice meetings (61%). Seventy-four percent of respondents stated they used the internet as a resource. With barriers to completing CPD including difficulties with getting protected learning time from employers; cost and fitting CPD around working patterns and family life, a rethink of how to achieve CPD was required and so it was felt online learning was an acceptable, practical solution (NMC, 2014).
Internet research and online learning or ‘learning facilitated and supported through the use of information and communications technology’ (Carroll et al, 2009: 236) come in many forms: the Royal College of Midwives' (RCM) e-learning platform ‘i-learn’ is a learning resource with over 50 online courses, free to RCM members; however, for totally cost-free online learning, OERs or MOOCs may be worth considering. So what are they?
What is an OER?
Open educational resources (OER) are learning and teaching materials, freely available online for anyone to use; examples of which are full courses, modules and lectures (Jisc, 2015). They are shared via websites of education providers and through public services such as JORUM and Slideshare (Table 1).
| Host | Course title | Description |
|---|---|---|
| JORUM | Diabetes in Pregnancy Timeline | This interactive tool shows the care plan for a diabetic woman throughout pregnancy and childbirth. It is aimed at student midwives as it is intended to give a basic overview of the care provided and includes links to other useful resources. The timeline might also be useful for practising midwives as a refresher |
| JORUM | The Biology of Pain | A visual representation of the anatomy and physiology of pain which includes editable links to online resources |
| JORUM | Reflection in Learning | Two videos introducing the role of reflection in learning and reflection in problem solving |
| Slideshare | Search ‘midwifery’ | 3347 resources available |
| Slideshare | Search ‘maternity care’ | 31 636 resources available |
| Slideshare | Search ‘Nursing and Midwifery Council’ | 9539 resources available |
What is a MOOC?
A MOOC is a massive open online course. The aim of a MOOC is unlimited participation (anyone with an internet connection can sign up); with no prerequisites needed, they have no ‘credit’ attached to them, and are usually free. The most well known providers are Coursera (2015) led by the University of Stanford; edX (2015) led by Massachusetts Institute of Technology and Harvard University; FutureLearn (2015), which is UK-based and Udacity (2015) led by Google.
MOOCs: how they developed
The first MOOC was hosted by the University of Manitoba, Canada in 2008 and was entitled ‘Connectivism and Connective Knowledge’ (Sandeen, 2013). The hosts were surprised when over 2000 participants enrolled with little advertising. The expansion of online educational video content providers, such as TED (2015) has led to the proliferation of MOOCs. By 2012, which is referred to as ‘the year of the MOOC’, most of the main providers had been established and some MOOCs were attracting more than 100 000 participants.
MOOCs are offered via virtual learning environments and include video; peer learning/assessment; e-tivity tasks; discussion boards; wikis and journals. As time has gone on some MOOCs are offered with credit but these often involve a fee to register and to be assessed.
Application to practice
The aim of this article was to introduce you to alternative ways of achieving prep standards (NMC, 2011) using free online resources. OERs and MOOCs have potential as suitable learning activities to underpin evidence-based practice under the current standards.
Revalidation will be introducing changes to prep including the potential for more prescriptive prep activities and the requirement for five reflective accounts during the preceding 3 years. The Centre for Achievement and Performance (CfAP, 2015) at the University of Northampton has developed a MOOC entitled ‘Study Skills for Academic Success’. While this was initially targeted at health care students new to, or preparing for, higher education, it could also be a useful resource for qualified midwives to access to develop their confidence in their writing skills in preparation for revalidation (available on the Open Education platform).
| Host | Course title | Description |
|---|---|---|
| Openeducation.blackboard.com | Study Skills for Academic Success | An interactive and participative course designed to improve academic skills and confidence of students new to, or preparing for, higher education |
| Futurelearn | Understanding Drugs and Addiction | How do addictions develop? How are they best treated and prevented? |
| Futurelearn | The Science of Medicines | Learn the science behind how and why medicines work and what can improve patients' treatment |
| Futurelearn | Obesity: Causes and Consequences | Obesity is a global epidemic. As the world gets fatter, explore its impact on our health and lives |
| Futurelearn | Introduction to Cyber Security | Gain essential cyber security knowledge and skills, to help protect your digital life |
| What? | …was I trying to achieve? |
| …was the response of others? | |
| …was my role in the situation? | |
| …were the consequences of my actions? | |
| …was good (or bad) about the experience? | |
| So what? | …does this tell me about…? |
| …was I thinking at the time? | |
| …are the other issues in this situation? | |
| …is my new understanding of the experience? | |
| Now what? | …do I need to do to make things better? |
| …are there any other issues to deal with? | |
| …are the consequences of these actions? |
Participants in the NMC consultation (2014) wanted clear guidance on the expectations and requirements for the five reflective accounts, including format, comprehensiveness and academic level. It was also requested that it be easy to complete; have headings to help with structuring; not require academic referencing and include suggestions for appropriate topics.
In 2001, Rolfe et al published ‘Critical Reflection for Nursing and the Helping Professions: A User's Guide’. Since its publication, this model of reflection, often known colloquially as, ‘what? so what? now what?’ has been used successfully by health professionals, including midwives to reflect on practice. The statement ‘what? so what? now what?’ simplifies the concept of reflection; however, within each of the three trigger questions, are deeper, more searching questions, which are outlined in Table 1.
So what?
Midwives need to be creative to successfully juggle the demands of clinical practice, regulation and their private lives. Online learning offers great flexibility to meet such demands so why not sign up to the MOOC to refresh your writing skills and try out Rolfe et al's (2001) user-friendly reflective model?