Midwifery training: the views of newly qualified midwives

Sarah Robinson

In 1981 midwifery training for State Registered Nurses was extended from 12 to I8 months. It is hoped that this extended course, will improve the newly qualified midwife’s confidence in her clinical skills and in her ability to practise midwifery.

This article reports the findings of a study which compared views about training

held by a group of midwives who took the 18 month course with the views of a group who took the 12 month course. Data obtained from the two groups on the following topics are discussed and compared: whether they felt they had sufficient clinical experience during training; their views on the amount and content of

clinical and classroom teaching; the extent to which they felt the course had prepared them for the various responsibilities involved in practising as a midwife;

their career intentions having qualified.

Although a considerable body of research now

exists on various aspects of nurse education,

both on wards and in school, much less atten-

tion has focused on the education of the mid-

wife. The existing research has looked mainly

at post-basic training and at continuing educ-

ation, e.g. Kilty & Potter’s (1975) investigation

of factors related to pass rates for the Midwife

Teacher’s Diploma Examination; Balch’s study

of students’ experiences of the MTD course

(Balch 1981), and Maclean’s identification of

needs in relation to continuing education for

midwives (Maclean 1980). In the area of basic

training, Mander (1983) has attempted to

identify the ways in which students who drop

out of the course differ from those who

complete it.

Sarah Robinson, Research Fellow, Nursing Education Research Unit, Kings College, London

In this article data are presented from a

survey which examined the effects of the ex-

tended 18 month midwifery course on students’

views of their training. Data were obtained

from a group who qualified after taking a 12

month course and then compared with data

obtained from a group who qualified after

taking an 18 month course. Information was

also sought on the respondents’ career

intentions.

The decision to extend midwifery training

from 12 to 18 months was made in the late

1970s by the Central Midwives Board in re-

sponse to concern expressed by staff of mid-

wifery training schools that 12 months was

insufficient time to cover the syylabus ade-

quately (Central Midwives Board 1977). In

particular it was maintained that not enough

time was available for clinical experience and,

as Stewart (1981) comments, it was hoped that

an extension of time would be ‘used to develop

49

50 NURSE EDUCA’I‘ION TODAY

clinical skills and to give opportunity for the midwife to become confident and wish to practise as a midwife’. The newly qualified midwife’s confidence in her clinical skills was regarded as an essential factor in her decision as to whether or not to practise midwifery subsequently. This was of particular impor- tance to a profession long dominated by a

concern that man) of those whom it trains do not practisr at all in the year after qualifying, with further wastage occurring in each suc- cessive year after qualification (a trend demon- strated in the annual figures published up until 1983 by the Central Midwives Board). Conseq- uently the midwives who took part in this study were asked about the amount of clinical experience they had received, for their views on the clinical and classroom teaching provided, and how well they felt their training had prepared them for the various responsibilities involved in practising as a midwife.

RESEARCH DESIGN

Identical questionnaires were sent to two groups of newly qualified midwives; the first group qualified in 1979 after a 12 month course and the second group qualified in 1983 after an 18 month course. This enabled a comparison to be drawn between the two groups.* It was decided not to send the questionnaire to the first group of midwives to qualify after an 18 month training, as their responses might have been affected by ‘tee- thing’ problems with the new course. All the midwives who passed the May and September 1983 examinations were included in the 18 month study group. In both 1979 and 1983 the questionnaires were piloted with midwives who, had qualified earlier in the year.

The questionnaire consisted almost entirely of closed questions with pre-coded answers; respondents were invited to make comments after some of the questions if they wished to

*A preliminary study wab undertaken of midwives who qualified in 1978. These data have bwn published elsewhere (Golden 19801.

amplify their answers. Each questionnaire was accompanied by a letter explaining the purpose of the study and a stamped addressed envelope for return of the completed questionnaire. One reminder letter was sent to the non-respondents some 4-5 weeks after the initial posting. Excell- ent response rates of over 80 per cent were achieved for both groups, as shown in Table 1.

Data obtained from midwives who respon- ded to the reminder letter did not differ signifi- cantly from those of other respondents. The 18 month trainees were asked if the course they attended was the first, second or third to he run by their particular school; analysis of the data showed that no significant differences existed between these groups. In this article the data obtained from the 12 month group are compared with those from the 18 month group using the test of difference between proportions. Given the large numbers of respondents in the two study groups, the lowest level of signifi- cance accepted was p < 0.001.

