Midwife Training and Distance Education

Certified Professional Midwife

Midwives are not required to be nurses. They help to identify physical, social, and emotional needs of women during pregnancy. A Midwife is defined as “a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle” (Citizens for Midwifery, 2010).

The Midwives’ Model of Care is described as a woman-centered model of care. Their responsibilities include monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle. They provide the mother with individualized education, counseling, prenatal care, and continuous hands-on assistance during labor and delivery as well as postpartum support. Midwifery is expected to minimize technological intervention and to identify and refer women who require obstetrical attention. This model of care is said to reduce the incidence of birth injury, trauma, and cesarean section (Citizens for Midwifery, 2010).

The institution that develops and administers the Certified Professional Midwife (CPM) exam is the North American Registry of Midwives (NARM). NARM requires applicants for certification to have graduated from an education and training program accredited by the Midwifery Education Accreditation Council (MEAC). MEAC creates standards and criteria for the education of midwives. (MEAC accredited programs are listed and described in the attached spreadsheet). These programs range from 1 year to 5 years in length and are all non-nursing in scope (Midwifery Education Accreditation Council, 2010). According to the MEAC, two institutions offer distance education curricula: the Midwives College of Utah (http://www.midwifery.edu/) and the National Midwifery Institute.

The content for most of the didactic courses in the distance midwifery programs is delivered online. However, the clinical portion of the program is scheduled for onsite training with an approved proctor in a local setting. This tells me that a midwifery program, although advertised as an online program, is actually a blended program with both distance and local or face-to-face modules. MEAC and NARM both require that applicants for the CPM exam complete a hands-on practicum consisting of the following:

• Must attend a minimum of 20 births.
• Functioning in the role of primary midwife* under supervision, you must attend a minimum of an additional 20 births:
• A minimum of 10 of the 20 births attended as primary under supervision must be in homes or other out-of-hospital settings; and
• A minimum of 3 of the 20 births attended as primary under supervision must be with women for whom you have provided primary care during at least 4 prenatal visits, birth, newborn exam and 1 postpartum exam.
• At least 10 of the 20 primary births must have occurred within three years of application submission.
• Functioning in the role of primary midwife* under supervision, you must document:
• 75 prenatal exams, including 20 initial exams;
• 20 newborn exams; and
• 40 postpartum exams.

These requirements cannot be simulated or virtual. However, the didactic courses should include virtual experiences as part of preparing the learner for these real-world experiences.

Learner progress can be assessed by utilizing those “assessment strategies” as described in the required text (Simonson, Smaldino, Albright, and Svacek, 2009). Assessment strategies include quizzes and tests, asynchronous and synchronous communication, portfolios papers and essays, presentations and problem-based activities as well as journal writing (Simonson et al., 2009).
In terms of evaluating program effectiveness, focus should be directed on gathering qualitative and quantitative data. These measures include measures of activity, efficiency, outcomes, program aims, policy, and organization(Simonson et al., 2009, pages 350 to 351).

Simonson mentions the evaluation process used by the Open University of Great Britain (page 350) as an example of “the systematic investigation of the merit of a particular distance education program, curriculum, or teaching method.” This includes the collection of data relating to carefully selected variables before, during, and after the instructional intervention. I interpret this to include such variables as student retention and graduation rates, placement rates, and course passing / failing rates.

Program assessment can also be carried out using the AEIOU approach whose six areas of focus include institutional and programmatic accountability, effectiveness, impact, organizational context, and unanticipated consequences. The AEIOU approach can be used for performing an assessment of a midwifery certification program.

Accountability information can be gathered from administrative records to determine if project goals, objectives and activities have been completed. Assessment for program accountability would gather information on the appropriateness of the size and number of class sessions as well as the provision of required resources such as textbooks, software, internet access, and handouts.

Program effectiveness could be determined by measuring student and faculty perceptions and attitudes relating to project activities, levels of newly acquired skill and knowledge. Simonson mentions the use of survey questionnaires, grades, and achievement tests for gathering qualitative and quantitative data on program effectiveness.

The impact of the program determines what changes take place as a result of the learning intervention. Simonson suggests the collection of longitudinal data using learner’s progress in subsequent courses or the workplace “to determine if what was learned ….was useful”. Standardized tests, follow-up surveys, focus groups and direct observation can be used to determine the impact of a program.

Organizational context evaluation focuses on “structures, policies, or events in the organization or environment” (Simonson et al, 2009, pg. 354) that increase or decrease program success with accomplishment of goals. This type of evaluation may require closer involvement with the program on the part of the evaluator. Simonson suggests that the evaluator may have to go as far as actually enrolling in program distance education courses.

Determining unanticipated consequences or changes of importance that occur as a result of the project is also evaluated. These unanticipated changes could include unexpected changes in relationships between stakeholders, development of complimentary projects, linkages, and unexpected impact on student learning.



Ref:

Citizens for Midwifery, (2010) http://cfmidwifery.org/midwifery/faq.aspx

North American Registry of Midwives, (2010) http://www.narm.org/htb.htm

Midwives College of Utah, http://www.midwifery.edu/

Midwifery Education Accreditation Council, (2010). http://meacschools.org/accredited_schools.php

Simonson, Smaldino, Albright, & Svacek, (2009). Teaching and learning at a distance: Foundations of Distance Education, Allyn & Bacon.