Midwives on the Cutting Edge: Competency-Based Educational Models

AUGUST 2013 Enews Articles

Midwives on the Cutting Edge: Competency-Based Educational Models
by Heidi Fillmore

In our own quiet way, midwifery educators are, and perhaps always have been, on the cutting edge of educational innovation. As the higher education world grapples with the changing student profile and their access to information in our technology-based global culture, innovative competency-based educational models are being developed that try to accommodate the non-traditional student or to take advantage of these changes. These competency-based models put high value on the knowledge and skills a student is able to demonstrate at the completion of the course/program. This is a familiar model for many midwifery educators—the way that knowledge and skills are obtained is less important than whether the student is competent to perform the tasks of a professional midwife at the completion of her training. Competency-based education is outcome-based—the focus is on what students are able to do at the end of a course rather than what goes into the curriculum. With a competency-based approach, you do not begin preparing a course syllabus by identifying content and readings. Instead, you begin by identifying competencies and then select the content, readings, and assignments to support student attainment of those competencies.

In many ways, midwives and other professions who use apprenticeship as the foundation of their training have been utilizing a competency-based model of education for a long time. Traditionally, apprentices follow a “master” around for a period of time, taking on more and more responsibility as they demonstrate their readiness for it, and self-direct their theoretical learning in their own way, in their own time. The strength of this educational model lies in its accessibility, flexibility, adaptability to the individual needs, relevancy to the future work the student is being prepared for, and assurance that the student is competent to practice the profession because a mentor has directly assessed their competency. The apprenticeship model works particularly well for women, who often must balance family responsibilities with their vocational goals and benefit from its flexibility and self-directed nature.

The potential weaknesses in the pure apprenticeship model are mostly due to its reliance on one or more mentors who may vary greatly in their ability or willingness to teach, their breadth of knowledge and level of skill in their field, their scope of practice, their professional conduct, their professional currency, and their methods of assessing their apprentice’s competency. In this model, apprentices may learn things differently, incorrectly or not at all depending on their mentor. Some apprentices will gather and assimilate their theoretical learning easily and completely and others may not value theoretical learning as much and do less in this area. If independent learning is difficult for a particular apprentice, that individual may never be able to demonstrate competency without formal instruction.

Competency-based models of education are currently being used in formal midwifery programs and are an attempt to integrate the strengths of apprenticeship style training into a more formalized education. The weaknesses of the pure apprenticeship model are addressed by creating structures and checks and balances to try to create a consistent standard that all students must meet in order to graduate. Programs typically utilize a set of core competencies from which they build their curriculum and then require students to demonstrate mastery of each competency in order to complete the program. In the case of MEAC accredited programs or institutions, the MEAC Curriculum Checklist serves as this minimum set of Competencies. The Curriculum Checklist is a compilation of the MANA Core Competencies, the NARM Knowledge and Skills List, and the ICM Essential Competencies. Competencies must be defined at a sufficient level of specificity that they can be assessed.

In competency-based education, assessment is embedded in every step of the learning process in order to provide students with guidance and support toward mastery. Some assessments are considered “formative,” meaning they are part of the learning process and give information to the student and the instructor as to the student’s needs and the effectiveness of the instruction. In this sense, formative assessment informs both teachers and students about student understanding at a point when timely adjustments can be made. Other assessments are considered “summative” assessments and are given periodically to determine what students know and do not know at a particular point in time. This is considered more of an accountability measure—has the student met this competency and therefore is ready to move forward in her learning? Designing reliable and valid assessments is not an easy thing to do and could be the greatest challenge of competency-based programs, but they are essential to this model of education. As midwifery educators, this is an area that we need to focus and collaborate on if we are to assure competency in our graduates.

Although most, if not all, midwifery programs use a competency-based approach, there has been an expressed need for the availability of more pure competency-based, or direct-assessment, programs. The distinction here is that these programs would not necessarily provide a set curriculum, direct instruction, or specific learning materials, but rather its major role would be in setting competencies and designing assessments. Formative assessments would serve to guide the independent student’s learning and summative assessments to determine that the student has met the particular competency being assessed. More and more institutions of higher education are beginning to offer direct-assessment courses, and some institutions have been founded solely to administer direct-assessment education and award credits and confer degrees achieved through direct-assessment coursework. Western Governor’s University, for example, has been offering online competency-based courses and programs since 1998 and currently offers many Bachelor’s and Master’s level degrees, including a Bachelor of Science in Nursing. This is what WGU has posted on their website regarding their programs: “WGU does not rely upon classes in the traditional sense. We don’t base your progress on accumulating credit hours, but rather on completing challenging assessments that measure your knowledge and skills in a subject area. We ask you to “prove you know your stuff.” You’ll study. You’ll write papers. You’ll take tests. You’ll complete assignments.” In this model, the student can complete the course by doing their own research, by taking workshops or courses in their local community, by working in the field with supervision, by hiring a tutor, etc, and they can do it at their own pace. The bottom line is that they must pass the assessments designed to demonstrate achievement of all identified competencies for each course in order to pass the course. The way that they achieve that competency is irrelevant.

There is a reason why apprenticeship (or preceptorship in the case of formal educational programs) was and continues to be the way that midwives become trained—it is really good at transmitting the tactile skills, clinical judgment and professional behaviors that are the core of midwifery care. Competency-based education is a natural model for midwifery educators because it does put demonstration of competency at the center of the process. Because midwifery students tend to be women who are older than the traditional college student and therefore often have families, it is imperative that we have a variety of educational options that meet these unique needs if we are to expand our profession’s work force. There already is a rich variety of educational programs for aspiring CPMs to choose from, and my hope is that this spectrum of choices will continue to expand to include direct-assessment models that will establish the apprenticeship model as an accountable and accepted method of midwifery education into the future.

Heidi Fillmore, CPM, is Vice-President of the Midwifery Education Accreditation Council, Executive Director of Birthwise Midwifery School in Bridgton, Maine, and practicing midwife in a home birth/ birth center practice. She is also mother to two grown daughters.

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