Experiences of Midwifery students on placement
Literature review
Student’s name
Student’s number
Abstract
Background
The clinical experience obtained by midwifery students during any clinical practice is essential in their identity formation and the practical knowledge required. The literature review consolidates information on the difficulties and possibilities these students experience during practical training.
Aim
The present review aims to explore midwifery students’ experiences during their placement.
Methods
The review was carried out using a secondary qualitative research design that entails using a search strategy while extracting data from the EBSCO Database. The search strategy entailed the selection of three relevant articles, which were first critically appraised using the CASP checklist. The analysis was done through the thematic analysis technique, and one common study finding was the role of the clinical environment in learning achievement.
Findings
According to the students’ perception, positive and proper organisation of placements promotes the learning process, self-confidence and skills development. However, when the placement is poorly supervised, with too much work pressure, they are likely to experience stress and anxiety, thus having a negative impact on their learning process and health. The other important issue which is investigated is the concept of mentorship. Credible assertions of professionalism by clinical mentors and communication, support, and feedback increase student experiences and clinical competencies. Practical knowledge and the progressive integration of strenuous tasks help develop competence amongst students, as would be favoured by the students.
Conclusion
Moreover, the review demonstrates the role of reflective practice in midwifery education. Reflective practice allows students to go through their experiences, reconcile the theory learnt in class with actual practice and enhance their problem-solving abilities.
Table of Contents
Selected Journal for Submission. 6
Rationale for the Selected Papers. 7
Quality Assessment and Data Analysis. 8
4.1.1 Theme 1: Challenges and Stressors in Midwifery Education. 9
4.1.2 Theme 2: Promoting Resilience and Well-being in Midwifery Education. 11
4.2 Comparison of the Findings. 12
5.1 Findings of the Review.. 13
5.2 Strengths and limitations of the review.. 13
Appendix A: Critical Appraisal 18
Appendix B: Summary matrix. 26
Appendix C: Search Strategy. 30
Introduction
Background
Midwifery placements offer students a vital educational opportunity to apply their theoretical knowledge to actual clinical work settings (Mbakaya et al., 2020). The quality of placements depends on multiple variables affecting supportive supervision, employee workloads and learning environment standards (Folkvord and Risa, 2023). The data shows that positive placement encounters by midwifery students drive better job pleasure and professional advancement (Sun et al., 2022). In contrast, students who experience negative aspects of their placement develop work-related stress, which negatively affects their mental wellness (Oates et al., 2019). Hence, assessing midwifery students’ placement experiences is vital because this knowledge allows healthcare practitioners to provide proper support for their academic development and job proficiency.
Problem Statement
Students facing challenges in their midwifery clinical training encounter various problems, from inadequate institutional support and elevated emotional strain combined with limited practical engagement opportunities (Negm et al., 2024; Kool et al., 2024). It should be noted that students who have unfavourable placement experiences face compromised learning, which affects their professional development. However, the present literature lacks consistent evidence about how midwifery placement influences students’ overall experience by exploring their perspectives. Most of these studies are either conducted in one location, limit the generalisability of students’ experiences in other settings (Oates et al., 2020) or have been conducted in a short period that might compromise the experiences faced by these students in the longer run (McNeill and Kitson, 2024). Therefore, the present study is needed to gather evidence regarding midwifery students’ experience during placement to fill the literature gap and develop a comprehensive understanding of how different students’ experiences can transform their professional journey.
Aim and Objectives
The present review aims to explore midwifery students’ experiences during their placement. To achieve this aim, the following objectives have been devised:
- To evaluate potential challenges and stressors faced by students in Midwifery education
- To promote resilience and well-being in midwifery education through positive placement experiences
Research Question
What are the experiences of midwifery students during their placement journey?
Research Rationale
The research seeks to fill an essential gap in the existing literature by studying midwifery students’ unique placement experiences, especially regarding their emotional wellness and their pursuit of professional identity development. Prior studies showed general placement difficulties, but few investigated the effects of such placement on the students’ emotional status and professional working competencies (Oates et al., 2020; McNeill and Kitson, 2024). In addition, the theoretical justification of Kolb’s Experiential Learning Theory increases the justification to conduct this research since it supports the use of reflection practices and learning in actual practice by midwives as a strategy that will lead them to improve their professional learning outcomes during their placement (Sourinejad et al., 2021). Therefore, the research findings will improve academic learning environments for educational settings and benefit both midwifery educators in their supervision roles by promoting nursing education quality and workplace readiness.