THE RESPONDENTS

About half of the respondents in both groups were 23 or 24 years old when they qualified as midwives (52 per cent of the 1979 group and 49 per cent of the 1983 group). A further third fell into the 25 to 30 age group and a small proportion (9 per cent of both groups) were aged 31 or over at the time of qualification.

All members of the group who qualified in 1983 had attended an 18 month course having previously qualified as State Registered Nurses. At the time when the questionnaires were sent out in 1983, none of the three year direct entrance courses were completed and so mid- wives without the SRN qualification were not included among the respondents. Of the group of midwives qualifying in 1979, 3 per cent were not SRNs: two members of this group had no nursing qualifications and were direct entrants to the profession. Eleven per cent of both groups were on other registers or held addi- tional nursing certificates. Over 90 per cent of both groups of respondents had practised as nurses before entering midwifery training. Of

NURSE EDUCATION 7‘0D4-f 51

Table 1 Questionnaire survey response rates

Year of study

Number of Number of questionnaires questionnaires Final response sent out returned rate (%)

1979 12 month 927 782 84.4 course 1983 18 month 927 828 89.3 course

these, the largest group had done so for less voted to it. Secondly they were asked if they than a year: 55 per cent (406) of the 1979 found the teaching very helpful, helpful, or not group and 42 per cent (322) of the 1983 group. helpful.

Just under two-thirds of both groups of midwives had undertaken their midwifery training in a non-teaching hospital, and approximately one-third had trained in a . _ teaching hospital: no significant difference emerged when the data were analysed by the type of hospital in which the respondents had

trained.

It is expected that student midwives receive teaching in the clinical setting from the trained staff on duty as well as from the midwifery tutors, and so the respondents were also asked for their views on the amount and the helpful- ness of teaching provided by these staff. For sisters in particular, teaching student midwives and helping them to develop confidence in their skills is regarded as an important part of their role. Studies of the educational oppor- tunities for learner nurses have identified the ward sister as a key person in creating an environment that is conducive to learning (e.g. Fretwell 1980, Orton 1981). Other studies see- king to identify the characteristics of effective ward teachers have emphasised the importance of a ‘participative mode of communication’ (Marson 1982) and an ‘approachable nurse- learner orientated style of leadership’ (Ogier 1980). Teaching by midwifery sisters and staff midwives has not been the subject of extensive research as yet; this study provides some in- formation on how newly qualified midwives

CLINICAL AND CLASSROOM TEACHING

The education of student midwives has differed from that of student nurses in that the midwif- ery profession has maintained that only one grade of teacher is necessary to teach in both the classroom and the clinical setting. In a recent article Roth (1984) has drawn attention to what are regarded as the advantages of this system: it produces confident teachers who have credibility with their students and other trained staff; it enables teachers to maintain some of their clinical skills; it can produce excellent trained staff/teacher cooperation which facilitates the education of students. In particular it afIords teachers the opportunity to integrate theoretical and ward practices and this in turn helps students to apply theory to practice. The midwives who took part in this study were asked firstly if they found the amount of time spent on classroom and clinical teaching by tutors to be about right, or whether too much or too little time was de-

perceive this teaching. Medical staff also provide both clinical and

classroom teaching for student midwives, and respondents were asked about the helpfulness and the amount of teaching received from obstetricians and paediatricians. Respondents were given the opportunity of ringing ‘not applicable’ if they had not received any teach- ing from the source specified. Data on class- room teaching are discussed first, followed by that relating to clinical teaching.

52 NURSE EDUCATION TODAY

Classroom teat h ing

The data obtained on the amount of time

spent on classroom teaching were cross-

tabulated by the data on the helpfulness of this

teaching. The proportion of respondents who

said that the right amount of time was sepnt

on classroom teaching and that it was helpful or

very helpful is shown in Table 2 for each group

of staff specified. The figures diff‘ered little fin-

the two groups of respondents and ranged from

over 60 per cent for teaching by paediatric

medical staff to over 80 per cent for teaching

by midwifery tutors.

