Globally the shortage of skilled midwives is at a critical state. Across the UK the shortage continues, with pressure on placements to support an increased number of students. Hannah Tizard, Midwife, Educator and e-Learn Innovator addresses the new NMC report on simulated practice learning for nursing students and asks if the same could be applied to midwifery.
___________________________________
The NMC has published a new report that evaluates the use of simulated practice learning (SPL) in pre-registration nursing programmes (NMC, 2024).Within pre-registration nursing programmes, SPL allows approved education institutions (AEIs) and their practice learning partners (PLPs) to deliver a proportion of practice learning through simulation. Could the same model be applied for midwives in the future?
The global midwifery workforce is currently facing a critical shortage. The State of the World’s Midwifery Report highlights a need for an additional 900,000 midwives worldwide (UNFPA 2021), while the Royal College of Midwives reports that the UK alone requires 2,400 more midwives (RCM, 2023). These shortages place immense pressure on healthcare systems and on midwifery educators who must ensure that students receive sufficient, quality, clinical practice education before entering the workforce. This article will explore whether SPL could be part of the solution to current midwifery workforce challenges, especially given the increasing demand for safe and competent care at a time when funding and resources are limited.
The problem; limited clinical placements and capacity challenges
The capacity to accommodate increasing numbers of student midwives in clinical practice settings is progressively difficult, making it challenging to provide the essential hands-on experiences that are an essential part of midwifery education. Preceptorship adds another layer of complexity. Newly qualified midwives, who are undergoing a supported preceptorship period, often find themselves supervising students earlier than is ideal (Spets et al., 2024). This requires a delicate balance between avoiding excessive strain on new midwives and relying on a reduced pool of experienced midwives to mentor students effectively, part of the complex factors affecting recruitment and retention of midwives.
Furthermore, work demands exceeding capacity was identified as a factor in 43% of the maternity investigation reports (Devereux, 2024). When this happens, staff may be required “to make a trade-off between efficiency and thoroughness”. Safe, compassionate care is a growing concern in healthcare systems worldwide. The need for direct supervision of student midwives in clinical practice is increasingly difficult to meet, and the need to address safety adds additional pressure to ensure that students are sufficiently prepared for complex and high-risk situations. Could AEI’s and PLP’s include SPL as a way to complement, traditional clinical placements in midwifery?
SPL as Part of the Solution?
Simulation-based learning is not a new concept in midwifery education and is generally used to support skill development and learning of obstetric emergencies. In fact, its use has been increasing in nursing and midwifery programmes globally, particularly following the COVID-19 pandemic, which further limited access to clinical placements. However, research has previously suggested there are elements of midwifery practice that may be impossible to simulate particularly around the art and philosophy of midwifery, including working in partnership with women and the holistic nature of care (McKenna et al., 2011).
While SPL cannot currently replace clinical hours in midwifery programmes (NMC, 2019), could it be used more extensively to supplement traditional placements in the future, especially in situations where placement capacity is limited?
Visioning SPL for Midwifery
Given the new NMC evaluation of SPL in pre-registration nursing learning programmes, is there a potential of integrating SPL into midwifery too? To do so, would require a reimagination of both education and practice models. Whilst these ideas are visionary, with the appropriate research base, funding for infrastructure, technology and training investment, there is potential to enhance midwifery education, continuous professional development and safety in care.
Enhancing skills associated with personalised care
Incorporating empathy and cultural safety into midwifery education is crucial given the disparities in care outcomes highlighted by reports such as MBRRACE (Knight et al., 2024). Simulated placements could include immersive scenarios that teach midwives to provide equitable care, particularly to vulnerable populations, these could be tailored to local demographics. By simulating care for people from diverse cultural backgrounds, or those with complex social needs, midwives can practice navigating difficult conversations, gaining consent, or supporting informed choices in sensitive situations. These placements could also emphasise emotional intelligence development, teaching midwives to recognise and respond to the emotional and psychological needs of the families they care for. This could be a key strategy to reduce recognised disparities, the emotional burden midwives face, by building a workforce more attuned to both clinical and humanised care.
Safety-focused simulated placements
Improving safety is key to improving maternity services, and the demands on midwifery care are becoming increasingly complex. Visionary SPL could develop high-fidelity safety scenarios designed specifically to develop students in triage, risk management, escalation, elements of enhanced midwifery care and human factors in maternity care. These simulations would focus on integrating the latest safety recommendations, whilst also enabling midwives to handle complex emergencies such as, pre-term birth, sepsis and maternal mental health crises.
