 I'd love to invite Anna to turn her camera on so I can introduce her to you all but I'm sure she already knows a lot of you and you already know a lot about her as an amazing midwife and educator. So welcome, Anna. Hi, thanks so much, Jane. It's lovely to be here. And I'm going to go ahead and read a little bit about your bio for those of you that don't know you as well as some of us do. Anna has been a midwife for 18 years. She's got a passion for relational, humanized, and right spaced midwifery care for all. And she has worked across the UK as a caseload team and birth centre midwife. Before moving into our current role as a midwifery educator and researcher at the University of Central Lancashire, she led infant feeding services in a local maternity service, implementing the UNICEF UK baby-friendly initiative. Yay, we know how hard that is, so salute you for that. In 2019, she completed her PhD with the maternal and infant nutrition and nurture unit at UCLan. She is a member of the UNICEF UK baby-friendly qualifications board and designation committee. She's co-director of all4maternity.com and publishes the practicing midwife and student midwife journals. I think she probably actually never sleeps. She was awarded a national teaching fellowship award in 2019 for her contribution to midwifery education. She leads the MSc midwifery at UCLan and is principal investigator with the main and thrive centres and units there, leading research projects, exploring collaborative learning in practice and continuity of carer across undergraduate education and midwifery continuity of carer throughout Lancashire and South Cumbria. Let's go ahead and welcome the amazing Dr Anna Byram. Thank you so much, Anna. Thanks honestly for your huge support, Jane, in preparing for today, but also to Linda and Ally and Chris and the incredible team and creating this space for sharing and learning and caring for each other over two days and around the world. It feels a real honor to be here with you all and so wonderful to see so many familiar names in the chat and online today. So a big hello to my lovely friends and colleagues and to see lovely new names and to hear from so many of you. Thank you for joining this session. So today I'm sharing with you some of my research work that's just started this year exploring what I believe to be a really crucial and essential part of my work as an educator is finding and enabling relational continuity of carer opportunities for future midwives and it's lovely to hear Jane welcoming our student colleagues onto the call because you are our future and I've got lots of fellow educators as well on the call so it's really wonderful to be in this space with you. I'd like to just take a moment to introduce a couple of my colleagues who help prepare the slides. So Carol Machadi is the lead midwife education at the University of Central Lancashire in the UK. Each university that offers midwifery training and education has a lead midwife education to enable quality and to help with curriculum development and Carol led our most recent curriculum development to be in line with the new nursing and medical council standards in the UK that were actually supported by Jane's sister Professor Mary Remfrew so we're really excited to be able to work towards those new standards and then my colleague Nisha Ridley from UCLan who's currently working with Health Education England in a workforce and education transformation and expansion role helping to really make room for more students to become midwives in the UK which is what we need in the UK and around the world and we're hearing lots about that with all of the amazing social media from the ICM all about investing in midwives and in each other and the need to follow the data in the massive impact that universal care for midwives can bring. So this presentation is brought to you from all of us and also the research team that's involved in supporting student midwife continuity of carer at UCLan and beyond. So in this presentation I'm going to be sharing some of the context for the work that we're undertaking and then give you some insights from my colleague Carol has done a little video and so she's going to tell you a little bit about how we created our curricula and hopefully that will give some insights for those of us on the call that are involved in developing curriculum and are interested in particular in embedding continuity of care experiences for students and then I'll talk to you a little bit about the research evaluation and the ways that we're hoping to transform things within our organisation but across our whole system across the region and then nationally as well in the UK. So why midwifery continuity of carer for student future midwives? So we've been working really closely with Nisha Wigley in our locality so we're based at UCLan in Preston in the United Kingdom and this is in the northwest region in Lancashire and South Cumbria so our students are placed in one of four maternity sites in that area and we're really interested in learning how we can support students and we asked ourselves this question why is midwifery continuity of care is so important for future midwives education? Well the reason for us is that it's actually about centering the woman the person and the family at the heart of the education that we offer to student midwives and wrapping our curriculum around that family unit however that family may look is the goal of any curricula any midwifery curricula and rather than focusing and centering on the institution on the education institution or the placement areas we feel it's really crucial that any education that we develop actually has that family and that woman that person that we care for as midwives right at the heart and putting them at the heart of everything what did they need from future midwives what do they need from our education curriculum and approaches helps to direct a really holistic approach to curriculum design and development but in the UK there are also a range of key drivers and obviously a lot of this is underpinned by key and up-to-date information and evidence so we've got the amazing Lancet midwifery series that was pulled together by an incredible team of researchers led by Professor Mary Renfrew and you can read all of those open access papers from 2014 and they're setting an amazing tone for how we should develop quality maternal and newborn care and the quality framework for maternal and newborn care is an amazing tool for any educator to think about how they can develop the curriculum to meet the