In November 2019, ACNM and the Developing Families Center (DFC) introduced the Midwifery Clinical Education Empowerment Project. The vision of this project was to increase the capacity of the District of Columbia to support quality full-scope clinical education experiences for midwifery students representing diverse or historically marginalized populations. DFC experience has previously shown, and the evidence supports that, midwifery-led perinatal care services generate superior health outcomes for women and their families.
As part of this project, preceptor pairing was supported with intentionally selected students in organizations that received reimbursement to partially offset the institutional cost of accommodating student needs. Preceptors were recognized and received a monetary award to support professional development activities. Later, discussion groups with the same preceptors and students were facilitated to collect qualitative data related to preceptor and student clinical experiences.
The preceptor focus groups revolved around barriers and facilitators to clinical precepting and dimensions of diversity & cultural competence in clinical precepting.
The student focus groups broadly generated experiences of BIPOC/LGBTQ students about their institution’s and preceptors’ approach on diversity, inclusion and belonging as well as the impact of COVID-19 and political climate on midwifery practice.
Key findings from this project and focus group discussions include:
- Diversity and Inclusion: Preceptors and students agreed that training needs to be accommodating to more diverse lifestyles/schedules. Black students reported lack of diverse racial representation amongst midwifery faculty. Black and queer students reported that some faculty may interact with them through a different lens as a student-midwife. Students perceive that the school administration lacks the capacity to specifically support students of color (and other minorities) to be successful in the program. Students lack the psychological safety to speak up and feel listened to in terms of contributing to a more diverse and equitable environment.
- COVID-19: Due to the lack of clinical supervision and training during the pandemic, students feel ill equipped and ill prepared to practice as competent midwives. The pandemic has been an unpredictable and difficult obstacle to clinical experiences and stress levels for preceptors and students alike.
- Training: Preceptors would like to have more time to get to know each other (the preceptor-student dyad). Preceptors do not receive formal training to become a preceptor; being “precepted” was the only preparation for the role. Preceptors don´t feel midwifery education and preceptorship are valued within clinical settings. They do not receive specific training nor is time allocated to supervise students appropriately. Preceptors were concerned about the quality of education provided in this context and about their capacity to teach with the added external stressors. The additional stressors faced in 2020 changed the concerns that patients were having and therefore changed how midwifery was practiced. Preceptors identified that students had to focus much more on mental health issues than in previous years.
- Race relations: Preceptors are aware that race, ethnicity, and sexual orientation are integral to who midwives are as students and this impacts their education. Preceptors identified the lack of diversity among their cohort as a concern. Preceptors do not feel that racism is being dealt with adequately within educational institutions. They identify the need for improving diversity and representation, yet do not trust that the institutions are doing enough to dismantle racism.