 So, um, title of the presentation that I'll be listening to at this session is called is, is, um, students stand at the door exploring views on professionalism in midwifery, um, spaces. We have two presenters, Moira, Louis and Tom McEwen. I'm going to introduce, um, the two of them to us very quickly. Dr. Moira, Louis is a physician who has worked in universities in Australia, in Sweden, and the UK within joint roles. She started her training as a clinic in clinical medicine as a consultant endocrinologist. Moira is a fellow of the Royal Australasian College of Physicians, as well as the Royal College of Physicians in the UK. In 2009, Moira joined the University of the West of Scotland as a senior lecturer supporting innovation in learning and teaching. She was awarded a personal professorship in 2010. Please join me to welcome Moira. Our second presenter is Tom McEwen. Tom is a midwife and has been practicing as a team midwife, delivering case load based care. He is a senior charge midwife within a neonatal unit and an advanced neonatal nurse practitioner. Tom is currently the head of program for the women's children, young people and family team within NHS education for Scotland, and he has been a midwife since 1999. Tom is an honorary advanced neonatal nurse practitioner within NHS Greater Glasgow and Clyde. He is undertaking clinical teaching around newborn examination. He is a board member for the Scottish court debt trust and he has published in numerous peer-reviewed journals and written textbooks, midwifery textbooks as well, including physiology in child bearing, which he wrote with his mentor and friend, Professor Jean Rankin. Tom, you're welcome. So, I will now hand over to Tom and Moira for their presentation. Thank you very much, editorial and a very happy International Day of the Midwife. To everyone who is joining us, Moira and I are delighted to have the opportunity to share our research with you. So, really, maternity care occupies many different spaces in the public consciousness. For many, it is an essential and valued component of our UK National Health Service, but equally and more recently, it has been a subject of much criticism in the media with suggestions of a broken public service. And this has been encapsulated within several formal inquiries, notably Kirkup in 2015 and more recently, Don Ockenden's report in 2022. And this has undoubtedly impacted on the perception of professionalism, particularly in the UK maternity care context. And the notion of the grift of care and morality at all costs are being mentioned in various forum and questioning our professionalism as a community. And that professionalism is a key characteristic that we expect our students to develop throughout their program. And part of our role as educators and clinicians is to support that transition. And considering this component of their journey to become a midwife, it provided really the impetus for this research project. And we're going to present some of the components of that from the published article. So, a performance turn has emerged in qualitative inquiry. In particular, poetry has been used to explore feelings and to open inclusive spaces for health promotion, for example. And it's used as a therapeutic tool in some settings. We use poetry to help connect in the present moment and also to connect to past feelings that are evoked in that process. The changes that are taking place in midwifery today, it's our emotional having performance questioned. Those reports from government inquiries are upsetting. Public perception of midwifery as a professional group, perhaps devalued sometimes. All of this elicits emotional responses that impact on the experience of our students. For this research, in a conversation with midwifery students, we captured and performed their words as poetry. This was an immediate performance in the moment. And therefore we believe it's a novel approach. So what did we do? Well, we wanted to have a professional conversation with the selection of students and we were fortunate enough to have participation from two bachelors of science midwifery students and two masters of science midwifery students, all of which were in the final year of the program at the University of the West of Scotland. And that was important because we wanted to understand the experiences of those about to transition to become a registered midwife and make that transition in the very near future. And when we considered how best to have that conversation, we developed a range of questions, a series of questions that I asked this group and these revolved around defining professionalism had their view of professionalism changed during their time as a student. Do we need to better define professionalism? Is it adequately explored within our curriculum? And how does that transfer into practice? But the reality is that these questions, my contribution in posing these questions was very quickly overtaken by the huge amount of responses from those in that conversation was led very much by the students. And the anticipation of that conversation and to try and help, we brought a series of images that we laid out for the students to help them to consider how they might respond to these questions. But what we found is that very few of these images were selected, the conversation just developed and evolved so naturally and the students shared their experiences and these are just a couple of the images that were selected. We did audio record the conversation but in addition my role was to sit to the side of the group and transcribe in real time some of the words that were spoken. So after a conversation for about 45 minutes, I then performed those words that I had captured to everyone and I joined the circle for further discussion. The entire conversation was recorded, transcribed as short phrases with line breaks where there were natural speech pauses so it appeared as poetry on the page. Then both researchers, both Tom