The Nursing and Midwifery Council (NMC) is the regulating body for nurses and midwives in the UK (NMC, 2015); its principal role is to protect the health and wellbeing of the public by ensuring that the care provided by nurses and midwives is always of the highest quality. In order to achieve this, it sets standards for education, training, professional conduct and performance (NMC, 2018a). Revalidation was introduced by the NMC to increase public confidence in nursing and midwifery by promoting a culture of professionalism and accountability (NMC, 2017). Revalidation became effective in April 2016, superseding the Post Registration Education and Practice Standards (Prep) handbook (NMC, 2011).
Revalidation reinforces the Code (NMC, 2015), and requires midwives to prioritise people; practise effectively; preserve safety; and promote professionalism and trust—underpinned by the requirement to safeguard the public. Key requirements of revalidation are the completion of 450 practice hours; five pieces of practice-related feedback; and 35 hours of continuing professional development (CPD), of which 20 must be ‘participatory’ (NMC, 2018a). Appropriate CPD activities are not prescriptive; the NMC provides no guidance on specific CPD activity, stating only that it should be relevant to the individual's scope of practice (NMC, 2015).
What is CPD?
CPD is one of the seven pillars of clinical governance (education and training), which is described as:
‘The system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence can flourish.’(Scally and Donaldson, 1998:61).
As autonomous, accountable practitioners, midwives are expected to be lifelong learners, updating their clinical knowledge and skills throughout their careers, as monitored by the revalidation process (NMC, 2017).
What is participatory CPD?
The pedagogical roots of participatory CPD lie in 20th century social learning theories. For teachers and their practice, the ideas of the Soviet psychologist Vygotsky (1978) have been particularly applicable. At their core, Vygotsky's ideas boil down to some fundamental concepts: the first is that we learn through the social process of trying to solve a problem with others, and the second is that, during such a process, a person working with another will solve a problem and develop a skill in a more sophisticated way than working alone.
Participatory CPD: Midwifery
Participatory CPD was identified in the NMC's Revalidation evidence report (NMC, 2014) as the most effective form of CPD, thereby giving registrants the opportunity to learn with and from each other. Multiprofessional education and training is high on the political agenda (National Maternity Review, 2016) as key to high quality care. Furthermore, it is suggested that a participatory rather than a didactic approach is more likely to lead to positive changes in practice and better levels of care (NMC, 2014).
Historically, midwives' CPD was work-based: conducted in the form of appraisals or clinical skills sessions; delivered face-to-face at events such as conferences or study days; and enabled through private study or, more recently, via ‘learning facilitated and supported through the use of information and communications technology’ (Carroll et al, 2009: 236). The use of social media in a professional context continues to gain momentum by offering a flexible means of achieving CPD requirements. The NMC is not prescriptive in what constitutes appropriate CPD activities but some suggestions are provided in Table 1.
| CPD activity | Individual/participatory |
|---|---|
| Structured learning (direct or distance learning style) | Individual/participatory |
| Accredited college or university-level education or training | Individual/participatory |
| Mandatory training specifically relevant to role/scope of practice | Individual |
| Learning events such as workshops, conferences | Participatory |
| Reading and reviewing publications | Individual |
| Enquiry-based research | Individual |
| Peer review activities | Participatory |
| Coaching and mentoring in a specific skill (either delivering or participating) | Participatory |
| Structured professional clinical supervision | Participatory |
| Undertaking short supervised practice for specific skills development | Individual/participatory |
| Group or practice meetings outside of everyday practice (e.g. to discuss a specific event or new way of working) | Participatory |
| Participation in clinical audits | Participatory |
| Practice visits to different environments relevant to scope of practice | Individual/participatory |
| Training related to job rotation or secondment, shadowing | Individual/participatory |
Participatory CPD: Teaching
Teaching can be a more isolated profession than midwifery, especially for teachers who may often be the only adult in the room. Even though this has changed in recent decades with the increased presence of a teaching assistant, this is still a very different environment in which to learn and develop new practice (Hargreaves et al, 2014). Recently, standards for CPD have been set for teachers by the Department for Education, although there is no compulsory requirement for teachers to complete CPD once they have completed their Newly Qualified Teacher year (now becoming 2 years).
CPD for teachers is primarily based on three models:
An enormous amount of CPD undertaken by teachers is conducted through small-scale research, although often this research is never formally published or disseminated. Research involves examining elements of practice in context (Anderson, 2014), self-reflecting and re-developing ideas. Such opportunities are often as part of Masters' courses. Although very different to midwifery CPD, this is a form of self-directed CPD via participation, typically with a mentor or supervisor, who works with the teacher to develop their understanding of the research undertaken and what this means for practice. A significant difference, however, is that the mentor may never even be in the same classroom as the teacher, but instead guides the mentee through their reflections (Creaby, 2013) either online or through meetings at a university or other supporting organisation.
Small-scale research is a valuable personal, reflective process, but it often does not impact on a whole school in the way that teachers and school leaders would like (Frost, 2014). There have been various initiatives that have attempted to broaden out the impact of teacher research, with varying degrees of success. These have sometimes attempted to reframe teacher research as teacher-led development work or as non-positional teacher leadership (Frost, 2015). Even though there is an acknowledgment that this has proved challenging, the positive personal impact on teachers' practice of undertaking teacher research is widely accepted, and small-scale research certainly dominates the forms of long-term CPD undertaken by teachers.
What can midwives learn from teachers?
There are similarities between choices of CPD for midwives and teachers, such as attending training courses or conferences, or more recently, via e-learning or social media. An innovation in midwifery CPD with the potential to positively impact on service provision would be to adopt the ‘teacher research’ model. Reflection is already firmly embedded in midwifery practice, being key to high quality care and a requirement of revalidation (NMC, 2015). The concept of taking personal reflection a step further and using it as a driver for undertaking small-scale primary research or, at the very least, a clinical audit is an exciting prospect with the potential to make a real difference to standards of maternity services and service user satisfaction as a result.