Action research for curriculum improvement in pre-registration midwifery education
This thesis examines the effectiveness of a new curriculum for the preparation of midwives. Data were collected over a three year period in seven case study institutions, from women who had their babies in one large maternity unit and from a professional network of experienced midwives whose role is to advise the statutory body regulating midwifery programmes in England. The overall intention of the study was to improve the pre-registration midwifery curriculum locally and influence national policy and guidelines. Action research provided the framework for the study where a multi-method approach was largely qualitative to attempt to capture the context and complexity in which the midwifery education programme operates. The research explores and compares curriculum intentions with the perceived experiences of the curriculum as reported by key stakeholders. The development of a holistic integrated model of a competent midwife provided the framework for discourse on curriculum effectiveness, the design of an assessment matrix and recommendations for curriculum improvement. Overall the three year pre-registration route into midwifery was found to be an effective preparation for contemporary midwifery practice as judged against a model of a competent midwife. However there was evidence to suggest that not all students were equipped to practice competently and confidently in contexts of uncertainty and change in the health service. Factors which emerged as influencing curriculum effectiveness related to: recruitment and selection, curriculum structure, appropriateness and robustness of assessment schemes, the preparation of and support for assessors and the role of the midwife teacher in assessment in practice settings. Diagnosing problems and initiating actions as a collaborative process formed an important part of designing and implementing an ideal curriculum in changing and constrained health and higher education contexts. The need for on-going dialogue, critical reflection and research to facilitate and assess learning more effectively in the caring professions emerged as necessary to ensure only competent practitioners have a licence to practice.