and I, independently read and reread the transcript, identified concepts, discussed the concepts and then connected the concepts together through a concept mapping exercise. That helped us to refine and identify the dominant themes and these have been published in the February issue of British Journal of Midwifery. So in that paper we used some of the poetry to illustrate the themes that we're going to present now. So we identified five dominant themes within that research and we're going to deal with each of these in turn and what we're going to do is for each of these we're going to show the words that were found within that conversation and also perform some of them there and give you enough time to read the slides and read that found poetry within there. And those themes surrounded midwifery spaces. They sounded the notion of bad professionalism so being able to recognize what bad look like. The notion of control which is such a fundamental component of our roles as midwives and trying to ensure that that woman has control. About we should make it more personal about how at times they felt they had to remove the personal part of themselves in order to survive and function and having to walk into that door to perform as a midwife. So some of the spaces we identified are shown here. So the space within an organization in that clinical context, the educational space within the university, a true midwifery space considering that role and also a space for reflection. In the organization you have to step into a different pair of shoes. You have to have your different hat on. In university you're told you're important. In practice you're not. Senior midwives sit. Junior midwives stand. Students stand at the door. In the midwifery space we just sit there as students and they just blank us. We don't really exist in their little chat but there are reflective spaces and this midwife says don't do that come with me. Sit on a chair and we sit and we have a full discussion about exactly what's happening. Now the notion of these spaces where as described by the student spaces that they inhabit spaces and move between during their journey to becoming a midwife. They very clearly articulated that move between the university space, that space of learning, that theory building, developing an understanding and that application into practice but they also spoke very clearly about feeling like always a midwife and considering that in all of their interactions in their social lives and social media and saw these spaces as ever interconnected. And in stepping into the space of an organization students often felt bringing those personal attributes but needed to leave some of that personal outside that room in order to survive, in order to function as a midwife. However they also made clear that stepping into the private sphere again those professional standards of conduct accompanied them as they moved in there. Words of power and affect people, they can be flippant, they can swear, everybody has their moments but it is unprofessional. Also unprofessional, ticking those boxes all sorted, ticking those boxes and afterwards get her up to the ward quick as possible and get the bed back. That feeling over your shoulder keeping you in check, you shouldn't have done this, you should have done that. Scared the sister's going to shut the door and tell them they've done something wrong. And that notion of being watched, being closely watched and monitored linked to that next theme of control. Sisters keep everybody safe, that's their role. Every single woman, midwives as well, but the safest thing to do can also be holding power over and some people don't feel in control unless they are controlling. You can't handle a situation like when you see something wrong. Instead of instantly reacting, take the emotion out of it, take a breath, find a way to stay calm, take the emotion out. And that final thought linked to what the students articulated having to remove the personal, which linked really well to our next theme. I thought professionalism was being strong, someone in power, but it's caring for women, doing something good for your woman. I'm allowed to be here, I'm allowed to protect this woman, allowed to have the birth that she wants. We should make it more pure personal, we are all human. As students, the further you're walking in the door, you don't have the dread, the fear, you're going to be confident, competent. When you step into being a midwife, you're going to be a mentor, an educator, you're going to be nurturing people. Can professionalism be taught? Yes, there's a professional language, professional behaviors. Can professionalism be taught? No, you can't teach compassion. It's a really powerful language that we captured in that conversation. And in terms of what we learned, we really find that despite its complexity, our educational problems often frame, and our students see professionalism as simply a list of attributes and behaviors. And as the students spoke about their experiences, they often referenced this code that would make them a professional. However, they also saw themselves as always a midwife, and that notion of moving between different spaces, most notably between university and practice, but that also mixed them with their social lives, and they're developing an understanding of professionalism from how they interact in that ever-growing social media world. But there are also tensions between these spaces, and there was a sense that familiar experiences and seeing different role models, examples of bad professionalism, that fast midwife who was focused on the tasks and not looking at women, and also a sense that midwives feel constrained and fearful by external forces, that external scrutiny when our profession is called into question, that need to practice defensively in some way limit their ability to support the needs of women in childbirth. We learned that poetry is a wonderful tool. This in-the-moment