Women and Birth
Volume 20, Issue 3 , Pages 127-130, September 2007

Out of the Ashes: The new bachelor of midwifery curriculum at Victoria University

  • Mary Carolan

      Affiliations

    • Corresponding Author InformationCorresponding author. Tel.: +61 3 9919 2252; fax: +61 3 9919 2832.
    • ,
  • Gina Kruger

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    • Tel.: +61 3 9919 2697.
    • ,
  • Vera Brown

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    • Tel.: +61 3 9919 2420; fax: +61 3 9919 2140.

School of Nursing and Midwifery, Victoria University, PO Box 14428, Melbourne 8001, Australia

Received 8 December 2006; received in revised form 23 May 2007; accepted 23 May 2007.

Article Outline

Summary 

In the past decade, midwifery education has changed significantly in Australia. Previously, a nursing qualification (division 1) was required for entry into midwifery programs and on completion, graduands obtained a postgraduate diploma of midwifery. More recently, bachelor of midwifery programs have also been offered in Australia and currently, a considerable percentage of midwives are prepared for practice in this way. In Victoria, the bachelor of midwifery has been available since 2002, and at this time the third group of graduands are poised to enter the field.

Implementation of the bachelor of midwifery program has given rise to many concerns about the development and applicability of this course. Concerns include: complexities of registration with a regulatory board set up primarily for nursing registration; concerns about readiness for practice among bachelor of midwifery graduands; escalating requirements within midwifery courses; and difficulties with meeting course requirements. As this course comes of age in Victoria, it is useful to reflect on some of the challenges encountered along the way.

Thus, this paper reports on the journey of one university as it approaches the end of a first year of implementing an independent bachelor of midwifery program, following 5 years involvement as a consortium partner. In particular, it addresses concerns and difficulties encountered during early implementation of the program and then outlines strategies used to improve and strengthen the course. The basic premise of the paper is lessons learnt along the way.

Keywords: Bachelor of midwifery, Midwifery education, Curriculum development, Online learning

 

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Background 

In 2002, the Werna Naloo consortium was established to offer undergraduate midwifery education across three Victorian universities, including Victoria University, Monash University and the Australian Catholic University.1 This new direction in midwifery education in Australia was fuelled by several developments, including: changes to midwifery philosophy resulting in a need for new educational programs; parallel, though earlier moves in England and New Zealand,2, 3, 4 and concerns around shortages of future midwives.2 Growing dissatisfaction with existing models of fragmented maternity care,5, 6, 7 increasing consumer advocacy and maternal preference for continuity of carer also influenced the development of new programs.6, 8, 9, 10, 11 Undergraduate programs, in turn, aimed to promote midwifery as a separate profession, distinct from the illness orientation of nursing. Changing philosophy promoted midwives as the ‘specialists of normal birth’ and actively promulgated the notion that pregnancy and birth were normal events in a woman's life.12, 13 A range of terms, suggestive of midwifery's new direction, were adopted by the profession. Examples include: ‘with woman’, ‘in partnership’ and ‘woman centred’ care.12, 13 All were chosen to reflect midwifery's orientation to the childbearing woman and endorsed measures of maternal choice, control and collaboration. Undergraduate midwifery programs aimed to produce a new type of midwife,11 who would reflect these changes while at the same time having a clear understanding of evidence based research.14, 15

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At Victoria University 

At Victoria University, the bachelor of midwifery program has been offered to students since 2002 and the third group of completing students are now approaching registration. Initially the course was offered in conjunction with two other universities, however in 2004, a decision was made to offer the course autonomously. This decision involved easing out of the consortium partnership, a process that will be completed by 2008. A variety of circumstances influenced the university's decision to ‘go it alone’ and these circumstances can best be described by providing an historical overview. The Werna Naloo consortium course, a three year pre-registration midwifery course, commenced in March 2002 with a total of 50 students.1 In subsequent years, 20 students enrolled annually in each university to a total yearly student load of 60 students. Each university within the consortium had its own curriculum independently accredited by the Nurse's Board Victoria [NBV]. This meant that curricula varied from one university to the next, but all met with approved standards. Each semester students completed a variety of units at their home university and these units of study were offered in the traditional classroom manner. Selected units were also conducted on line and this medium accounted for approximately 40% of course content. Each consortium partner offered on-line units in which all 60 students from the three universities enrolled.