Selected Journal for Submission
All Maternity’s Student Midwife Journal serves excellently for this research due to its mission of empowering student midwives alongside promoting evidence-based dialogue. Through its emphasis on student reflection and innovative research, the journal publishes content that explores topics within midwifery education and future placements (The Student Midwife, 2019). The Student Midwife Journal reaches its audience, including midwifery students, families, maternity workers, and concerned stakeholders, ensuring that research findings reach relevant domains in midwifery education. Additionally, the journal welcomes submissions dedicated to handling challenges faced by midwifery students to support the study objectives and discoveries focused on enhancing practical training opportunities (The Student Midwife, 2024).
Methodology
Study Design
The study reviewed the literature on qualitatively exploring midwifery students’ experiences during placement. The rationale for using the literature review research design was to observe how students’ experience has been impacted due to various challenges they faced during placement. A literature review also aids scientists in examining data from earlier studies to identify important insights for the primary research topics and to establish the background for ongoing investigations (Synder, 2019). Using this research strategy, researchers could locate pertinent publications and the materials needed to address the research issue.
Search Strategy
The researcher extracted relevant articles from the EBSCO academic database to address a research question. Scientists can find educational content through this platform, which allows them to browse multiple resources, utilising detailed search filters and applying Boolean logic to achieve better research outcomes (Gusenbauer and Haddaway, 2020). The database selection represented in Table 1 (see Appendix C) provides the core search terms used in identifying relevant studies. An analysis of relevant studies employed Boolean operators using the terms “OR” and “AND.” The research focused on extracting pertinent literature through keyword searches and conducting article screening with the inclusion and exclusion criteria described in Table 2 (see Appendix C).
Rationale for the Selected Papers
Three major qualitative studies were selected through applied inclusion and exclusion criteria. Figure 1, shown in Appendix C, depicts the entire process from literature screening to final article selection. The research analysed studies that met three significant requirements concerning midwifery education practices combined with exposure during the placement and issues that student midwives faced in clinical environments. Research supports that assessing student perceptions within clinical environments offers crucial insight into learning barriers that may affect their professional practice (Amoo et al., 2022). Thus, the literature included in this paper addressed the research question and highlighted significant mental well-being issue areas for midwifery students during clinical placements.
Quality Assessment and Data Analysis
The critical appraisal of research papers utilised the Critical Appraisal Skills Programme (CASP) since this assessment method has become a normative tool for evaluating qualitative research quality. Research suggests that CASP provides a framework for structured analysis of essential research components, including design methods, ethical considerations, and data integrity (Long et al., 2020). This assessment tool helps identify the trustworthiness and reliability of studies reviewed to answer the proposed research questions. Through strict adherence to the guidelines of CASP, studies could be conducted using methodological analyses that formed the sound basis of critical analysis of research findings that helped increase the trustworthiness of the results stated (Long et al., 2020). For the data analysis, a thematic analysis of the literature was done to detect the themes or the underlying structures within the qualitative findings. The researchers chose thematic analysis because this method extracts real-life data on the placement experience of student midwives (Oates et al., 2020). Thus, thematic analysis methodology facilitated understanding the voices of participants and constructing research findings on the actual experiences of students in healthcare settings.
3. Critical appraisal of papers
The outcomes of the critical appraisal based on the CASP checklist are presented in the appendix (see Appendix A). The assessment findings have indicated that the research by McNeill and Kitson-Reynolds (2024) is a source of helpful information concerning student midwives in clinical learning environments, specifically the role of staff members in developing student midwives. Carrying out semi-structured interviews with an interpretive phenomenological analysis, it outlines the themes of compassion, resilience and self-belief. Strengths include a homogeneous sample and complex, thorough thematic analysis, allowing for enhanced depth in addressing students’ views. This study is especially essential since it examines the clinical education experience faced with COVID-19. However, it highlights the need for a supportive educational climate applicable to staff development to build student confidence and competence. The other selected study by Oates et al. (2020) has successfully applied appreciative inquiry to strengthen the student midwife experience, supported by profound participants’ involvement from various health districts. Its main advantage is based on the engagement of stakeholders in developing solutions that are most appropriate for finding real-life applications. Implementing the ‘Senses Framework’ in midwifery education is novel and key critical practical and relational aspects like safety and connectedness are crucial to the student experience and meaning-making. Thus, the given study’s strength, based on its qualitative approach that provides a lot of detailed information, may become a research limitation due to the restricted generalizability of the findings. However, the sample may be regarded as relatively small in covering the diversity of midwifery students’ needs and concerns across the country.
