Bachelor of Midwifery students' experiences of achieving competency for beginning practice

This study, commencing in 2005, explored the experiences of Bachelor of Midwifery students' achievement of competency for beginning practice. Data were collected via interviews with nineteen final year Bachelor of Midwifery students, completed competency assessments and reflective journals, along with field observation of 5 of the students periodically during their final placement, for a total of 48 hours. Data were analysed using grounded theory methodology augmented by situational analysis. Achievement of competency involved a number of social processes as the students adapted to a largely medically dominated system. The overarching process was termed assimilation, linked to which were realisation, adaptation and consolidation. Assimilation represents the processes of adjustment that occurred within the various clinical agencies where the students were learning to become midwives. During their final placement the students acknowledged what had been an ongoing realisation of the nature of midwifery practice and the midwife's role within a medically dominated system where medical discourse held sway, resulting in restrictive midwifery practise and autonomy. This was in direct contrast to an alternative midwifery discourse which underpinned the Bachelor of Midwifery curriculum. Very few students worked with a preceptor on an ongoing basis and less than half worked with midwives who role modelled appropriate midwifery care; when this did occur it was usually in midwifery-led models of care such as caseload, birth centres, non-tertiary hospitals and community midwifery practice. Adaptation therefore involved modifying behaviour to appear to fit in and thus avoid disciplining practices, such as intimidation, social exclusion and criticism from the midwife preceptor.;This enabled the students to gain the experience needed to achieve competency through practical application of knowledge, increasing independence and confidence in practice, so called consolidation. Achievement of competency standards and confidence to practice was perceived to be made difficult because of the restricted nature of midwifery practice within the hospitals in which they were learning. This was linked to criticism of the competency assessment process where the intense focus on achieving requirements for registration set by the regulatory bodies was often to the detriment of personal learning objectives. This study raises awareness of a number of issues to be considered for those involved in the development and implementation of Bachelor of Midwifery curricula, namely competency assessment methods, clinical placement allocation and related student preceptorship needs. A critical review of the time frame for achievement of the requirements for practice is also needed as is provision of a variety of agencies to allow students to achieve professional competencies that promote autonomous midwifery practice, in partnership with women throughout the continuum of childbirth.