Executive summary

Feedback from the learners at this meeting highlighted an improved educational experience within midwifery compared to the previous visit undertaken in November 2023.  

The following areas were identified as working well, or were noted as improvements for the department: 

• All learners, practice supervisors and assessors valued the support of those in practice education roles. It was shared by the Education team that these roles are now embedded into the permanent structure within the department.
• The legacy mentors were also praised by both learners and practice supervisors and assessors for their offer of wellbeing and teaching support.
• There was a noted improvement in the perceived value of complementary placements such as time in the neonatal unit, gynaecology wards and with the sexual health team.
• It was shared that there had been development of a Shared Governance Council, which includes learner participation, to deliver improvements across the clinical learning environment.
• Learners shared several multi-disciplinary opportunities that are on offer within the department to gain practical educational experience.
• Learners reported improvements to the process for allocating both practice supervisors and assessors. The new process was described by learners to be much more organised.
• Whilst there were still some inconsistencies with receiving timely written feedback from practice supervisors and assessors, the Education team provided us with assurances that this action is being addressed after a successful recruitment process to have more substantive midwives in post. This should alleviate some of the workload pressures on midwives who are working at the trust and are also in an educator role.

There were reports of an ongoing concern which requires continuing improvement: 

• There were individual reports of poor behaviours being displayed by some members of the Midwifery team. This can impact negatively on the learner’s ability to feel safe, including being freely able to raise concerns, within the clinical environment.  

In addition to the above, recommendations were made by the learners for the following area:

• Learners recommended that the trust provide a tour of the department in advance of their first shift to support their preparation for placement. Learners also shared that a practical session with the fire warden, similar to what is offered for staff, would be helpful for familiarisation with emergency procedures alongside the e-learning module.

Based on the overall positive findings, the panel will be recommending this item is reduced from an Intensive Support Framework (ISF) Category 2 to an ISF Category 1 and removed from the Quality Improvement Register. A trust improvement plan will be required against the remaining mandatory requirement outlined in this report. 

Review overview

Background to the review

This quality intervention was held as a follow-up to the November 2023 learner educator meeting to test progress against the trust’s active improvement plan for pre-registration midwifery training.  

Who we met with

Learners

• Pre-registration midwifery learners (BSc and MSc programmes)

Educators

• Midwives undertaking the Practice Supervisor and Assessor roles

Education team and Senior team

• Chief Nurse
• Director of Midwifery
• Deputy Head of Midwifery
• Institute of Care Excellence Senior Nurse for Practice Education
• Maternity Matron for Education and Training
• Practice Development Midwife – Students
• Clinical Educator – Students

Review panel

• Panel Chair, Jackie Brocklehurst, Assistant Director of Clinical Leadership & Education (Nursing and Midwifery)  
• Specialty Expert, Jo Hadley, Midwifery Quality and Professional Development Lead 
• Quality Representative, Amelia Harbon, Quality Deputy Manager

Review findings

Culture – supportive environment

The majority of learners felt that the clinical environment at both City Hospital and Queen’s Medical Centre was welcoming. Those in practice education roles were praised by the learners for their dedication and support. This was echoed by the practice supervisors and assessors, who shared that these colleagues actively supported them to deliver their roles. Learners also reported that there is good visibility of the senior team within the clinical areas, with the Director of Midwifery regularly undertaking walk arounds to check in with them.

The use of legacy mentors was widely commended by learners, practice supervisors and assessors. Midwives within this role were praised for both their wellbeing support and for the clinical skills sessions they taught. The water birth session during induction was particularly praised by learners who felt it helped them prepare for their roles in the department.

Whilst learners shared a mostly positive experience of being on placement at the trust, some felt that poor behaviours continue to be displayed by individual midwives. Reports were made particularly about behaviours in ward C29 at Queen’s Medical Centre. Examples were given of negative comments being made about the physical appearance of a learner, and midwives undermining their midwifery colleagues in the unit in front of learners. These instances of poor behaviours were reported to be negatively impacting on learner wellbeing and feeling part of the team.

Culture – complementary placements

During the visit in November 2023, we heard from practice supervisors and assessors that there was little value in providing ‘non-midwifery’ (complementary) placements, as these opportunities did not support the training needs of learners. At this visit, it was recognised that learners required clinical experience across a breadth of areas, including gynaecology and neonates, in preparation for their roles in midwifery. This was supported with learners reporting that they are rostered in to spend time in the neonatal unit, sexual health, and gynaecology.