Meanwhile, Dewar et al. (2020) successfully employ a qualitative descriptive design to reveal midwifery students’ emotional experiences. Strengths include a well-defined approach to emphasising the clients’ feelings that midwives go through during their training and a proper formulation of the support requirements. The approaches to intervention that the study suggested, namely for offering direct individual assistance and peer contacts, are realistic and conducive to education. Nevertheless, such a discussion concerning the researcher bias factors and how they might have skewed the results is missing. Moreover, it is necessary to note that the analysis of themes is comprehensive; however, there is a lack of a detailed description of assigning codes to the texts.
4. Results
4.1 Thematic analysis
The selected articles are thematically analysed based on two main themes below. The overall findings of each study are presented in a tabulated matrix (see Appendix B).
4.1.1 Theme 1: Challenges and Stressors in Midwifery Education
This theme aims to share the difficulties and stress factors that concern students and educators in getting Vanderbilt training. It covers aspects like excessive academic and clinical expectations, the emotional toll that comes with facing death, and resource constraints which impact the student experience. Knowledge of these challenges thus empowers stakeholders to formulate strategies for supporting learning environments, adequate preparation, and well-being among students and trainers in midwifery. Meanwhile, the objective of this study by McNeill and Kitson-Reynolds (2024) was to establish student midwives’ experiences during clinical practice and how the experience influences their decision of whether or not to join the professional register as midwives. This study invited seven student midwives in their final year, undertaking clinical placements as components of their pre-registration education, to contribute to semi-structured interviews. The interviews conducted in this study were analysed by employing an interpretive phenomenology research approach with an emphasis on themes within the transcripts. This process uncovered 79 themes, organised into five sub-themes under two main themes: kindness and compassion, growing future midwives and strength, and growing through COVID-19 and beyond. The first recurring theme was “I can be a good midwife when I qualify,” where student midwives are motivated toward practising good midwifery competencies and seek constructive educational settings. Therefore, the study implies that positive actions and comments from other seniors during placements affect students’ confidence as they prepare for their careers. The study’s findings have profound significance to the education preparation of midwifery and the practice of midwives. Attendants, explicitly attending to women and newborns, should aim to foster a safe learning environment that improves students’ entity, relatedness and mastery. This implies being polite and patient with students while teaching or helping them in class. Furthermore, the cognition of each learner helps staff adapt and adjust to their teaching and assists in meeting every learner’s needs.
In contrast, the other selected study by Oates et al. (2020) aimed to gain an understanding of the student midwives through student midwives’ actual experiences learning effective practices. The intention was to engage in the joint formation of such experiences that would improve learners’ experiences. To achieve this objective, the study employed an appreciative inquiry approach to discover the positive features and favourable experiences based on the perception of student midwives, practising midwives, and midwifery managers. The research was carried out in four health districts in New South Wales, Australia, and the sample included 45 midwifery students and 79 practising midwives. Semi-structured interviews and focus groups were conducted, followed by the data analysis through immersion crystallisation and coded against ‘the Senses Framework’. This provided a structured means of understanding the entire student process and practising midwives to analyse patterns and themes within the data set. It was found that, through the work of a midwifery champion and implementation of appreciative inquiry, both student and practising midwives benefit from confirming and building on experiences of safety, connectedness to learning and working environments, purpose, recognition of accomplishments, and feeling valued. These research results indicate that there is a necessity for respect for individual differences and focus on students as personalities, extending opportunities for personal and occupational growth.
Furthermore, it is also crucial to the midwives as these experiences help promote learning in the workplace. Therefore, this study has significant implications for students and practising midwives regarding the climate within social spaces; it is crucial to establish an environment that rewards the participation of all members. The results of this research inform SW about midwifery education and practice. Therefore, it has been recommended that midwives and educators embrace attitudes that support the protection of vulnerable women.
4.1.2 Theme 2: Promoting Resilience and Well-being in Midwifery Education
This theme aimed to discuss the aspects of midwifery students dealing with stress and psychological health in their careers. This programme seeks to increase the capacity of the educational frameworks in developing pro-resilience strategies for students so that they can meet the emotional and physical challenges of midwifery education. Thus, academic programmes have an opportunity to accept well-being as a priority in their paradigm and create conditions for the students’ effective professional and personal transformations. The selected study by Dewar et al. (2020) explored the narratives of midwifery students studying a Bachelor of Science in Midwifery at a southern English university. Conducting qualitative research using 20 students informed by semi-structured interviews, the purpose was to explore these students’ education. In analysing interviews, two major themes that emerged and made up the concepts of their experiences were revealed. The first was called ‘the rollercoaster’, describing the students’ strained process of moving through the program. This journey involves experiencing multiple cultures whenever they move from one clinical assignment to another and the university environment. These are emotionally demanding, and the student feels stressed and insecure. The second CQ, “Being noticed, feeling connected,” is about students’ desire for individual attention and their relationships with teachers and peers. Participants provided their overall views about their current experiences in school regarding how they would like at least one educator to acknowledge them as unique persons, how they would like to engage with their peers and how they would like to have consistent support throughout their training. These results highlight the importance of students’ sense of belonging and relatedness for their psychological and academic success. By addressing the emotional challenges of midwifery training as necessary, the study recommends that educators ensure students receive ongoing personal support and converse with peers more frequently. Midwifery educators being mindful of the students and their individual needs helps foster an environment that will develop competent midwives with compassion.
