Where is the woman in the clinical assessment of midwifery students?

Woman-centred care (WCC) is a central philosophy of midwifery practice moreover, WCC is inherent in the international definition of ‘Midwife’ and a core element in midwifery curricula. Research has shown that midwifery student assessment tools have been validated to assess competence in clinical settings however, the inclusion of the woman in the clinical assessment of the student is less well understood. To collate and report the evidence on the role of the woman in the clinical assessment of midwifery students. A scoping review was conducted using the framework of Arksey & O'Malley (2005). Articles where sourced from MEDLINE, CINAHL, EMCARE and SCOPUS and controlled vocabulary and key words were combined systematically for each database. Central concepts were woman-centred care, midwifery students and clinical assessment. Articles included were peer reviewed with no restriction on year or date of publication. PRISMA was used to report the results. A total of 2,540 articles were identified before duplicates were removed. Following title and abstract screening, a full text review was conducted resulting in seven (7) included articles. Descriptive quantitative analysis, and qualitative analysis guided by the Braun and Clarke was conducted. Publication dates ranged from 2007 to 2020. Studies were conducted in Australia (n=5), Indonesia (n=1), The Netherlands (n=1) and there were an extensive variety of study designs, from trials to exploratory descriptive studies. The concepts of woman-centred care (WCC) were well explored particularly in terms of the continuity of care experience. There was consistency in the evidence that the symbiotic relationship between the student-woman during the continuity of care experience further enhanced the student’s and woman’s experience of woman-centredness. Midwifery students were provided with knowledge and skills to provide WCC through measurable tools e.g. simulation-based learning, graded observational assessment and performance instrument tools. Although women were able to provide feedback on their experience, it was mostly in the form of criteria-led evaluations (online survey, questionnaire) and not woman-led evaluations on the care that they received. Detailed information on what women value in the student-woman continuity of care experience, and whether this varied with the model of care provision e.g. fragmented care, was largely under-represented. This review questions the equity and robustness of the current midwifery student assessment tools as reliable tools to assess WCC from the perspectives of those directly involved; that is the woman, the midwifery student and the assessing midwife. A clearer understanding of how WCC is realised in midwifery student assessment regardless of the model of care provision needs to be explored. For example, how the woman is included, what her role is and how she can provide feedback will inform how WCC is reflected in all practice settings. A tool that is acceptable to the woman to enable her to provide feedback on her experience may serve to strengthen midwifery student assessment tools, identify if the care is truly woman-centred and more importantly, give the woman a ‘voice’ to validate her experience. This review demonstrates that there is a major gap in our provision of woman-centred care and one that will be addressed by two studies that are currently underway.