A very large proportion of respondents were

satisfied with the content of and the amount of

time spent on classroom teaching. The figures

for paediatric medical staff are lower than

those for the other two groups. This was

because approximately one-fifth of both groups

(25.8 per cent of the 1979 group and 19.8 per

cent of the 1983 group) said that they did not

get enough classroom teaching from

paediatricians.

Clinical teaching

Most respondents said the clinical teaching pro-

vided by each group of staff specified was

helpful or very helpful; this is shown in Table

3. There was, however, considerably less satis-

faction with the amount of time spent on clin-

ical teaching and this is shown in Table 4.

Amount of clinical teaching by midwifery

tutors

Considering first the findings relating to mid-

wifery tutors, around 45 per cent of both

Table 2 Respondents who said that the amount of classroom teaching was about right and that it was helpful or very helpful

Respondents

Classroom teaching by

Midwifery tutors Obstetric medical staff Paediatric medical staff

‘Total respondents 782 tTotal respondents 828

1979 1983 (12 month course) (18 month course)

N’ % Nt %

648 82.9 692 83.6 603 77.1 638 77.1 487 62.3 542 65.5

Table 3 Helpfulness of clinical teaching by different groups of staff

Percentage of respondents who said teaching was helpful or very helpful

Clinical teaching by

1979 1983 (12 month course) (18 month course) (N=J82) (N=828)

Midwifery tutors 86.0 83.1 Hospital midwives 86.4 90,8 Community midwives 90.8 93.1 Obstetric medical staff 67.2 66.3 Paediatric medical staff 58.8 60.9

NURSE EDUCATION TODAY 53

Table 4 Views on amount of time spent on clinical teaching by various groups of staff

Clinical teaching by

Amount of time spent on clinical teaching

Midwifen/ Hospital Community Obstetric tutors midwives midwives medical staff

1979 1983 1979 1983 % % % %

Too much time 1.4 1.7 0.4 0.1 About right 54.6 51.9 35.0 43.4 Too little time 37.5 42.1 60.9 54.1 Not applicable 4.7 3.3 2.6 1.1 No answer 1.8 1.0 1.2 1.3

1979 1983 % %

1.0 0.6 75.6 81.6 20.6 15.6 2.0 1.2 0.8 1.0

1979 1983 1979 1983 % % % %

1.4 0.5 0.9 0.4 37.1 31.2 27.5 27.9 44.1 56.2 48.8 57.5 16.6 11.5 21.9 13.4 0.8 0.7 0.9 0.8

medical staff

Total % 100 100 loo 100 106 loo 100 100 100 100 (Total numbers) (782) (828) (782) (828) (782) (828) (782) (828) (782) (828)

groups (42.2 per cent of the 1979 group and

45.4 per cent of the 1983 group) said that

tutors either spent too little time on clinical

teaching or none at all. It might be expected

that this view would be expressed by a smaller

proportion of the 1983 respondents, as the

longer course should allow tutors more time to

spend in the clinical setting, but in fact the

proportion has increased slightly (although not

significantly at the 0.001 level). Comments

added by those who stated that insufficient

time was spent on clinical teaching by tutors

fell into two main categories: firstly those sug-

gesting that there were not enough tutors for

them to spend sufficient time teaching in the

wards and clinic; secondly those suggesting that

tutors could have spent more time with stu-

dents in clinical settings, but failed to do so.

Can either of these points be supported by data

from other studies?

Turning first to shortage of staff, other

studies have demonstrated a national shortage

of midwifery tutors. Standon-Batt (1979), drew

attention to a deficit in the number of tutors

qualifying each year. She pointed out that

although an estimated 80 new tutors were

needed each year in England and Wales to fill

vacancies caused by ‘retirement, marriage,

motherhood, side stepping to administration

and (hopefully) an increase in establishment’,

figures published by the Central Midwives

Board for the years 1973-77 showed an

average of only 57 new tutors qualifying each

year. Data on staffing levels obtained in the

course of a national survey of the midwifery

profession (Robinson 1980) showed that in

England, there was a 15 per cent shortfall

between funded establishment and practising

tutors as at 31st December 1978, and 5 per

cent for senior tutors.

No research to date has focused on factors

other than stalling shortages that may deter

midwifery tutors from teaching in the clinical

setting. Given the importance of clinical teach-

ing and the findings of this study, some re-

search in this area is indicated.