needs of families based on global evidence and information we've also got local and national evidence on how midwifery continuity of carer relational continuity of care improves outcomes for women birthing people and families but also improves well-being for staff and staff satisfaction which is really important and you know midwives and like other health professionals you know want to see good job satisfaction feel good about our work and get a lot of meaning and generate meaning in our work and a lot of that meaning for midwives comes from relational care we've then got the better births transformation agenda that was a review of maternity services in the UK and across England actually and because our university is set in England that's how this framework helps to govern our approach to strengthening maternity services so this set out ways to improve care for families and by reviewing all of the maternity services listening to what families wanted and then setting out an agenda we're coming towards the end of that better births agenda but it's been most of the principles set out in that transformation agenda have been picked up by the NHS long-term plan and a big component of both the better births and the NHS plan agendas links to maternity and midwifery continuity of carer and then we've more recently had the NMC standards that set out the requirements to become a midwife for the learner and those standards of proficiency for midwives and also sets out the standards for supervision and assessment in practice and also the standards for educational institutions and practice learning partners so that's really guiding us to think about that so the NMC is the Nursing and Midwifery Council in the UK that regulates midwifery as a profession and ensures good educational standards for educational programmes in the UK and we also have national maternity workforce strategies that really also set out intentions around how many students should be trained in order to meet the needs of the service and to provide optimal care to women and families so they set out targets for workforce but we know that everybody around the world has been have been facing huge challenges in supporting effective student learning because of COVID-19 that's had a massive impact on staffing and service demands we also know that when we want to change practice and change approaches to education it can be really difficult because all change requires huge transition and it requires people to do things differently and you know that can be really difficult especially in the context of COVID and we know that like many areas of healthcare there can be challenges with recruitment retention and staffing that can really have a knock-on effect on learning for students as well so whilst we've got amazing policy directives and evidence to support what we should do we have to remember that we also have some challenging contexts and consequences because of the global pandemic so these we know that by using some of this evidence we can really make a difference and as a university and many universities now because we're validating against the nursing and midwifery council standards these have been actually set alongside the framework for quality maternal newborn health so this is the Lancet series framework that was developed from mapping and charting all the evidence that's out there about what women people and families want from the care and what components of care matter for improved outcomes and we know from the midwifery Lancet series that midwifery care improves over 56 outcomes for mothers and babies and actually the features of effective care are included in this diagram so if you haven't already had a look at the Lancet midwifery series I would really recommend that you read it because it's still relevant today in 2021 we should really be using this to set out some of the practice categories how we organise our care as midwives what values should underpin our practice and the importance of philosophy midwifery philosophy and how we should be functioning as care providers how we should balance our knowledge and skills and respecting cultural safety and cultural influences on people's lives and experiences so the nursing and midwifery council standards of proficiency in the UK have been launched in early 2019 and part of these standards have been to provide safe and effective midwifery care promoting and providing continuity of care and carer so you can see there there are six domains within the standards but domain two clearly sets out that student midwives have to demonstrate at the point of qualification that they are proficient at providing and promoting and supporting continuity of care and carer and actually as a university we when we reviewed these brilliant and important standards we realised that if you support students to offer continuity of care and carer they will actually develop all of the other domains so they will also develop the skills to be an accountable autonomous professional midwife they will learn how to provide universal care for all women and newborn infants they'll learn about the importance of additional care for those women and newborn infants with complications and they'll learn how to be an excellent colleague scholar and leader and of course develop themselves as a skilled practitioner so this is why we wanted to really focus in our curriculum on centering continuity of care experiences because we feel that by doing that it centres women people and families it will offer a transforming learning experience and environment for students which will enable good quality learning opportunities whilst also helping to increase the capacity and allowing more learners to have opportunities to become midwives by following women and families and it will help to prepare the future workforce to meet those drivers that I talked about meeting the better births agenda in the NHS long-term plan so we really felt confident that this was a really important and good approach to take when we were looking at our curriculum development. So I'm now going to share a video with you from our principal lecturer Carol Machade who will talk you through our steps to creating our curriculum which as you'll hear from Carol really centres the importance of following women and families through and providing continuity of care along with other things so I know Jane you're going to share a little video now thank you. Hello everyone my name is Carol Machade and I'm a principal lecturer and lead midwifery education at the University of Central Lancashire. I