4.2 Comparison of the findings
Three selected papers involved student midwives who identified the importance of supporting environments, close communication with instructors and peers, and individual focus. Dewar et al. (2020) discovered that students feel a ‘rollercoaster’ of emotions through clinical practice and class. This highlights the need for continual assistance and specific focus on their needs to enable them to deal with these difficulties successfully. Similarly, McNeill and Kitson-Reynolds (2024) found that the attitudes and behaviours of the senior staff when students are on clinical placements greatly determine their confidence and competence of student midwives. Staff and management-clad interactions were captured as having a role to play in enhancing a favourable learning environment. In the current study, Oates et al. (2020) conducted an appreciative inquiry focused on the positive aspects of the student and practising midwives. Their research focus areas include safety, relatedness, identity, competence, and the sense that one is valued as vital for learning. Although these studies share similar broad conclusions concerning the significance of a supportive schooling milieu, they are methodologically and substantively dissimilar. Dewar et al. (2020) and McNeill and Kitson-Reynolds (2024) included student midwives in qualitative descriptive and interpretive phenomenology research to explore their experiences. On the other hand, Oates et al. (2020) interviewed the midwives and used an appreciative inquiry approach to explore the positive aspects of practice. These studies help expand the knowledge base about the antecedents of midwifery education since, individually and collectively, they paint a lucid picture of the issue in focus.
5. Discussion
5.1 Findings of the review
This literature review uncovers a complex phenomenon of learning and professional development, emotions, and practice difficulties experienced by students. Significant findings include the nature of support provided by clinical mentors and the nature of learning promoted by clinical settings. In supportive and structured environments, students are likely to gain improved realistic clinical experience, as revealed through this study, with findings supported by prior literature about how role models or student relationships affect the learning process, respectively (Karimi et al. 2014). However, frequent concerns include a lack of ample opportunities for hands-on practice and mental pressure originating from high stakes, which coincides with the findings obtained in previous studies that demonstrate such factors as significant impediments to efficient learning (Bragg, 2024). The nursing review also highlights inter-professional relationships, indicating that positive experiences with other staff members, such as the nursing team and other carers, make the learning experience valuable, whereas negative experiences may be a barrier. Wieczorek et al. (2016) stated that Teamwork and Interprofessional respect are essential in producing competent midwifery practitioners. Further, the review says a need for widened placement models that emanate from theoretical knowledge and include skills, thus adding to previous calls for models of learning integration in midwifery education (Baird et al. 2022). In conclusion, the review is a reminder of the continuous and progressive improvement of the placement process for midwifery students in the challenging clinical environment.
5.2 Strengths and limitations of the review
Its main strength is the use of qualitative data that provides insight into the experiences and perceptions of the students and allows for a more comprehensive understanding of the placement challenges and opportunities. Each section of the review focuses on areas such as mentorship, improvement of clinical skills and offering emotional support to students, thus enriching the general overview that can enable educational development. However, the study is constrained by its dependence on self-reports, and therefore, there could be socially desirable reporting bias. Also, the review sample size and population participation may be small and homogeneous and thus may not translate well with other midwifery student populations. This study’s potential directions for further research revealed that it could be helpful to carry out further research that employs mixed methods and more extensive and diverse samples to increase the construction and generalizability of the findings.
6. Conclusion
In conclusion, one of the identified trends is the influence of the clinical placement context on learner outcomes. Students highlighted that placements in various settings or from hospitals to communities can give them broad experiences. Still, there are concerns about higher variability in the quality of role models or the exposure to practice. This variability can significantly impact the student’s self-efficacy and performance. Another prominent theme concerns mentorship/supervision. One aspect of placement quality deemed most crucial is mentorship, which reflects positive and competent mentors’ influences on students’ learning.