Amount of clinical teaching by hospital

midwives

Table 5 shows that a majority of both groups

of respondents claimed not to have received

enough clinical teaching from hospital mid-

wives (63.5 per cent of the 1979 group and

55.2 per cent of the 1983 group). Comments

made about this lack of clinical teaching re-

vealed the same two themes as made in rel-

ation to midwifery tutors:

First, a lack of staff on duty:

‘The hospital I trained at has a very busy

54 NURSE EDUCA’I‘ION I’ODAY

midwifery unit and so often we were too

busy and understaffed to have clinical

teaching’.

Second, a seeming unwillingness to teach,

even when the opportunities were available:

‘Many hospital midwives are reluctant to

teach midwifery students. Reasons - lack of

knowledge, failure to keep up with post

registration education, insecurity’.

With regard to staffing levels, Robinson (1980)

showed that a shortage of hospital based mid-

wives existed in England at 31st December

1978: a 4 per cent shortfall of sisters and an I8

per cent shortfall of staff midwives. Obviously a

shortage of trained staff on duty affects the

time available for teaching. As part of the same

study just over 2000 hospital midwives were

asked if they had enough time to teach student

midwives (Robinson et al 1983). In response,

59 per cent said that they were able to teach

some of the time, 32 per cent said most of the

time and 9 per cent said rarely.

Some respondents commented that hospital

midwives seemed reluctant to teach. Other

studies have shown that staff may feel

inadequately prepared for their teaching role,

e.g. of the 2500 midwives who took part in the

study undertaken by Robinson et al (1983),

just over a quarter said that they did not feel

adequately prepared for teaching respon-

sibilities. In a study of ward sisters in general

nursing, Farnish (1983), found most felt less

than adequately prepared for various aspects of

teaching: 60 per cent expressed this view in

relation to teaching methods; 65 per cent in

relation to setting learning objectives; and Sly;,

in relation to assessment of learners.

Amount of clinical teaching from com-

munity midwives

Only a small proportion of respondents said

that they did not have enough teaching from

community midwives. This is not surprising as

there is usually a one-to-one relationship be-

tween a midwife and her student during com-

munity experience.

Amount of clinical teaching from medical

staff

A substantial majority of both groups of re-

spondents said that they did not receive

enough teaching from medical staff or that

they received none at all: 60.7 per cent of the

1979 group and 67.7 per cent of the 1983

group expressed this view in relation to teach-

ing by obstetricians and the corresponding

figures in relation to paediatricians were 70.7

per cent and 70.9 per cent respectively. Again

the two themes of short staffed, busy units on

the one hand and a reluctance to teach on the

other were cited as the main reasons for this

lack of teaching, e.g.

‘Due to a shortage of stafl; clinical teaching

sessions by doctors were very limited’.

‘We definitely could have benefited from

more clinical teaching from medical staff,

who didn’t show a lot of interest in teaching

midwives’.

Discussion

In summary, the information obtained in this

study on classroom and clinical teaching show

that the majority of respondents from both

groups found the teaching in these two settings

helpful or very helpful. The majority were also

satisfied with the amount of classroom teaching

they received, but this was not the case for

chnical teaching, and a substantial proportion

felt that they had not received enough during

their training. Some respondents also expressed

concern about the effects of what they per-

ceived as a lack of liaison between ward and

tutorial staff, e.g.

‘The ward staff and tutors worked in oppo-

sition rather than as a unified “team”,

neither parties meeting halfway’.

. . could be better liaison between tutors

and ward staff. We were often taught one

thing in class but found it not practised on

the wards’.

Concern about the lack of clinical teaching provided for student midwives and poor liaison between ward and school staff are of course not new. These issues were discussed by the 1947 Working Party on Midwives (Ministry of Health, 1949).

CLINICAL EXPERIENCE

Confidence in clinical skills and knowledge is developed not only by teaching but also by experience. Consequently the midwives who took part in this study were asked if, in their view, there were any clinical areas in which they felt they should have spent more time during training to gain sufftcient experience of the work. Significantly fewer of the 18 month course group than the 12 month course group said they had needed more time in this respect (73.2 per cent (600) compared with 85.2 per cent (666) ~ p<O.OOOOl) but the proportion still remains a substantial majority of those who have taken the extended training.