At Victoria University, the consortium curriculum went through the required university and regulatory processes. However, once the curriculum was implemented, it became apparent that no hours had been allocated to the learning of skills in the laboratory setting. To rectify this error, hours were subsequently taken from the time allocated to clinical practice units to ‘create’ the time needed to teach students skills. Misinterpretation related to unclear unit descriptions contributed to this problem and while it would be easy to disparage such an oversight, we must be mindful that this was an entirely new course, embracing a new philosophy, with a group of midwifery students who for the first time were not nurses. Although there was some uncertainty around course hours, it was not until December 2004, as the first group of students were completing, that the full extent of the problem became evident. Completing students had not met their requirement of clinical hours. Once it was discovered, Victoria University worked with the Nurses Board and implemented strategies facilitating student placement for deficit clinical hours. This measure was so successful that all students graduated in a timely fashion and most had completed requirements by 31 December.

Nonetheless, it was a difficult time for academic staff and during subsequent debriefing, other issues emerged with the course, most of which related to student dissatisfaction with on-line learning. Many students seemed to struggle with this medium of delivery of essential midwifery knowledge. Therefore, once early dilemmas around clinical hours were resolved, the School of Nursing and Midwifery made a decision to withdraw from the consortium course over the course of the next 3 years and to instead implement a ‘stand alone’ bachelor of midwifery course. This course of action was driven by staff interest in developing a rigorous curriculum which would address earlier shortcomings. They also wished to ensure that lessons learnt would be used to further develop and strengthen the course.

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The new curriculum 

In 2005, the new bachelor of midwifery was approved by the Nurse's Board for implementation, at Victoria University, in 2006. For the midwifery academics involved, this step represented the culmination of a long period of intensive academic activity and much soul searching as to why earlier problems had arisen. Staff resolve to strengthen the course meant that other weaknesses identified over the 3-year course could now be addressed. These weaknesses included: student dissatisfaction with on-line learning, and this was especially evident among first year students. Particular concerns related to: difficulty comprehending complex midwifery theoretical concepts; difficulty in accessing lecturers for clarification of lecture material; and concerns that the acute care part of the course was taught on-line. Feedback from clinical partners [hospitals, birth centres] indicated that bachelor of midwifery students were also not well prepared for practice in terms of clinical skills and pharmacological knowledge.

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Addressing concerns 

To address concerns with on-line learning, the new curriculum allocated on campus tutorial and laboratory hours for each core midwifery theoretical unit. This allowed for clarification of course material and for student discussion with lecturers. Although a small percentage of lectures remain online, tutorials afford opportunities for face-to-face discussion for all theoretical subjects. Some new units have also been included in the curriculum. These subjects encompass the acute care portion of the midwifery program and involve care of women with pregnancy complications and care of women during obstetric emergency. Previously this material was covered in a single on-line subject for 3rd year students. Students raised concerns that they encountered many such women during clinical placements but had little understanding of care requirements until they completed the unit in their final year. In the new curriculum, care of a woman with pregnancy complication is introduced early in 2nd year and is followed up with a second unit in 3rd year. We hope that this initiative will result in better student experience and greater comprehension of care of women with pregnancy complications. Finally, feedback from hospital staff raised concerns about the depth of student pharmacological knowledge and, to address this concern, a dedicated pharmacological unit is now included in 3rd year of the new curriculum. In the past, this information was included as part of two other units. By offering pharmacology as a discrete unit it is hoped that students will gain greater insight into this important part of care.

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Unanticipated benefits 

As we have completed our first year of the new curriculum, a range of other incidental benefits have come to light. Those benefits include: greater control of course administration; greater ability to monitor struggling students and preclusion of difficulties associated with cross-institutional enrolments. Of these concerns, staff consider that the lack of overall control of the course, in addition to unfamiliar course content, contributed significantly to the misinterpretation of course hours and early difficulties with the consortium course at Victoria University. With the new curriculum, course control resides entirely within the School of Nursing and Midwifery, which may help prevent similar difficulties arising in the future. Secondly, with the consortium course, there was a possibility of missing struggling students until they were well advanced in the course. Although the university had in place structures to identify students who failed more that one unit per semester or who failed the same unit more that once, the system did not identify cross-institutional units. This lapse was significant as 40% of the course content was covered in this way. Thus, when one of the failed subjects was an on-line consortium subject, these safety mechanisms did not initially function but were dependent on staff diligence and manual adjustments at semester's end. This issue has been identified for continuing consortium students but is considerably more streamlined in the new curriculum. Finally, the process of complimentary cross-institutional enrolment for students is both administratively time consuming and onerous. With this new course, we will no longer be involved in this process biannually.

