The Master of Midwifery Practice (MMP) is a newly accredited postgraduate midwifery course offered in a university in Western Australia, and successful completion of the course leads to registration as a midwife with a Master's degree. This is the first midwifery degree at Master's level offered in Western Australia, which offers another route of entry into the midwifery profession, alongside the Diploma of Midwifery for postgraduate students and both the Dual Degree in Nursing and Midwifery and the Bachelor of Midwifery for undergraduate students. Midwifery students enrolled on the 2-year MMP course are registered nurses, who are offered flexible learning options involving on-campus workshops and online learning, as opposed to traditional on-campus lectures and tutorials.
The learning environment in universities has changed a great deal in an aim to cater for the differing needs of the students it now attracts while continuing to fulfil the obligation to industry and registration agencies to produce safe practitioners. Flexible delivery options allow students to plan work and life commitments around studying (Chan et al, 2014). More mature students are enrolling in university courses than in previous years (Kahu et al, 2014; Keogh, 2014; O'Boyle, 2014), and most fee-paying students need to work to support themselves while studying (Ziskin et al, 2014). Therefore, flexible delivery options were designed and incorporated into the new MMP course, which involved rethinking the structure and course content.
The course consists of nine units, the structure of which comprises a mixture of online self-directed learning, critical-thinking exercises, YouTube clips and documentaries, Adobe Connect online ‘drop-in’ sessions, audio PowerPoint lectures and face-to-face clinical skills workshops, lectures and tutorials. Assessments deviate from using the traditional essay, and include critical analysis of topics, case studies from clinical practice, PebblePad e-learning, presentations, poster-making and video-making, as well as a variety of written assignments and reflections. Presentations, posters and videos are peer-reviewed and marked by the students as well as the lecturers, providing yet another form of learning. The mixture of learning being online and face-to-face gives the student flexibility and some control over his or her learning needs, and is known as blended learning (Lim et al, 2014).
Blended learning
Blended learning is an assimilation of theoretical and clinical skills learned in the classroom and online; and the blended learning process encourages higher-order thinking among students in higher education (Hsu and Hsieh, 2014). Students learn through the transfer of content and instruction via online learning, collaborative working between students and academic staff, and with students having some control over time, place or pace of work. Postgraduate midwifery students are encouraged to think critically, apply evidence-based research to practice and critically analyse in order to prepare them for clinical midwifery practice. Blended learning has been linked with encouraging student achievement (Bernard et al, 2014) and provides access to educational content at any time (Arving et al, 2014). Therefore, assessment of students is important in determining what students find important during their learning process because this is a necessary component of helping them to learn (Brown et al, 2013).
Evaluation
The MMP course is a 2-year programme, which utilises the paid employment model. Midwifery students are employed for 2 days per week at the hospital of training and attend university for 1 day per week. The midwifery students were asked to evaluate the course at the end of the 2 years, using a structured questionnaire containing closed and open questions. The questionnaires were filled in anonymously by the students and consent was implied if the students completed the questionnaire. A pre-paid envelope was supplied with the questionnaire so that completed questionnaires could be returned.
The questionnaire contained 10 questions that were ranked with a 10-point Likert scale with answers ranging from ‘strongly agree’ to ‘strongly disagree’. Space was also provided for students to give a written answer to each question. It was also an opportunity for students to provide their own perspective on the methods of learning they had experienced while completing the MMP course.
The evaluation was analysed by the two authors using a spreadsheet approach and a consensus on the final interpretation was reached. The results were then discussed with the participants to ensure correct interpretation of the themes.
Participants
Twenty-five midwifery students were given the questionnaires, and 17 were completed and returned. The students' ages ranged from 24–48 years old, all were female and all had previously qualified as a registered nurse (RN). The students had a variety of nursing experience collectively.
Ethical considerations
Ethical permission was granted from the university's ethics committee and permission to publish results was granted. The midwifery students were told they would face no penalty for not participating in the study; and the questionnaire was anonymously completed at the end of the students' course.
