Action research to improve the pre-registration midwifery curriculum - Part I: an appropriate methodology

The purpose of this first of three papers is to discuss the rationale and a ppropriateness of an action research approach to bring about curriculum imp rovement. This abstract relates to the study as a whole. The abstracts for the subsequent two papers relate to the specific parts of the study they de scribe. Objective: to improve the pre-registration midwifery curriculum locally and influence national policy and guidelines for these programmes. Design: action research provided the framework for the study where a multi- method approach was largely qualitative to attempt to capture the context a nd complexity in which the midwifery programme operates. The study comprise s a synthesis of two separate but interwoven research projects: a national study about the effectiveness of midwifery education (the EME project) and an evaluation and re-design of the three year preregistration midwifery pro gramme in a large multi-sited university in England. Setting: a large university in England. Participants: the EME project 39 case study students, their teachers, pract ice-based mentors/assessors, preceptors and supervisors of midwives or mana gers; 50 students from the local university's midwifery programme, their te achers and practice-based mentors/assessors from six sites; 41 women who ga ve birth to their babies in a large teaching hospital in the East Midlands; and a professional network of experienced midwives whose role is to advise the statutory body regulating midwifery programmes in England. Findings: overall the three-year, pre-registration route into midwifery was found to be an effective preparation for contemporary midwifery practice a s judged against a model of a competent midwife at the point of registratio n. However, there was evidence to suggest that not all students are equippe d to practise competently and confidently in contexts of uncertainty and ch ange in the National Health Service. Factors which emerged as influencing c urriculum effectiveness related to: recruitment and selection; curriculum s tructure, appropriateness; and robustness of assessment schemes; the prepar ation of and support for assessors; and the role of the midwife teacher in assessment in practice settings. Conclusion and implications far practice: diagnosing problems and initiatin g actions as a collaborative process formed an important part of designing and implementing an 'ideal' curriculum in constrained health and higher edu cation contexts. The need for on-going dialogue, critical reflection, and r esearch to facilitate and assess learning more effectively in the 'caring' professions emerged as necessary to ensure that only competent practitioner s have a licence to practise. (C) 2000 Harcourt Publishers Ltd.