want to share with you today the midwifery team journey for our new curriculum through to the successful approval event. The curriculum planning process for the preparation of the three course proposed which are BSE midwifery a BSE and MSc shortened program occurred over approximately 18 months although it feels significantly longer due to the impact that COVID-19 had on our original plans which I know many of us have been affected by. The initial stages of development involved education and service staff working collaboratively to design an experience for the students that is grounded in practice and underpinned by evidence. Current students, practice placement representatives and service users were involved in the planning process to ensure a truly collaborative approach was taken throughout this time. The courses developed were driven by the NMC standards of pre-registration midwifery programs including part one standards framework for nursing and midwifery education, part two standards for student supervision and assessment and part three standards of proficiency for midwives. During the initial stages of development for this program academic staff, stakeholder groups which included clinical staff, service users and students were consulted to canvas their views on the current program and the future development mapped to the new NMC standards. This facilitated collaboration in developing the program structure, themes, modules and teaching, learning and assessment strategies. To fully embrace the new standards a number of key themes were identified which are either needed adding or enhancing in our current curriculum and the key changes that we are specific to this program are the introduction of the newborn infant physical examination, continuity of care and carer, flexible assessment strategy with optional choices, BFI, interprofessional learning integrated into cases and relevant to midwifery practice and involvement of service users in program planning, case design and delivery. The midwifery curriculum planning team collectively agreed to continue but further developed the already established midwifery and educational philosophies of salute genesis and case-based learning as this was well reflected in the feedback from the focus groups. The team felt the curriculum themes should reflect the six domains of the NMC standards of proficiency for midwives and wrap around the midwifery and educational philosophies. The program, modular structure, module titles, length and credit value were agreed collectively with task and finish groups being convened to determine module aims, content, learning outcomes, teaching, learning and assessment strategies. The philosophy of our midwifery education programs is underpinned by a salutogenic orientation to healthcare which stems from Antonovsky's theory. This represents an approach that has moved away from the traditional pathological paradigm of dichotomizing normal abnormal and low risk high risk to perceived health on a continuum. The curriculum is designed to ensure that learning skills development and care delivery are focused on the promotion of health and well-being irrespective of the classification of risk assigned to the woman baby or family and that both education and practice are sensitive to the socio-cultural context of all individuals concerned. Salute Genesis informed the selection of case-based learning methodology, enabling a woman, baby and family-centered curriculum that also meets students' individual learning needs. CBL as a student-centered approach to learning invites students to work in small teams to review case scenarios from midwifery practice. The cases ensure students consider the holistic needs of women and families whilst building their midwifery knowledge and skills aligned with the quality framework for maternal and newborn health and NMC standards. Individual cases are supported by core learning activities including simulation and through appropriate work-based learning. The midwifery curriculum planning team agreed that learning is a situated contextualized activity that is integral to and inseparable from social practice. As midwifery is a social practice, students of midwifery work alongside experienced practitioners in placements in order to develop their learning and skills as they engage with others in routine, tacit and explicit collaboration. Students are exposed to new and challenging situations guided by qualified supervisors and assessors in the practice settings to become fully participating members of the midwifery profession at the point of qualification. This transformative approach to learning and teaching is also employed in the university setting as it is deemed to be effective at capturing the meaning-making process of adult learners. A spiral curriculum enables topics to be introduced generally and revisited more specifically at increasing levels of complexity as the program progresses. Longer modules facilitate integration of curriculum themes and allow the program team through collaborative timetabling to create links across subjects and thereby enhance the student learning experience. Feedback is seen as an important component of learning and teaching. This is given formally and informally to individual students and groups to enhance their learning experience. As students need to experience a variety of settings and models of maternity care, the program has reflected this in the planners with continuity models being used throughout the course alongside in-hospital provision and specialist services including neonatal and multidisciplinary provision. A focus on the continuity in the final period will help to prepare students for registration and becoming the future midwife. During the planning, the team were keen to fully embrace the continuity theme embedded within the new midwifery standards and the concept of the gestational curriculum emerged. By mapping the gestational pathway of a woman through her maternity experience, the team mapped a corresponding curriculum with the aim to have students on placement at critical points during the woman's experience. From the sample planner, you can see the students are in placement between 19 to 17 weeks, 27 to 36 weeks and 39 to 3 weeks postnatal. The hope is that students can fully engage in continuity of care in this new curriculum unlike our current model of case holding which can be limited with requirements for theoretical attendance. Within the theory elements of the program, recognition has been given to the varied learning styles of adult learners and aligned