[Solved]1. Integrates theory and practice more constructively – the dissatisfactions of the students are given formal curricular

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[Solved]1. Integrates theory and practice more constructively – the dissatisfactions of the students are given formal curricular time and become part of the learning process itself rather than being ignored.

Reflective Practice Strategy for Midwifery Education

Reflective practice continues to play a central role in the teaching and learning strategy of the 2012 curriculum. Why is this an important aspect of the curriculum, and why does it require to be formalised in this way?

It is particularly important for midwives to engage with personal philosophies and beliefs –

Concern about the quality of care, and particularly the quality of the patient/client experience, are central to the NHS Clinical Governance agenda. Care depends not only on cognisance of research and understanding its application to practice, but also a sensitivity to the potential uses and abuses of power within the practitioner/client relationship. These are all therefore, political issues demanding that the student develop the tools to identify their expression in practice customs and traditions, as well as thinking about ways they can change either their practice, or the organisation of care, or both in the interests of clients and practitioners. 

The disparity between classroom theory and clinical reality can create tensions and confusion for students manifested as disaffection with the course or their chosen profession. A sort of triangle of demands opens up – what the University expects/what the mentor expects/what the student expects – and the student can get lost in the process. There needs to be a formal space in the curriculum to explore these tensions, and perhaps to reassert the individual student practitioner’s voice in the educational process. Without time to do this, as a group, the process of becoming a midwife remains largely ignored and consists of a muddling through in the hope that it will all turn out alright in the end. 

The strategy therefore, is to provide students with the opportunity and the skills to trace their own narrative as they become midwives. Through this, they access their own beliefs and values, building this into a personal philosophy for practice, articulated in their journal and increasingly in their analysis of midwifery issues. What this strategy does is to incorporate within the present unitary framework, a formal process of dialogue between students and tutors which aims to tease out from the student, their initial values and beliefs about midwifery practice (there is a formal session in the induction block devoted to this) which they will use as a first reference point for their journey. The aim over the length of the course, as students develop more and more sophisticated analytical tools, is for the emerging practitioner to see how their own experiences and knowledge have affected their beliefs, how they continue to affect them, and how there can be points of tension between things they may wish to do (their notion of desirable practice), and the things they actually do.

The advantages of having a timetabled, reflective practice strategy are that it:

1.             Integrates theory and practice more constructively – the dissatisfactions of the students are given formal curricular time and become part of the learning process itself rather than being ignored.

2.             This responds to the need to develop practitioners who are more self-aware.

3.             It helps build skills of assertion and advocacy – if students know what they believe and why then they are more likely to grow in confidence to defend those beliefs, and understand the need of others to do likewise.

4.             The sessions provide a focus for the reflective journal – and the habit of keeping a journal is a lifelong way to maintain mindfulness in practice.

5.             Clinicians require the knowledge and skills to be supervisees and supervisors – the dialogue between tutor and student is a means of preparing students for their own supervision, and giving an insight into the skills required to supervise as they begin to both support and challenge their colleagues in reflective sessions.

6.             Students welcome the opportunity to tell their story – this process formally recognises the importance and value of their narratives within the learning process.

7.             The essentially political nature of practice is recognised, as debates are opened up and competing ideologies explored.

8.             Constructing and maintaining an open dialogue about practice is an important element in undermining the blame/shame culture that permeates midwifery and which is an important contributor to unsafe practice.

9.             The dialogues that emerge provide the University with the basis for ongoing research about the nature of their processes, their output (what kinds of practitioners emerge) and also provides a reference point for ongoing research into the development of practitioners post-registration.

Students may feel threatened by these expectations – and it is vital that there is a balance of challenge and support within reflection – but healthcare professionals must encounter difficult situations on a regular basis, and the equitable, just and ethical delivery of midwifery care ultimately depends on midwives being awake to their own attitudes/prejudices and values, as well as those expressed through the organisations within which they work.

Level 6

The theme for the third year is vision and voice. The aim is to move the student from narrative analysis to a more complete awareness of their own philosophy for practice. Alongside this, they will develop the skills of articulating their vision, justifying it and working through it in practice.

Learning outcomes:

• Students are able to evaluate health care practice according to their own beliefs and values about how practice should be.
• Students are able to begin to make informed judgements about desirable practice.
• Students are able to locate the tensions between actual and desirable practice.
• Students can begin to articulate their own vision of desirable practice.
• Students are able to discuss strategies to realise desirable practice within the constraints of present health care systems.

This years’ theoretical input will focus on:

• Feminist perspectives on science and caring
• Leadership
• Dealing with conflict
• Building philosophies of care/working with groups to build philosophies of care
• The ethics of care.

The learning outcomes stated above are desirable, reflecting a wish for students to become critical, and maybe even visionary, thinkers. However, they are not formally assessed through this strategy – this is seen as an opportunity to set aside timetabled sessions that are simply about ‘education for its own sake’.