The respondents were also asked to specify in which of the clinical areas listed in Table 5 they needed more experience.

Table 5 shows obstetric theatre, special care baby unit and labour ward were the three areas most likely to be specified by both groups of respondents as those in which more time was

NURSE EDUCATION TODAY 55

needed. The 18 month group were however less likely to express this view than the 12 month group (the level of significance was p <O.OOOOl for each of the three areas). It could be argued that both obstetric theatres and special care baby units are specialised aspects of maternity care and that it is un- realistic to expect students to gain enough experience of this work during basic training to feel confident upon qualifying. The same com- ment, however could not be made about the labour ward. Although the proportion of re- spondents who said that they did not gain sufficient experience of labour ward work de- creased from 46.3 per cent of those qualifying in 1979 to 27.5 per cent of those qualifying in 1983, this still remains a substantial minority. The comment made most frequently by the 1983 group with regard to labour ward work was lack of experience in caring for the baby. The emphasis for the student midwife was on ‘getting the required number of deliveries’, and the care of the baby immediately after birth was provided by other members of staff. In the words of one respondent,

. too little opportunity to “take the baby” as this wasn’t specified as needed as part of training, but it would have been very useful, especially as it’s expected of you as soon as you qualify’.

Table 5 Proportion of midwives who felt they needed more time to gain sufficient experience in specified clinical areas

Midwives qualifying in

Clinical areas

1979 1983 (12 month course) (18 month course) (N=782) (N=828)

No % No %

Obstetric theatre 477 61 .O 415 50.1 Special care baby unit 422 54.0 307 37.1 Labour ward 362 46.3 228 27.5 Community 163 20.8 170 20.5 Antenatal ward 125 16.0 127 15.3 Antenatal clinic 53 6.8 60 7.2 Postnatal ward 37 4.7 10 1.2 Other 18 2.3 27 3.3

56 NURSE EDLJCATION TODAY

Most of the comments made about insufficient

time in the community referred to little or no

experience of home confinements. Lack of ex-

perience of home confinements is of course not

necessarily due to insufficient time spent in the

community, but rather to the substantial de-

crease in the number of women delivered at

home.

ADEQUACY OF THE TRAINING

Results presented so far have been concerned

with separate components of the course: clinical

experience and clinical and classroom teaching.

In looking back on their training as a whole,

respondents were asked how well they thought

it had prepared them for the various responsi-

bilities involved in practising as a midwife.

They were asked to indicate whether their

training had prepared them adequately, less

than adequately or more than adequately, for

the components of hospital care, community

care and teaching, listed in Table 6.

This table shows that the majority of respon-

dents said that their training had prepared

them adequately or more than adequately for

the various aspects of maternity care listed,

with the exception of home confinements

(Items 10 and 11) and special care baby units

(Item 7). It can also be seen that respondents

who took the 18 month course were more likely

than those who took the 12 month course to

say that they felt more than adequately pre-

pared to take responsibility for items l-6, 8, 9,

and 12-15. (These differences were all signili-

cant at the 0.001 level or better, except for

item 1 [p<O.O5] and item 9 [p<O.O05]).

Answers relating to item 4 are of particular

interest: 23 per cent of the respondents in the

preliminary study said that they felt less than

adequately prepared to take responsibility for

caring for babies on the labour ward (Golden

1980). When the 1978 data were published,

this finding was regarded with some concern

by midwifery tutors and by the educational

supervisors at the Central Midwives Board.

Consequently, particular mention was made of

this finding when visits were made by the

Board supervisors to training schools (personal

communication), and it may be that the de-

crease in the proportion of 1983 respondents

expressing this view is due partly to this

Findings for special care baby units showed

that just over half (57 per cent) of the 1979

respondents felt less than adequately prepared

for this aspect of maternity care and, as shown

in Table 5, 54 per cent said they had not had

enough experience of this work. Students had

only a four week special care allocation within

the 12 month course, and it would perhaps

have been surprising if a substantial majority

had felt adequately prepared, particularly in

units with a high proportion of’ intensive care

cots. In the 18 month course the special care

unit allocation has been increased to 6 weeks.