with the university's learning and teaching strategy. A range of assessment methods is used throughout the program to facilitate students' development and progression. The curriculum has been developed to be inclusive, applied, flexible and sustainable with the introduction of flexible assessment strategies and varied modes of achieving the theoretical elements within the modules. The accessible learning and assessment enable people irrespective of their backgrounds to fulfill their potential and meet their life and career goals. In January, following an approval event in November, we had confirmation that our programs have been fully approved. But this is not the end, just the beginning. Now we need to work to implement these innovative programs. Thank you for listening. It's lovely to have Carol being able to join and share with us and have an opportunity to share the really important work that she and the team have done to really centre families at the heart of our curriculum and we hope it does give opportunities to inspire other people that will be working really hard towards developing their education curriculum and certainly that anyone working around the world is welcome to get in touch with us to talk about the practical side of things and the work that we did and how we came to build this approach. Basically, I just wanted to share now some insights from the research that we're doing which we hope will help us to learn ways that we need to approach the support that students need, but also practice learning midwives and colleagues that are supporting learning in practice, what their needs are, but also of course most importantly women, families and the people that we care for. So I actually just wanted to introduce my other colleague, Christina Felton, who's a midwifery educator at the University of Cumbria. This piece of work is being done in collaboration with the two midwifery training schools in Lancashire and South Cumbria. There's two universities that offer midwifery training and education, so we're working together to do this and what I believe that collaboration is the best way to approach transformation in midwifery education. So I want to talk now about our projects supporting and sustaining midwifery continuity of care for future midwives. So we have gone from or we're in the process of transitioning from a placement-orientated learning. When students go out into practice alongside the theoretical components of their degree program, we often and historically place them in very specific placement settings. So for example they've been placed in a community setting or in a hospital setting and within the hospital that's been placements such as antenatal ward, birthing centre's delivery suites or postnatal wards and others such as neonatal units, gynecology wards and departments, early pregnancy assessment units and wider services within the health system. But this has been very much driven by the placement and the students have become part of the service and followed the service and what we're aiming to do with our new curriculum is to encourage the students to follow women and families. So no longer will they be going to specific placements, they will be meeting specific families and following the journey that family will take through all of those placement areas. So they will still go and do community visits and community care and antenatal ward based care as appropriate and intranatal care in birthing centres, homes or delivery suites or obstetric units and obviously we'll offer care on postnatal wards but this will all be wrapped around the families that they're caring for and this is the big transition that we are making and requires a lot of practical thinking through of how we offer this support and so we are leading a research program to help. We are basing this on the amazing work that has come out from around the world, especially in Australia. There's fantastic insights and research being done from especially around the Gold Coast and the university there. So it's Griffith University has put lots and lots of information out and research out about the benefits. Not only the benefits for women and families have been provided care in this way from students but also students experiences in their learning journey. So we know that it actually improves outcomes for learners, it improves outcomes for women and families. I just wondered if people could remember just to keep their microphones muted because I think I can hear somebody's got their microphone on. Thank you but we'll look forward to having some questions later. So what we're interested in doing is learning from the research evidence about continuity of care but also applying our own experiences locally. So this is our locality here, you can see we're close to Blackpool and the coast in the northwest of England just underneath Scotland so we're quite high up in the UK and England and we've got four maternity sites that are in our local system, our local area so four hospitals that students and maternity services that students will engage with and we're interested in offering students an opportunity to work in small teams together with midwives and community teams and get involved in a coaching and peer learning opportunities so that we will be building on collaborative learning and practice principles which is a movement from one-to-one mentorship models where a student works with one mentor building on the new NMC standards for supervision and assessment in practice. We're moving to a coaching model where a group of peers will work alongside one midwife coach to learn together and that's really important for developing that scholarship, that collaborative working and sharing learning together because we want to keep a really positive culture in practice. So the project that we're running is a great amazing research team have come together to share expertise and experience so I'm leading this project but working alongside Professor Jill Thompson, Professor Sue Down who are giving me their support as a junior researcher. We've also gotten a fantastic team of research fellows and associates so Dr Kenny Finlasen, Dr Clive Palmer, Dr Claire Feely, Christine Fulton and John T Kenwood and these this team are made up of practitioners with skills and confidence in practice learning and approaches to practice learning educators so that we can make sure that we attend to the education needs and curriculum development needs and then others that are involved in coaching, collaborative learning and also midwifery research so that we can bring