Institute of health sciences



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The Learning Process

As midwives may be the sole health-care providers for most Afghan women for some time to come, especially in rural areas, it is clear that any significant and sustainable improvement in maternal and newborn health will require that midwives be highly competent in a broad range of skills and able to work independently and with confidence.


Community midwives must have the knowledge and skills essential to the provision of safe and effective pregnancy, childbirth, and newborn care. It is necessary, therefore, that they participate in a learning process that facilitates the development of:





  • appropriate professional behaviors and interpersonal communication skills, and




  • competency in a range of essential clinical skills for basic maternal and newborn care and for the management of common complications in pregnancy and childbirth.

In addition, the learning process must be supported by:




  • training programs that provide appropriate managerial and technical support,







  • teaching and learning materials that reflect the most recent evidence-based information.

The Learning Environment

The learning environment should:




  • be supported by enough funds to maintain quality




  • incorporate an educational philosophy that encourages the development of problem-solving and critical thinking and emphasizes behaviors that respect and respond to a patient’s/client’s perceived needs,




  • include relevant educational materials that reflect an adult learning approach,




  • involve teachers who are adequately prepared to use competency-based learning methods and clinically competent to teach and serve as role models for learners according to the essential midwifery competencies (see Textbox 2 and Annex 3),




  • involve competent clinical preceptors who are able to use competency-based assessment tools,




  • facilitate comprehensive, supervised clinical learning experiences that will enable the development of essential skills for maternal and newborn care and for the management of common complications in pregnancy and childbirth, and




  • include evaluation methods that assess knowledge, skills, and attitudes.


Preparation of Teachers

Ongoing in-service training and capacity building of teachers is necessary to help ensure that the classroom and clinical teachers are:




  • current in their knowledge of care during pregnancy and childbirth,




  • proficient in the skills they will teach,




  • able to use competency-based learning methods and methods of assessment,




  • capable of serving as role models for learners and colleagues, and




  • interested in being teachers.

Preparation of Classroom Facilities

Classrooms should be available for interactive presentations (e.g., illustrated lectures) and group activities. Seating in classrooms should be comfortable and lighting and ventilation adequate. At a minimum, a writing surface should be provided for each learner, and a chalkboard and/or flipchart, chalk and/or felt pens, and an overhead projector and/or LCD should be available in each classroom. If possible, classrooms should be within easy access of the clinical sites used for the program.




Selection of Clinical Sites

Practice in the clinical setting is essential for developing healthcare delivery skills. Clinical practice helps prepare students for the roles and responsibilities they will hold in their profession, and gives them opportunities to become competent, gain confidence and with further experience become proficient.


Clinical sites should be assessed and selected based on the following criteria:


  • Patient/client mix and volume. Are there sufficient patients/clients in sufficient numbers for learners to gain the clinical experience needed? There should be an opportunity for each student to undertake a minimum 25 competent deliveries each, through the training.




  • Equipment, supplies, and drugs. Does the facility have the necessary equipment, supplies, and drugs, in sufficient quantities, to support the learning process?




  • Quality of care. Does the care in the principle clinical learning facilities adhere to the national standards and guidelines and the content of the program?




  • Staff. Are staff members at the site willing to accept learners and participate in the learning process? Do they use up-to-date, evidence-based practices for pregnancy, childbirth, and newborn care? Do their practices reflect the knowledge and skills described in this learning resource package (there may be a need to update their knowledge and skills)? Do they use correct infection prevention practices?




  • Transportation. Is the site within easy access for learners and teachers? Do special transportation arrangements need to be made?




  • Other training activities. Are there other training activities at the site that would make it difficult for learners to gain the clinical experience they need?

Practical components must also include community based experiences. If the situation allows, these can be close to the student’s homes and/or intended place of work on graduation.




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