SPL as a parallel track for preceptorship
It is essential to address the demands placed on newly qualified midwives, who are expected to assume supervisory roles immediately upon qualification and consolidate their learning, all while navigating the challenges of supervising students during their preceptorship. Whilst many newly qualified midwives, enjoy supporting students, many lack the confidence and skills to attend to varying student needs. By creating a parallel-track system where newly qualified midwives undergo simulated preceptorship while simultaneously engaging in real-world practice, they can build practice confidence and leadership skills in a supported environment before mentoring students. This would offer a gradual, less pressured introduction to supervisory roles. Newly qualified midwives could mentor “virtual” students in simulated environments, tackling complex or rare situations without the risk of error impacting service users or increasing the anxiety of student midwives. Simulated preceptorship could also include role-playing scenarios of common workplace challenges such as conflict resolution, incivility training, managing incidents, and working within multi-disciplinary teams. This reflection certainly, is particularly visionary and would potentially be difficult to achieve due to current staffing issues within maternity services, but a point for consideration none the less.
Challenges and Considerations
Despite the benefits of SPL use in nursing, there is little research specifically in midwifery. Within the existing research, there are also challenges associated with implementing and sustaining SPL. One key concern is that, while SPL can provide a safe environment for learning which encourages transferability of learning to actual care situations facilitated in clinical practice (Roberts et al., 2019), but it does not fully replicate the unpredictability and intensity of real-life clinical practice. This is particularly important in midwifery, where emotional and interpersonal dynamics play a significant role in care. Therefore, it is essential that simulation is used in conjunction with, rather than as a replacement for, clinical placements.
Another challenge is the resource-intensive nature of SPL. It requires specialised equipment, trained facilitators, expensive technology, and dedicated space, all of which can be costly for educational or practice learning partner institutions. The NMC evaluation report (Holt, 2024) on ‘simulated practice learning in nursing programmes’ indicates that while students and stakeholders value SPL, the financial sustainability of such programmes is a significant concern. Some NHS Trust practice learning partners in England have raised concerns about the loss of placement tariff funding, as they have observed a reduction in these funds due to their reallocation to AEIs providing Simulated Practice Learning (SPL). AEIs are keen to maintain strong relationships with their practice learning partners and avoid straining these collaborations.
Additionally, some students may initially feel that simulation is not as valuable as real clinical experience. However, as the NMC report (Holt, 2024) demonstrates, student feedback often becomes more positive as they engage in simulation activities and see the benefits of practising in a controlled environment. This suggests that SPL could be better integrated into curricula to provide students with a more cohesive and comprehensive learning experience.
Final thoughts
It is interesting to consider the developments of SPL in undergraduate nursing programmes, likewise these developments could influence future midwifery education. On paper, SPL could offer solutions to both placement shortages and influence key education gaps required to improve maternity services. However, this shift is complex and will require visionary thinking, investment in resources, and a commitment to reimagining how midwives are developed.
What are your thoughts?
References
Devereux, E. (2024) National Report reveals key factors impacting safe maternity care, Nursing Times. Available at: https://www.nursingtimes.net/professional-regulation/national-report-reveals-key-factors-impacting-safe-maternity-care-08-05-2024/#:~:text=Work%20demands%20and%20capacity%20to%20respond&text=Work%20demands%20exceeding%20capacity%20was,thoroughness%E2%80%9D%2C%20warned%20the%20report
Knight, M., Kenyon, S., Kotnis, R., Patel, R., & Felker, A. (2024). Saving lives, improving mothers’ care 2024 – lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2020-22: MBRRACE-UK: NPEU. https://www.npeu.ox.ac.uk/mbrrace-uk/reports/maternal-reports/maternal-report-2020-2022
McKenna, L. et al. (2011) ‘Is simulation a substitute for real life clinical experience in midwifery? A qualitative examination of perceptions of educational leaders’, Nurse Education Today, 31(7), 682–686
NMC. (2019). Standards of proficiency for Midwives. www.nmc.org.uk. https://www.nmc.org.uk/globalassets/sitedocuments/standards/2024/standards-of-proficiency-for-midwives.pdf
NMC (2024) Simulated practice learning, The Nursing and Midwifery Council. https://www.nmc.org.uk/standards/guidance/supporting-information-for-our-education-and-training-standards/simulated-practice-learning/
RCM (2023) Numberjacks: New calculations reveal growing midwife shortage, RCM. https://pre.rcm.org.uk/news-views/rcm-opinion/2023/numberjacks-new-calculations-reveal-growing-midwife-shortage/#:~:text=We%20crunch%20all%20these%20numbers,of%2024%2C588%20full%2Dtime%20midwives
Roberts, E., Kaak, V. and Rolley, J. (2019) ‘Simulation to replace clinical hours in nursing: A meta-narrative review’, Clinical Simulation in Nursing, 37, 5–13.
Spets, M. et al. (2024) ‘Midwives views about preceptorship and peer-learning in a birth unit: A cross-sectional study’, Nurse Education Today, 139, p. 106255.
UNFPA (2021) The State of the World’s Midwifery Report, United Nations Population Fund. https://www.unfpa.org/sowmy