The development and the Validation of scenarios to compare midwives’ knowledge and skills with the International confederation of midwives’ essential competencies in four European countries.

Valerie Fleming, Pehlke-Milde Hebamme J, Davies S, Zaksek T (2011) 27 : 854- 860. Cotton S, Sharp L, Cochran C et al (2011) 61(587) e333-339.

This was a prospective qualitative multicentre observational study that recruited 265 midwives in four countries. The aim of the study was to develop, pilot and validate a number of scenarios which encompass all of the International Confederation of Midwives’ (ICM) competency statements in the European Union and in those which might become members in the future, for the education and examination of midwives or for self-assessment of competence. The Delphi study definition of competence was used, their final document produced 214 competencies, which were classified into six domains of professionalism, pre-conception, antenatal, intrapartum, post partum and neonatal care. In all the six domains, knowledge and skills are assessed, but, in addition, professional behaviour was also assessed as part of professionalism. The sample size may have been pre-judged as there was no prior determination of the number of participants required.

Twenty-seven scenarios were developed by a group of midwives representing each of the countries involved through brainstorming and carefully refined to address each of the ICM competencies. A table of these lists of scenarios and the competencies required may have allowed easy comprehension of what was to be analysed. A pilot was done among final year midwifery students to determine if these represented their experiences, but this was not clearly stated in the study. There were no ethical issues, as patients were not involved. The final study was carried out on midwives who had been practising for a minimum period of two years.

The data were collected over a three-year period from 2005-2008, where midwives were interviewed on various clinical situations ranging from emergencies to non-urgent situations, mimicking true life. Their responses were audio-taped and the researchers analysed their responses through comparing the text of the responses to the scenarios with the ICM competencies. The results of each country were compared, paying particular attention to similarities and differences between each country. Some of the scenarios were reconstructed when they were found to be ambiguous and did not yield the expected competencies, and one scenario was added, leaving a total of 22. Further interviews were therefore conducted on these modifications. Only 258 midwives participated in these interviews.

The findings showed adequate professional knowledge, skills and behaviours amongst the midwives interviewed in their management of antenatal patients, intrapartum care, postnatal and neonatal care. The poorest results were shown for preconception care as this may be outside the remit of their training. These findings were difficult to follow, as there was no consistency in the use of scenarios or competencies, and overall the study was unable to account for the initial 214 competencies nor the 28 scenarios being assessed. The authors concluded that this study addresses the issue of transferability of midwifery practice from one area of Europe to another and may be used with confidence by experienced midwives in each of the areas involved, to determine their own competence, but the reviewer of this paper would advise our reader to exercise caution in making generalisations based on this paper.

The researchers also suggested that further research on a large scale is required on the use of the scenarios probably as a virtual reality using multi-media and allowing midwives at any stage in their career to assess their performance or utilise these for their continuing development is warranted and this is supported.