On the other hand, lack of supervision results in loneliness and a lack of proper professional development. The review also speaks on the affective and psychosocial aspects of placements. A relatively high number of students face stress at the workplace, which is challenging and developing; therefore, people need support to help them cope. Subsequent research should examine measures to align the quality and supervision of mentors across the placements to maintain quality experiences. Also, it is noted that there is a need for additional, comprehensive resources to cope with students’ emotional issues. These areas could reveal possibilities for enhancing students’ performance and increasing the competency of midwifery staff.
References
Amoo, S.A., Aderoju, Y.B.G., Sarfo-Walters, R., Doe, P.F., Okantey, C., Boso, C.M., Abraham, S.A., Druye, A.A. and Ebu Enyan, N.I., 2022. Nursing students’ perception of clinical teaching and learning in Ghana: A descriptive qualitative study. Nursing research and practice, 2022(1), p.7222196.
Baird, K., Hastie, C.R., Stanton, P. and Gamble, J., 2022. Learning to be a midwife: Midwifery students’ experiences of an extended placement within a midwifery group practice. Women and Birth, 35(1), pp.e19-e27.
Bragg, R.M., 2024. High-Stakes Test Anxiety in Students: Perspectives of Students and Principals (Doctoral dissertation, Ball State University).
Dewar, B., Stulz, V., Buliak, A., Connolly, L., McLaughlin, K., Newport, K., Rebolledo, S., Stephenson, L., MacBride, T., Lennon, K. and Drayton, N., 2020. Exploring and developing student midwives’ experiences (ESME)—An appreciative inquiry study. Midwifery, 91, p.102844.
Folkvord, S.E. and Risa, C.F., 2023. Factors that enhance midwifery students’ learning and development of self-efficacy in clinical placement: A systematic qualitative review. Nurse Education in Practice, 66, p.103510.
Gusenbauer, M. and Haddaway, N.R., 2020. Which academic search systems are suitable for systematic reviews or meta‐analyses? Evaluating retrieval qualities of Google Scholar, PubMed, and 26 other resources. Research synthesis methods, 11(2), pp.181-217.
Karimi, S., JA Biemans, H., Lans, T., Chizari, M. and Mulder, M., 2014. Effects of role models and gender on students’ entrepreneurial intentions. European Journal of Training and Development, 38(8), pp.694-727.
Kool, L., van Hoogen, M., Heerema, L. and Feijen-de Jong, E.I., 2024. Exploring the determinants of student midwives’ well-being during their studies: A qualitative study. Women and Birth, 37(4), p.101626.
Long, H.A., French, D.P. and Brooks, J.M., 2020. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine & Health Sciences, 1(1), pp.31-42.
Mbakaya, B.C., Kalembo, F.W., Zgambo, M., Konyani, A., Lungu, F., Tveit, B., Kaasen, A., Simango, M. and Bvumbwe, T., 2020. Nursing and midwifery students’ experiences and perception of their clinical learning environment in Malawi: a mixed-method study. BMC nursing, 19, pp.1-14.
McNeill, M. and Kitson-Reynolds, E., 2024. Student midwives’ experiences of clinical placement and the decision to enter the professional register. British Journal of Midwifery, 32(1), pp.14-20.
Negm, L.M.M.A., Mersal, F.A., Fawzy, M.S., Rajennal, A.T., Alanazi, R.S. and Alanazi, L.O., 2024. Challenges of nursing students during clinical training: A nursing perspective. AIMS Public Health, 11(2), pp.379-398.
Oates, J., Topping, A., Arias, T., Charles, P., Hunter, C. and Watts, K., 2019. The mental health and well-being of midwifery students: an integrative review. Midwifery, 72, pp.80-89.
Oates, J., Topping, A., Watts, K., Charles, P., Hunter, C. and Arias, T., 2020. ‘The rollercoaster’: a qualitative study of midwifery students’ experiences affecting their mental well-being. Midwifery, 88, p.102735.
Snyder, H., 2019. Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, pp.333-339.
Sourinejad, H., Haghani, F., Beigi, M. and Adibmoghaddam, E., 2021. Midwifery Students’ Learning Styles in Iran: A Review Study Based on Kolb’s Learning Theory. Journal of Guilan University of Medical Sciences, 30(1), pp.52-63.
Sun, J., Wang, A. and Xu, Q., 2022. Exploring midwifery students’ experiences of professional identity development during clinical placement: A qualitative study. Nurse Education in Practice, 63, p.103377.
The Student Midwife., 2019. [online] All4Maternity. Available at: https://www.all4maternity.com/transforming-midwifery-education-3/ [Accessed 27 Jan. 2025].
The Student Midwife., 2024. [online] All4Maternity. Available at: https://www.all4maternity.com/about-us/the-student-midwife-writing-for-us/ [Accessed 27 Jan. 2025].
