How Well Does Pre-service Education Enable Midwives to Provide Quality Care: Assessment of Competence of Midwifery Students at the Level of Graduation in Ethiopia

Session: Supporting Midwives through Education, Mentoring and Partnerships

Presenter: Tegbar Yigzaw, Jhpiego
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Background: The Government of Ethiopia has recently improved the supply of midwives by scaling up pre-service education. However, the extent to which graduating students acquire the essential midwifery competencies is not known. The purpose of this study was to assess the competence of graduating midwifery students and identify factors associated with it.

Methodology:  We conducted a cross-sectional study to assess the competence of midwifery students graduating from 25 public training institutions in 2013. We assessed achievement of essential midwifery competencies through direct observation, using a 10-station Objective Structured Clinical Examination. We also interviewed students to obtain their perceptions of the sufficiency and quality of educational resources and processes. We calculated average percentage scores of performance for each station and an average summary score across all stations. Chi-square test, independent sample t test, and linear regression analysis were used to assess the statistical significance of differences and associations.

Results:  We assessed 484 students, about two-third from vocational colleges and one-third from universities. Majority of students rated the learning environment unfavorably in 8 out of 10 questions. Only 32% of students met the national standard of managing 20 or more births during training, and just 6% met the global standard of managing 40 or more births during training. Students’ overall average competence score was 51.8%; scores ranged from 32.2% for manual vacuum aspiration to 69.4% for active management of the third stage of labor. Being male, reporting sufficient clinical experience, and managing greater numbers of births during training were significant predictors of higher competence scores.

Conclusions:  The competence of graduating midwifery students was found inadequate. We recommend in-service training and mentorship to new graduates in the short-term but prioritize strengthening the learning environment and internal quality assurance systems at training institutions and strengthening accreditation and licensure systems for the long-term.