At this stage, it is important to add that the consortium course continues as a successful and robust course and a third university has been recruited to replace Victoria University. In the 5 years that it has been running, the course has been strengthened and improved by consortium partners, neither of whom experienced the same degree of curriculum difficulties as Victoria University.

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Lessons learnt 

At Victoria University, academic staff identified four primary lessons that they had learnt in their journey with the consortium course, all of which were related to structural deficiencies in course development. Those lessons were:

1.The need to proceed slowly and with caution when developing a new course.

2.The need for clear consultative processes with consortium partners and the development of curricula that were very similar.

3.The need for robust failsafe mechanisms and supports at university level.

4.The need for teaching staff to be involved in course development.

Each of the academics involved considered that the consortium curriculum had been developed and implemented hastily at Victoria University and also that this factor contributed to later difficulties. In retrospect, greater deliberation and discussion might have pre-empted subsequent misunderstandings around clinical hours. Secondly, although there had been collaboration with consortium partners, resulting accredited courses at each university were quite dissimilar and it was generally felt that some misinterpretation might have been avoided had the courses been more similar and collective interpretation possible. Thirdly, the consortium course was a new innovation for Victoria University and there had been no prior precedence established for supporting development of this type of course. Thus, existing failsafe mechanisms related to course development did not operate well and discrepancies in the curriculum went unnoticed. Finally, development of the consortium curriculum was undertaken by a core of staff who were not intimately involved in later teaching the course. Those teaching the course had minimal involvement in course development and thus had limited opportunity to review or discuss misgivings prior to course accreditation. With the value of hindsight, there should have been greater involvement of teaching staff.

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Why this will never happen again 

As a result of difficulties with the consortium course and in response to subsequent quality review, several processes have been put in place at the School of Nursing and Midwifery at Victoria University that will prevent such misinterpretation of course content from recurring in the future. Now, prior to each semester, unit outlines are audited independently for fit with unit descriptions in the curriculum. Particular attention is accorded to content and course hours. Any changes to the NBV approved curriculum must progress through separate processes within the school, at faculty level and be approved by the Nurses Board prior to implementation. Curriculum development committees monitor this process and a designated academic is available for advice and assistance.

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Online learning 

As a final point, the issue of online learning is one that deserves some attention and it is not entirely clear why this medium posed particular difficulty at Victoria University and not at the two partner universities. Difficulties may in part relate to student's limited prior exposure to eLearning and a lack of local access to technology. Within the limited extant literature, similar findings present and the successful application of eLearning is discussed as dependent on technological skills and local acceptance of technology.17 First-time eLearners are discussed as being prone to cognitive overload16 and Hannay and Newvine consider that this mode of education may be more suited to older students that to undergraduate populations.18 While there is no clear consensus as to why online learning was particularly problematic at Victoria University, it is reasonable to postulate that a combination of factors contributed to student dissatisfaction with this medium.

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Conclusion 

In general, the consortium bachelor of midwifery experience has been very successful and the third group of students are now approaching registration. The Werna Naloo consortium is an ongoing concern and another Australian University has taken the place of Victoria University from 2006, easing into the partnership as we are easing out. For Victoria University, the early days of this course were fraught with difficulties that the other two universities did not experience. However, as a result of these concerns, a rigorous new curriculum has emerged and academic staff have been able to further develop and strengthen the course. An additional bonus has been the opportunity to address newly identified issues such as inadequate pharmacological preparation for practice and earlier attention to complications of pregnancy. It is anticipated that this new program will better meet the needs and requirements of the midwifery profession and midwifery students.

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References 

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PII: S1871-5192(07)00057-1

doi:10.1016/j.wombi.2007.05.006

Women and Birth
Volume 20, Issue 3 , Pages 127-130, September 2007

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