Wieczorek, C.C., Marent, B., Dorner, T.E. and Dür, W., 2016. The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals’ perspectives on the implementation of the Baby-Friendly Hospital Initiative. BMC Health Services Research, 16, pp.1-15.
Appendices
Appendix A: Critical appraisal
Critical Appraisal of “The Rollercoaster: A Qualitative Study of Midwifery Students’ Experiences Affecting Their Mental Well-being”
- Research Aim/Question
Objective:
The study aimed to explore the lived experiences of midwifery students with a specific focus on their mental well-being during the course of their training. It sought to identify factors that influence their mental health and gather their perspectives on the support systems available.
Research Question:
What are the experiences of midwifery students regarding their mental well-being during training?
- Study Design
Design:
The study used a qualitative descriptive design, employing semi-structured interviews for data collection. This approach facilitated in-depth exploration of participants’ personal experiences.
Setting:
A midwifery undergraduate program at a university in South England.
Data Analysis:
Thematic analysis following Braun and Clarke’s framework was applied, allowing the development of inductive themes.
- Participants
Sample Size:
20 BSc midwifery students.
Demographics:
Participants ranged in age from 19 to 43 years, with representation from both younger (≤22 years) and mature (≥26 years) students.
Recruitment:
Convenience sampling from students who responded to a survey on mental health within their cohort.
- Key Findings
Two main themes emerged:
- “The Rollercoaster”
- Students experienced emotional highs and lows throughout the course, often described as a “rollercoaster.”
- Challenges included multiple transitions (e.g., between placements and academic settings) and the relentless pace of the program.
- Younger students faced challenges of adjusting to independence, while mature students struggled with balancing family commitments and financial sacrifices.
- “Being Noticed, Feeling Connected”
- Students valued being seen as individuals and having consistent connections with educators and peers.
- Support from mentors and consistent opportunities to meet peers were crucial in enhancing their experience.
Conclusion:
The mental well-being of midwifery students is significantly impacted by the emotional demands of the training. Support systems, both individual and institutional, must prioritise consistency, personalisation, and connectivity.
- Validity and Reliability
Strengths:
- Semi-structured interviews enabled detailed insights into participants’ experiences.
- Reflexivity by the research team helped mitigate biases, particularly since some researchers had pastoral roles with the participants.
Limitations:
- Findings are limited to a single institution and may not generalise to other settings.
- The convenience sampling method might have excluded students with more extreme experiences (e.g., those who left the program).
Ethical Considerations:
- Ethical approval was granted, and participants were fully informed about the study.
- Interviews were conducted by a near-peer to reduce power imbalances, and participants could withdraw at any time.
- Implications for Practice
- Midwifery educators should provide tailored and consistent support to students, fostering meaningful connections with both peers and mentors.
- Institutions should acknowledge the emotional challenges of midwifery training and develop strategies to build resilience and maintain mental well-being.
- Opportunities for peer connection and mentorship should be integrated into program structures.
Critical Appraisal of “Student Midwives’ Experiences of Clinical Placement and the Decision to Enter the Professional Register”
- Research Aim/Question
Objective:
The study aimed to understand how clinical placement experiences shape student midwives’ decisions to continue their training and join the professional register.
Research Question:
How do clinical placement experiences influence student midwives’ decisions regarding professional registration?
- Study Design
Design:
An interpretative phenomenological approach (IPA) was utilised to capture and analyse the lived experiences of student midwives, focusing on descriptive, linguistic, and conceptual aspects of their narratives.
Setting:
Interviews were conducted online with participants from various pre-registration midwifery programs across England.
Data Analysis:
Thematic analysis was performed, categorising 79 emergent themes into five sub-themes within two super-ordinate themes.
- Participants
Sample Size:
Seven student midwives who had recently completed clinical placements.
Inclusion Criteria:
Participants were required to be in years 1–4 of a pre-registration midwifery course and to have completed a clinical placement within the past 12 months.
Recruitment:
Participants were recruited via an online questionnaire advertised on a social media platform for aspiring and student midwives.
- Key Findings
Overarching Theme:
“I can be a good midwife when I qualify.”
Super-ordinate Themes:
- Kindness and Compassion Grows Future Midwives
- Positive interactions with mentors and staff were pivotal in fostering confidence and motivation.
- Feedback, support from peers, and being treated with civility encouraged students to persist in their training.
- Strength and Resolve During COVID-19 and Beyond
- The pandemic exacerbated stress due to staffing shortages and increased workloads.