The data show that the 1983 group were more

likely than the 1979 group to say that they felt

adequately, or more than adequately prepared

for special care work (59 per cent compared

with 43 per cent). As the period between 1979

and 1983 saw a continuing increase in the

complexity of neonatal intensive care tech-

nology, it could he argued that these figures

represent a considerable improvement in per-

ceived adequacy of preparation for work in this

area.

It is not surprising that the majority of

respondents from both groups felt inadequately

prepared to care for mothers or babies during

home confinements. The continuing decline in

the proportion of women delivered at homr has

meant that most student midwives get little, if

any, experience of home confinements. Of those

midwives who qualified in 1979, 59.2 per cent

had not undertaken any home confinements

during their training and a further 25.5 per

cent had only undertaken one; the corres-

ponding figures for the 1983 respondents were

64.4 per cent and 24.4 per cent. Turning to the

data on teaching, it is likely that the increase

in the proportion of the respondents who felt

adequately or more than adequately prepared

for teaching individual mothers and for teach-

ing parentcraft classes, reflects the increased

emphasis placed on these aspects of care in the

extended training.

NURSE EDUCATION TODAY 57

Table 6 Views on adequacy of training in preparation for responsibilities for maternity care

Responsibilities for maternity care

Date of More course than Less than No completion adequate Adequate adequate answer

Hospital care

Caring for mothers attending antenatal clinics

Caring for mothers in antenatal wards

Caring for mothers in labour wards

Caring for babies in labour wards

Caring for mothers in postnatal wards

Caring for babies in postnatal wards

Caring for babies in special care baby units

Community care

Caring for mothers attending antenatal clinics

Giving antenatal care to mothers in their own homes

Caring for mothers during home confinement

Caring for babies during home confinement

Caring for mothers during postnatal period at home

Caring for babies during postnatal period at home

Teaching

Teaching individual mothers in antenatal or postnatal period

Teaching parentcraft classes

1979 26 70 4 1983 31 63 6

1979 19 72 8 1983 29 64 7

1979 20 70 10 1983 32 61 6

1979 12 67 20 1983 22 66 12

1979 39 57 4 1983 56 43 1

1979 33 62 5 1983 48 50 2

1979 6 37 57 1983 7 52 41

1979 30 64 6 1983 40 55 6

1979 23 60 16 1983 32 58 10

1979 6 30 61 1983 6 31 60

1979 6 33 58 1983 6 33 68

1979 44 54 2 1983 61 38 1

1979 33 61 6 1983 51 47 2

1979 24 68 8 1983 38 59 4

1979 15 52 33 1983 19 58 23

Scores as percentage of group

0

0 0

0 0

0 1

0 0

0 0

0 1

1 1

1 0

3 3

4 3

0 0

1 0

0 0

1 0

58 NURSE EDUCATION TODAY

Findings relating to the postnatal care of

mothers and babies in hospital and in the

community deserve particular attention. Items

relating to postnatal care (5, 6, 12 and 13)

show that this was the area for which newly

qualified midwives were most likely to feel

adequately prepared to take responsibility.

However, there is some evidence to suggest

that postnatal care is more likely than other

aspects of the maternity service to suffer neg-

lect. Robinson et al (1983) showed that it was

midwives on the postnatal wards who were

most likely to say that there were not enough

midwives on duty to cope with the work: 67

per cent of those on day duty and 77 per cent

of those on night duty. Mothers’ dissatisfaction

with postnatal care has been documented in a

number of studies including Ball ( 198 I),

Laryea ( 1980) and Filshie et al ( 1981).

However, the newly qualified midwives who

took part in this study felt quite confident

about this part of their role. Postnatal care

requires interpersonal skills in establishing

women’s confidence in their ability to feed and

care for their babies. Although most student

midwives are likely to have developed inter-

personal skills in the course of their nurse

training, it is possible that as newly qualified

midwives they have not acquired a sufficient

understanding of the mother’s needs during the

puerperium, to be aware of any deficiencies in

their own interpersonal skills. Deficiencies in

technical and manual skills are much more

readily apparent than deficiencies in inter-

personal skills, and this may partly explain

why those aspects of care which require the

former skills are the ones about which newly

qualified midwives are most likely to express

feedlings of inadequacy.