Involving the learner in quality improvement

During this visit, the learners and the Education team advised that the department has developed a Shared Governance Council. As part of this initiative, learners have been able to express an interest to be part of the council which looks at the continual delivery of improvements in the clinical learning environment. Whilst we recognised that the council is in the early stages of development, it was reassuring to hear how the trust is providing opportunities for learners to take an active role in quality improvement initiatives.

Raising concerns

All learners were aware of the mechanisms to raise concerns at the trust and knew who they could approach for support. However, learners shared that they would not approach some midwives within the department to raise a concern due to the poor behaviours they had observed and experienced from them (see section ‘Culture- supportive environment’).

Multi-disciplinary learning opportunities

In addition to the improvements noted with complementary placements, learners, practice supervisors and assessors shared that there is a wide range of multi-disciplinary opportunities to receive practical experience. This included Practical Obstetric Multi-Professional Training (PROMPT), fetal monitoring training, time with the homebirth and infant feeding teams, and the opportunity to work with specialist midwives including teenage pregnancy and safeguarding.

Practice supervisors and assessors – allocation

When we met with learners in November 2023, reports of a lack of timely allocation of Practice Supervisors and Assessors were said to be impacting on practice education experience. Learners at this visit shared that there has been a change to the approach to allocation of practice supervisors and assessors. Practice supervisors were reported to be allocated in advance, and all learners confirmed that the level of supervision they are receiving is appropriate for their competence and confidence.

Learners also shared that Practice Assessors are now allocated in advance of their first shift on their placement. Protected time is then scheduled in advance for practice assessment review meetings to take place. Learners felt that the new process is ‘much more organised’ than it was previously.

The Education team shared that this approach to practice assessment had initially been adopted as a pilot, with learners on the MSc programme being the first to experience the process. This has been followed by implementation across the other cohorts and positive feedback shared about the approach to date.  

Practice supervisors and assessors – proficiency sign off 

In November 2023 learners reported that some practice supervisors and assessors were not signing off acquired clinical skills because they were not present to witness these taking place. During this visit, this was not raised as a concern by the learners we spoke with.

In addition, in November 2023 it was shared that some practice supervisors would leave completion of a learners’ e-portfolio for extended periods of time, resulting in the learner having to chase sign-off on several occasions. During this visit, learners shared that the feedback they receive verbally from practice supervisors and assessors is helpful and timely. It was shared that the timeliness of written feedback has sometimes been inconsistent however, learners recognised that there had been a recent change in email accounts for staff at the trust, which may have impacted on access to their electronic portfolios.

When we spoke with practice supervisors and assessors, they shared feedback that vacancies within the midwifery workforce and high workloads for staff within the trust has impacted on their ability to provide timely feedback to learners. The Education team acknowledged this feedback and provided us with assurances that these concerns will be addressed following a successful recruitment drive to have additional substantive midwives within the workforce. In addition, the team shared that they have implemented mitigations to these concerns by renumerating midwives that complete any additional work to support learner education outside of their working hours.

Induction

Similar to the visit in November 2023, the induction was generally described positively by learners. It was shared that there were opportunities to meet the Professional Midwifery Advocates (PMAs), and an overview was given of the Freedom to Speak Up Guardian and their role, access to clinical systems and some clinical skills training.

Learners who had recently participated in the induction shared that whilst they recognised the department needed to cover the key aspects of the placement with them, they felt that much of the process was based around sharing of PowerPoint presentations. Learners advised that some additional practical elements, such as a tour of the department in advance of their first shift, would be helpful as part of the induction to prepare them for their placement. In addition, learners suggested that it would be beneficial to receive fire warden training, similar to the training offered to staff, as well as the e-learning they receive, to become familiar with where emergency exits are and the process for evacuation.

Areas that are working well

Good Practice

Areas for improvement

Mandatory requirements

Recommendations

Report approval

Report completed by: Amelia Harbon, Quality Deputy Manager
Review lead: Jackie Brocklehurst, Assistant Director of Clinical Leadership and Education (Nursing and Midwifery)  
Date approved by review lead: 19 December 2024

NHS England authorised signature: Prof. Jonathan Corne, Regional Postgraduate Dean
Date authorised: 9 January 2025

Final report submitted to organisation: 10 February 2025