- Negative experiences included feeling undervalued, facing incivility, and witnessing emotional distress among staff.
Conclusion:
Supportive and compassionate environments during clinical placements play a critical role in student midwives’ perseverance and decision to join the profession. Negative experiences such as incivility and lack of support deter students and impact their confidence.
- Validity and Reliability
Strengths:
- IPA provided a deep understanding of the lived experiences of participants.
- The study addressed trustworthiness through reflexivity and researcher bias mitigation.
Limitations:
- Small sample size and reliance on volunteers might limit generalizability.
- Data collection during the pandemic may have heightened participants’ negative experiences.
Ethical Considerations:
- Ethical approval was granted, and participant confidentiality was strictly maintained.
- Participants could pause or withdraw at any stage, and support resources were provided for those in distress.
- Implications for Practice
- Clinical staff should focus on fostering a supportive and inclusive culture for student midwives.
- Feedback mechanisms should be formalised to provide students with constructive and consistent guidance.
- Programs must address systemic issues, such as staff shortages and incivility, to create a sustainable learning environment.
- The importance of mentorship and self-reliance should be emphasised, with additional focus on resilience-building strategies for students.
Critical Appraisal of “Exploring and Developing Student Midwives’ Experiences (ESME): An Appreciative Inquiry Study”
- Research Aim/Question
Objective:
The study aimed to investigate what contributes to an enriched learning experience for student midwives in clinical placements and to co-create strategies for enhancing these experiences through collaborative inquiry.
Research Question:
What factors support a positive learning experience for student midwives, and how can these insights inform future strategies for improving their training environment?
- Study Design
Design:
An Appreciative Inquiry (AI) approach was used to explore and develop understanding of the positive aspects of student midwives’ experiences in clinical placements. This methodology focused on identifying strengths and envisioning improved practices.
Setting:
The study was conducted across four tertiary teaching hospitals in New South Wales (NSW), Australia.
Data Analysis:
Data were analysed using immersion crystallisation and mapped to the “Senses Framework,” which focuses on safety, belonging, continuity, purpose, achievement, and significance.
- Participants
Sample Size:
124 participants, including 45 student midwives and 76 practicing midwives.
Recruitment:
Participants were recruited with the help of Essential of Care Coordinators in each health district, who facilitated participation and data collection through various methods.
- Key Findings
Themes from the “Senses Framework”:
- Safety and Belonging
- Both students and midwives valued environments that made them feel secure and supported.
- A welcoming culture during placements was critical to fostering self-confidence and reducing anxiety.
- Continuity and Purpose
- Continuity in learning relationships with mentors or preceptors enhanced confidence and learning outcomes.
- Clear guidance and support reinforced students’ sense of purpose.
- Achievement and Significance
- Recognition of contributions and positive feedback were essential for student motivation.
- Collaborative learning opportunities between students and midwives strengthened professional relationships.
Conclusion:
The study emphasised that relational and supportive workplace cultures are essential to enhancing the learning experiences of student midwives. Positive, collaborative environments enable both students and mentors to thrive.
- Validity and Reliability
Strengths:
- The AI approach focused on strengths and successes, offering a constructive lens to improve practices.
- The involvement of multiple stakeholders (students, midwives, and educators) enriched the findings.
Limitations:
- The study was confined to NSW, which may limit the generalizability of findings to other settings.
- The voluntary nature of participation could have led to a bias toward positive experiences.
Ethical Considerations:
- Ethical approval was obtained from both local health and university research committees.
- Participants provided informed consent, and their confidentiality was maintained.
- Implications for Practice
- Positive relationships between students and midwives are central to creating enriched learning environments.
- Institutions should invest in developing workplace cultures that emphasise collaboration, respect, and recognition.
- Mentorship programs should focus on continuity, with formal and informal mentoring strategies tailored to students’ needs.
- Emotional resilience and self-care strategies should be integrated into student training to prepare them for the demands of midwifery practice.