all that expertise together and then alongside the research as we also have an amazing range of students who are going to be piloting midwifery continuity of carer over the next six months to help us learn together to build together an amazing toolkit of resources for staff and students and to ensure that our curriculum plans over the next year and beyond are going to offer safe learning opportunities but also meet the needs of both students, the service and obviously families in the care. So we're interested in developing guidance, looking at what practice equipment is needed, we're interested in evaluating student experiences and learning what the supervisors and assessors need in practice. After the first six months we'll have this really lovely framework that will help us to understand what we do need to do going forward when we increase the student numbers to more than just the pilot group and over the next 12 months from really from October for a full year an academic year for us in the UK runs from September to September we're going to track then a full cohort of students and continue with this evaluation project just to be sure that we understand the kind of needs of students but also the service and the provision required. So we're really looking forward to being able to share that and perhaps next year we can come back and share where we're up to with our learning and then in addition to that we've reached out to the national continuity of care routine working with NHS England and Professor Trixie McCree leads that programme and we've been invited to be part of the national subgroup looking at developing a toolkit for educators, students and beyond because I just think rather than us doing this in one area of the UK it'd be great if we could have a national approach that obviously then can be shared globally so that we can understand if you're developing a curriculum what things do you need to consider for your course plans and modules but also if you're supporting students in practice what do you need to consider to enable this whether you've got continuity teams existing or not and then what students need to prepare to work in this way as a student but then beyond obviously as you transition to qualification and our Royal College of Midwives in the UK has put together a really helpful series to support us and it's about supporting that ongoing development so I know Mary Scott Davis and Leah Briganti are doing amazing work with the RCM to support this approach for students so that brings me to sort of the end of the presentation it'd be nice now just to play a little summary video to kind of pull together these key messages that you could take forward into your practice I think that'll be shared now thanks everybody and I think we've still got a little bit of time for any questions I know people have been commenting throughout or I can say Jenny oh hi Jenny I think the main question I'm seeing is Celine and a few people were asking about could you talk about the work life work balance for young midwives and then we need to finish up in about five minutes thank you okay yeah so these are the things that we'd like to learn through the project is understanding that because we what we found from the research that we've done before this piece of research was with continuity of care and midwives themselves and teams of midwives that are already established and we've learned that actually from that locally to us that it really strengthens work life balance working in these models that are very flexible and adaptable so we want to make sure that we put in really supportive programs of support for students that will include preparation support along the way and we're learning with students how to navigate those things and I suppose it's going to be different for every type of student and learner what their home life experiences are what issues are cropping up so it's about having a flexible and adaptable approach to this that allows for those you know shifts and changes that we see to people's lives as they move forwards so hopefully that answers the questions in part I think once we've completed this evaluation work we'll have definitely better insights into what particular issues arise for students and then how we can overcome and navigate those. The journey is asking how do you see issues of students meeting NMC requirements when they're all having different experiences in different areas? Yeah that's a really good question again it's part of what we want to try and find out and learn together but we know that students will be working in small teams so continuity teams where they're able to learn from each other's case loads as well and attend with each other to appointments to offer learning opportunities in that collaborative approach which is similar to how the midwifery continuity of carer teams work now so having some group opportunities and we also alongside the centre of their learning will be continuity of carer but then we've also mapped the capacity in the core areas of the service so students will also be able to book themselves on around their case load to those other opportunities and learning so we'll be creating a whole learning opportunity list and students can book themselves on to those wider learning opportunities so that's how we're hoping to address it but I think the sort of balance will be something that we review as we continuously work through just like we have to do now you know students some students can end up with imbalances where they've only end up seeing caesarians because that happens to be what happens on their shifts other multiple shifts and we need to relook at that with them so I think it's just doing what we always have done in that regard. I hope that's answered people's questions but if you'd like to find out more then you can email us my email address is there at UCLan or really happy to come and chat to people and offer any support and also Caitlin Wilson is is leading the national group so if there's UK midwives that want to be involved or contribute to that it'd be amazing. Well I think that was such a fantastic comprehensive presentation so inspiring for educators midwives student midwives I think I heard you call yourself a junior researcher so it's like you're just like respect Anna thank you so much and again would you mind typing I can see your email there but if anyone would like to contact you we will be posting the recording as well and so good thank you for all the resources in the chat it's so good we're able to shade all these resources as well