CONCLUSION

As noted at the beginning of this paper, one of

the reasons for increasing the length of mid-

wifery training was the hope that it would

increase the proportion of midwives who feel

confident in their abilities, this being regarded

as crucial to the newly qualified midwife’s

decision as to whether or not to practise mid-

wifery. The results from this study show that

overall, newly qualified midwives who have

taken an 18 month course are more likely than

those who have taken a 12 month course to feel

adequately prepared for the various responsi-

bilities of practising as a midwife. The 18

month course does allow more time to be

devoted to the various aspects of maternity

care, and this may explain the increase in the

proportion of respondents who felt adquately

prepared. Certainly the 1983 respondents were

significantly more likely than the 1979 respond-

ents to say that they intended to make a career

in midwifery: 24 per cent (199) compared with

17.4 per cent ( 136) (p < 0.005). The relation-

ship between career intentions and experience

of training is complex however: it may be that

the experience gained during the 18 month

course has had a greater effect than that

gained on the 12 month course in convincing

students that they would enjoy making a career

in midwifery. On the other hand it may he

that students who begin training with the

intention of making a career in midwifery (this

was the case for more of the 1983 than of the

1979 respondents) get more out of the course

than those not intending to do so.

Some respondents said they intended to

pratise midwifery for a short time only and

others said they intended to practise but were

undecided as to whether this would be for a

career or for a short time. If these two groups

are added to those intending to make a career

in midwifery, then the total figures obtained for

those intending to practise after qualifying are

85.0 per cent (704) for 1983 and 73.3 per cent

(573) for 1979 @<O.OOOOl). To what extent

these expressed intentions reflect respondents’

confidence in their abilities as a midwife and

whether they will be matched by actual career

patterns is of course not known. A follow-up

study of both groups of midwives who took

part in this project is proposed in order to

establish their career patterns and ascertain

whether wastage amongst those qualifying after

an 18 month course will follow the same pat-

tern as that for the 12 month course.

NURSE EDUCATION TODAY 59

Respondents who took the extended course Chronicle and Nursing Notes. 94: 1120, 15&154; 1121,

were more likely to say that they had had 198202 and 94: 1122, 231-233.

sufficient clinical experience, but views on the Central Midwives Board 1977 Letter from Board to

content and amount of teaching varied little midwifery training schools, regional and area nursing officers regarding the decision to extend the 12 month

between the two groups. A substantial majority training to 18 months. June 1977

of respondents from both groups were satisfied Farnish S 1983 Ward Sister Preparation: A survey in three

with the content of both classroom and clinical districts. NERU Report 2. Chelsea College, London University.

teaching and with the amount of classroom Filshie S et al 1981 Postnatal care in hospital. Journal of

teaching they received. But more than half of the Royal Society of Health 101: 2, 7873.

the respondents said that they had not had Fretwell, J 1980 An inquiry into the ward learning

environment Nursing Times occasional papers 76: 16,

enough clinical teaching from hospital mid- 69-76

wives and medical staff, and this proportion fell Golden J 1980 Midwifery training: the views of newly

to just over 40 per cent with regard to clinical qualified midwives. Midwives Chronicle and Nursing Notes, 93: 1109, 19&194

teaching by midwifery tutors. It is perhaps not Kilty J M & Potter F W 1975 Research project on the

surprising that satisfaction with the amount of Midwife Teacher’s Diploma. University of Surrey, Gnildford.

clinical teaching has not increased with the Larvea M G G 1980 The midwifes’ role in the postnatal

extension of training. Neither of the two factors

identified by respondents as contributing to a

lack of clinical teaching, namely short staffing

and an unwillingness to teach, would be af-

fected by merely increasing the length of train-

ing. Given the undeniable importance of clin-

ical teaching in the development of the student

midwife’s skills and confidence, factors which

appear to militate against it require further

investigation.

Acknowledgements

I wish to record my thanks to the following: Josephine Golden who was responsible for much of the work involved in the first stage of this project; the DHSS for funding the research; the midwives who kindly completed our questionnaires: Keith Jacka for statistical and computing assistance; Sharon Russell for secretarial assistance; Jack Hayward, Judith Lathlean and Keith Jacka for their help in commenting on drafts of this paper.

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