Findings and discussion
Four main themes were identified from the evaluation (Figure 1). These were categorised as:
Variety of teaching methods
All of the 17 responses highly rated the online learning modules, stating that the online learning was ‘easy to access’ and ‘enjoyable’. Several students commented that they liked having the responsibility to study the modules online, and working at their own pace. They also reported that
‘all information was delivered in a very interactive way which made it a lot easier to take in’ (SMP1)
and
‘I believe the mixture of interactive learning as well as the theory worked well.’ (SMP2)
The online modules provided an introduction to content which was then put into practice in the weekly clinical skills sessions held at the university. The clinical skills sessions took the form of hands-on workshops conducted over 2 hours every week on campus. All the students highly rated the workshops, which were assisted by two midwives currently working in clinical midwifery environments. This ensured that the students were able to practise clinical skills in small groups with three midwifery facilitators.
Many of the students were mature-aged students and some had not participated in formal study for many years. These students commented on how they believed education had radically changed from the rote learning they had experienced as nursing students. All the students agreed or strongly agreed that the critical thinking exercises were useful during the completion of the online modules, and all the students requested more use of YouTube clips to reinforce learning. Many students stated that they were visual learners and enjoyed seeing how information that had been read was transformed into a practical application. For example, students commented on how watching a YouTube clip on fertilisation and embryology helped them to understand the process, and commit to memory when revising for the end-of-semester examination on theory.
Feeling overwhelmed
Many of the students expressed that they had felt overwhelmed when attending a block week at the university at the beginning of the course. Students stated that although the information was ‘well presented’ there was ‘a large volume of information to take in’. This provided them with an in-depth view of midwifery, but they had little time to process the information prior to the delivery of new concepts. Contrary to this, some students felt the information provided during the block week helped them to understand some of the continuity-of-care experiences and birthing experiences in clinical practice, and the students also commented that they were able to distinguish routine nursing care from midwifery care. Students expressed concerns that if they were unable to attend all the sessions during the block week, because of work or family commitments, they would miss valuable information during discussions. One student expressed that it gave her an opportunity to ‘get a true understanding of what was involved’ in regard to theory.
Contextualising midwifery
The students expressed how being immersed in the culture of midwifery during a full week in university at the beginning of the course enabled them to obtain a ‘holistic view of midwifery’. Perceptions of a midwife's role were altered ‘for the good’ or consolidated during the students' initial exposure to theory. One student said:
‘It cemented in my mind that I want to be a midwife.’ (SMP3)
The information presented provided a clear picture of the expectations of the midwifery role in contrast to obstetric care. Discussions, critical thinking exercises and practical application of theory through the blended learning approach consolidated knowledge of midwifery concepts.
Support
Students identified that support from lecturers, tutors and peers was invaluable to their successful completion of the course. The ‘sharing of experiences’ from experienced lecturers enhanced the students' critical thinking processes, with some students acknowledging that ‘real experiences were inspirational’ and that this reaffirmed their decision to become a midwife.
Lecturers working alongside clinical midwives during simulation sessions enhanced the learning experience for the student. Students expressed an appreciation that they were together so that they could share their experiences and talk about topics they encountered in clinical practice. The discussions in the tutorials from students' experiences generated learning on how to address complex or unexpected real-life situations, preparing them to transition from midwifery student to novice midwife. Students appreciated that lecturers took a strong interest in the application of their learning.
Limitations and recommendations
Although this cohort of students was relatively small, the information remained consistent. Evaluations are generally retrospective, therefore it may be valuable to consider a prospective research design which may add valuable insight that could result in changes in the units of study. Many tertiary institutions do not publish their evaluations, which may be of benefit to all education providers, especially as academics and educators are encouraged to use a national approach to the registration of health professionals. Research into student understanding of the significance of course content and essential learning required for their future professional role will enhance students' experiences, both in theory and practice. Research into peer support, especially in midwifery, may provide an insight into the effectiveness of promoting and maintaining lifelong learning within the profession. A follow-up study, exploring how this method of teaching matches up with the practical experience of working in a midwifery environment, would be beneficial in understanding the students' experience of applying learning to clinical practice.
Conclusion
Evaluations continue to provide an effective communication tool between students and lecturers. This evaluation has provided an insight into the perceptions of midwifery students during an entry-to-practice MMP course. Findings indicate the students' enjoyment of the presented topics, at the same time acknowledging the overwhelming feelings associated with studying at university. The study demonstrated that consistent positive feedback on blended learning techniques cannot be underestimated and is important in content delivery. Midwifery education should to be relevant to the learning needs of 21st-century students.