The scale up of midwifery relies on education. But how can we develop a regulated education system that is not only able to produce quality midwives in a consistent manner, but also supports and maintains them in practice? This lesson covers an important document that came from the World Health Organization in collaboration with UNFPA, UNICEF, and the ICM. The document, the framework for action, strengthening quality midwifery education for universal health coverage, 2030. Presents a clear and achievable path to a streamlined and strengthen national midwifery education system. In particular, you will learn about the three strategic priorities in the seven essential steps outlined in the report. You will also learn about the midwifery assessment tool for education or MATE and how it can be utilized to strengthen midwifery faculty. To improve the quality of midwifery education and low and middle income countries, significant system wide changes need to occur. To reduce inconsistent educational standards, poor clinical training and precepting and limited access to water and sanitation. They will also need to address the social, cultural and economic barriers facing midwives globally. Let's begin. The three strategic priorities were identified for strengthening quality midwifery education. The first priority is that every woman and newborn be cared for by a mid wife trained to ICM standards enabled to practice full scope midwifery. The second priority is positioning midwifery leadership and high level policy planning and processes to ensure no policy carries forward that impacts midwifery care without the participation of midwives. The third priority is to ensure coordination between midwifery stakeholders at global, regional, national, and local levels. So that education and training processes, knowledge, research, evidence- based materials, indicators, and investments align. Radical innovation is required to bring about the needed changes in education and training. During the COVID-19 pandemic, we can see the need for remote learning that includes robust evidence. As well as creative methods for engagement, simulation and clinical experiences that in 2019 might have been thought too outside the norm or not essential. Now they may be life lines to ensure the training of the next cadre of midwives and essential health care providers continues. I encourage you to keep an open mind as we go through this policy document. To see how education will need to evolve in these new and uncertain times of social distancing and an increase in remote learning. Now, let's take a look at the seven essential steps that need to be moved through to achieve this radical change. Step one, strengthen align national leadership and policy which includes the creation or strengthening of a midwifery task force. And should include key members from the government, National Midwifery Association, other allied health professions, professional organizations, NGOs, UNFPA, WHO, UNICEF and educators. Two, gather data and evidence of what is currently in place. What is working, where the gaps are and what women want from their care and then align the existing systems and indicators. This evidence from this step will inform steps three, four, five and six. Step three, engage the public and build advocacy. This ensures women's voices are included in all stages of change and this will ensure the success of midwifery in communities. If communities feel listened to an invested in the services provided. Step four, prepare educational institutions, practice settings and clinical mentors. Ensure that all components of the QMNC framework are included in all improvements in these sectors. Step five, strengthen faculty standards and curricula. Ensure that all faculty meet the eight WHO midwifery educator core competences. Which you can read more about in the midwifery educator core competences, a WHO document from 2013 as it has much more detail and information. I'll highlight three of the eight competencies here. One, educators maintain clinical practice. This ensures educators are able to make the connection between theory and reality of day-to-day practice with the latest evidence. An educator who no longer practices, cannot relay the same clinical expertise as someone who is still engaged in clinical work. Two, educators need to create an environment that facilitates theoretical learning. Safe learning environments need to accommodate and engage the different learning styles of students. Using different methods, such as case-based studies, standardized patients or simulation can help different learners process and retain material. And three, educators facilitate learning in the clinical environment, ensuring the clinical setting is a safe environment that promotes experiential learning. There is a long history of bullying in medical and Nursing Education where instructors shame and bully students in the guise of teaching. This behavior must not be tolerated as as it does not help instill knowledge or confidence. But it does instill a fear of asking questions, which can compromise patient care and safety. Step six, educate students. This began with step five and an assessment of the current educators preceptors against international standards. It is critical that we ensure education is not only responsive to the needs of families and individuals being cared for, but it must also be effective for the students. This will require assessing the current cadre of midwives to find out if the standard is being met by the current programs. And then to strengthen those skills, knowledge, and behaviors in innovative ways such as team-based collaborative training that includes other members of the healthcare team, such as nurses and doctors. Skills such as shared decision making and respectful care need to be hallmarks in the education process. One innovative example is a program here at Yale called Interprofessional Longitudinal Clinical Experience or ILCE. Which is a curriculum built on collaboration between Yale School of Medicine, Yale School of Nursing, and Yale Physician Associate Program. Students from each school learn in a consistent clinical environment as a team under faculty leadership. Learning and practicing skills with and from one another helps prepare the students for practicing in healthcare teams when they enter the workforce. They understand and respect the skillset each brings and the shift from a hierarchical model to team-based allows for better communication and care. A variety of pathways to midwifery education should be supported to allow access for those in remote areas as well as for those who may be working another job. Having remote learning options will help learners in remote communities learn while still living and caring for their families. Remote learning also ensures that those communities have culturally aligned care from someone who knows their community. Innovative technology needs to be incorporated, including the use of e-learning that can be done at a distance. Finally, continuous professional development needs to be created and maintained from the beginning to ensure the highest quality and standards for midwives working in the wards, as they are the clinical teachers of the rising students. Ensuring students have the same high quality learning and clinical practice as they do theory. It makes no sense if students learn the latest evidence, but when they go into the clinical settings, they are trained under midwives who have not had adequate in-service training and are perpetuating poor an outdated clinical practice. For example, a student may learn that routine episiotomy is not recommended anymore. But when they arrive on the ward, they are scolded for not cutting an episiotomy on every first time mother. The seventh step, the final step, is to monitor, evaluate, review, and adjust. Ensuring data is being collected on progress and initiatives is key. The monitoring plan must be developed simultaneously with the program plan. Setting up regular intervals to review and process the data in order to adjust the programs is how we ensure what we're doing is producing the outcomes we desire. While this document is targeted to low and middle income countries, there is much here that all countries can benefit from if they have the will. For example, here in the United States, as you've heard in previous modules, midwifery is not well known or well supported. If we want to change this, we need to position midwifery leadership at high level of national policy and planning and budgeting processes. Without a strong voice at the table, it is unlikely much will change. Looking at our midwifery education system here, there are also areas of improvement. While all programs are accredited an held to national standards, our system could benefit from an extreme overhaul in order to create more accessible and equitable education programs. Most midwives and midwifery educators are almost exclusively white in the US. We have an urgent need to change this so that more people of color and diverse backgrounds are drawn to and supported in midwifery education and training. Let's now turn our attention to a newer document from the World Health Organization Regional Office of Europe. The midwifery assessment tool for education, or MATE. This tool is aimed at European states who want to, quote, develop midwifery education to strengthen the midwifery and nursing workforce, end quote. But this self-assessment tool has the potential to be used globally for countries committed to implementing improvements. The tool is divided into two different sections, one, the role of the midwife in caring For women and newborns and the education of midwives. And two, examining the midwifery role, including the support, understanding, and utilization of midwifery in your country. The current state of education includes access, general status, curriculum, theory and clinical, faculty preparedness, resources, and regulation of education. For each of these categories, the tool asks, quote, where are you now? Where do you want to be? And then has links to supportive documents and tools to help you achieve your goals. It is a simple but well designed and research tool that I would encourage you to look at and utilize if you are working towards improving maternal and child health and implementing the QMMC framework in your country. In closing this topic, I hope you're energized by the excellent groundwork that these core documents provide. Improving education is a complex process, one that must factor an infrastructure, innovative educational design, evidence-based curricula, and adequately trained faculty and clinical preceptors in the community. This work will take the commitment and support from all levels of stakeholders.