Appendix B: Summary matrix
| Title | Authors | Year | Country | Methodology | Participants | Recruitment Method | Key Themes | Key Findings | Implications | Strengths and Limitations |
| ‘The rollercoaster’: A qualitative study of midwifery students’ experiences affecting their mental well-being | Oates et al. | 2020 | United Kingdom | Qualitative, thematic analysis | 20 midwifery students | Participants were recruited via a survey distributed to their year group, followed by direct contact for interviews. | Emotional highs and lows, impact of transitions, importance of peer and educator support, need for individualised mentorship and connection. | Students experience emotional highs and lows due to transitions between academic and clinical worlds. Peer and educator support are critical for coping. | Individualised support and consistent peer connections can mitigate emotional challenges, enhancing retention and mental health. Educators should prioritise personalised mentorship and peer networking. | Strengths: In-depth exploration of emotional challenges with clear practical recommendations. Diverse participant perspectives across academic years. Limitations: Small sample size, single-site study, and potential for self-report bias. |
| Exploring and developing student midwives’ experiences (ESME): An appreciative inquiry study | Dewar et al. | 2020 | Australia | Appreciative inquiry, thematic mapping | 124 participants (45 midwifery students, 76 employed midwives) | Participants were recruited through collaboration with Essentials of Care Coordinators across four local health districts in New South Wales. | Positive mentorship, sense of safety and belonging, continuity in learning, recognition, collaborative and relational learning environment. | Positive mentorship, continuity in learning, and feeling valued are essential for enriching student experiences. The “Senses Framework” emphasises safety, belonging, and recognition. | Promoting relationship-centered approaches and collaborative mentorship can improve student experiences and retention. The “Senses Framework” provides practical guidance for enhancing relational learning environments. | Strengths: Large sample size across multiple health districts; innovative use of the “Senses Framework” for relational learning. Limitations: Focuses on positive experiences, potentially overlooking challenges; limited to specific healthcare settings. |
| Student midwives’ experiences of clinical placement and the decision to enter the professional register | McNeill and Kitson-Reynolds | 2024 | United Kingdom | Interpretive phenomenology, semi-structured interviews | 7 midwifery students | Participants were recruited through an online questionnaire shared via a midwifery-focused social media group (“Secret Community for Midwives in the Making”). | Positive mentor-student interactions, systemic barriers (understaffing, workload), influence of workplace culture, persistence despite challenges, professional identity formation. | Positive interactions with mentors and staff foster professional identity. Systemic barriers like understaffing and COVID-19 disruptions negatively impact students’ experiences and decisions to persist. | Building stronger mentorship programs and improving workplace culture are critical for student satisfaction and retention. Addressing systemic issues like understaffing can enhance both student and patient outcomes. | Strengths: Captures the nuanced impact of systemic issues on students’ professional identity. Rich, in-depth insights from participants. Limitations: Small sample size and lack of diversity in participants limit generalisability. Interviews conducted during COVID-19 may reflect extraordinary circumstances. |
Appendix C: Search Strategy
Table 1 Keywords for Search Strategy
| Primary Keywords | Secondary Keywords | Combination with Search Terms |
| Midwifery Students | Nurse Midwife
Midwives Students |
“Midwifery Students” OR “Learning Experience” AND “Placement” |
| Experience | Learning Experience | “Experience” OR “Midwives Students” AND “Student Placement” |
| Placement | Student Placement
Clinical Placement |
“Student Placement” OR “Nurse Midwife” AND “Learning Experience” |
Table 2 Inclusion and Exclusion Criteria
| Criteria | Inclusion | Exclusion | Rationale |
| Population | Studies focusing on student midwives enrolled in pre-registration training programs. | Studies focusing on other healthcare professionals or qualified midwives exclusively. | Focuses on the target population to understand challenges and supports specific to student midwives. |
| Language | Articles published in English. | Articles published in languages other than English. | Ensures comprehension and relevance, as translation resources are unavailable. |
| Publication Type | Peer-reviewed journal articles. | Grey literature, conference abstracts, opinion pieces, or non-peer-reviewed
sources. |
Ensures high-quality, credible, and validated evidence. |
| Study Design | Qualitative studies (e.g., thematic analysis, phenomenology, appreciative inquiry). | Quantitative studies or mixed-methods studies without a clear qualitative component. | Focuses on rich, detailed insights into the lived experiences of student midwives. |
| Focus Area | Studies examining experiences of student midwives, including mentorship, mental well-being, or systemic barriers. | Studies focusing solely on technical skills, academic outcomes, or unrelated areas of midwifery. | Targets the core themes relevant to the review’s objectives. |
| Date Range | Published within the last 5 years (2018-2024). | Studies published before 2018. | Ensures that findings reflect current educational, social, and systemic contexts. Experiences are different post pandemic. |
| Setting | Studies set in clinical or educational contexts relevant to midwifery training. | Studies conducted in unrelated settings, such as administrative or non-clinical environments. | Maintains relevance by focusing on settings where student midwives engage in training and professional development. |
| Access | Full-text articles available through EBSCO | Articles with incomplete access or requiring retrieval via unavailable sources. | Ensures that sufficient detail is available for a thorough critical appraisal. |
Figure 1 PRISMA Flow Diagram for the Proposed LR Study