poetry helped us to uncover emotions, capture emotions. It helped us to elucidate and communicate the views of participants. We've also found poetry helpful in our discussions amongst ourselves as researchers. These students also told us that the words that I performed to them created a shared voice. They couldn't differentiate their own voice. We believe that the use of poetry in this context allows emotions to be more authentically conveyed, therefore adding to the power of the message. And we also believe that this approach will be of interest and value to those that are developing pre-registration curriculum, developing that educational framework for midwives and practising that wider community, particularly understanding this notion of spaces and ensuring that we're incorporating that into our conceptualisation and design of these programmes. And this does build on other calls for research in this area, for example from Kathleen and Rossita and more work that's required. And I think probably what's helpful is probably for us to share our reflections of using this approach. And I think for me, it did take me out of my comfort zone. It was a very new way of thinking about the world and thinking about research. But there was something about it that just resonated with the artistry and the science of midwifery and the theme of our conference today, our celebration today. And the sense that I got that we often overlook the artistry within midwifery and focus more on the science. And sometimes we feel we're being forced to focus on the science and forced to forget that actually it's relationship-based care that we are providing and looking to provide and support and nurture. And the other thing I would stop by was the power of how powerful the words were when they were put together. The findings of this research, the spoken voice of our participants conveying it within poetry and performing it back how powerful that was. And as Moira said, that single voice the students felt it presented that it was impossible for them to disentangle exactly what they said but they knew their voice was there and it was shared with the voices of the others. Moira, you're first. So I'm not a midwife and I think that not only in midwifery but across healthcare that connection between artistry and science is not always strong. I really think what I experienced here was tapping into the emotional how the students were feeling. And it was certainly an emotional experience for me when I reflected those words in the moment particularly I can sort of feel the hairs on my arms. And I have the honour of being here and sharing those voices and I feel emotional about doing that. So I mentioned that Tom and I are using this in the context of our research and we're using it in developing other research. So we've created a small group, we meet regularly, we record our discussions, and I have been performing excerpts of those research conversations back to the group at the start of the next meeting which facilitates our ongoing research development. And it's different to this to some extent but it has also been a very powerful experience and I'm very grateful for that Tom. And I think for me as well it's given me the opportunity to experience how the students felt being part of a conversation and having my words, although some of my words were captured in the poetry as I facilitated discussion, actually the dominant voice was the students. So being able to hear and participate in conversations not just about midwifery but other subjects and topics has given me a real sense of how effective this can be used as a tool to convey findings from research in a really powerful way, a power that isn't there just when you read the words, although I think and would be interested to hear your thoughts in reading the poetry, did it cause an emotional response in you as well as well as hearing it recited back. And I think in terms of our key recommendations from this study, really at the top that was this notion of spaces and it wasn't just physical spaces, it was conceptual spaces. It was a movement between thinking about midwifery, thinking about the practice, thinking about the world that they're practicing in, thinking about the world they're about to enter as a midwife. So there was lots of movement in the air and we feel that this is something it's missed within policy and in curriculum design, we're lacking that understanding of the experience of those that will be part of that educational journey or part of that process. So co-creating it to make sure it's indicated. And the other thing was that the students particularly really clearly the women was at the centre of those spaces, those spaces evolved around that notion of the women at the centre. And there also does need to be consideration of that wider cultural health care and how that influences and impacts on educational spaces and how that impacts those future role models because what students are seeing in practice, they are emulating those behaviours because if they don't understand that that might not be the type of professionalism that we want to see, it's hard for them to see that. By having a space they can think about that and conceptualise that's really important. And capturing these experiences of these students just at that threshold, at that precipice of going into register practice, we strongly believe will be helpful as we design educational programmes to ensure that students do understand professionalism from the earliest point. And we'd like to encourage the use of poetry. It certainly enabled someone who's not a midwife, me to contribute and help allow that student voice to be heard. It certainly facilitates research conversations or we've used it in that context and is a powerful medium for thematic analysis, a dissemination of findings, I hope, today. We recommend further research that explores the impact of poetry on those engaging, you know, the participants in the room, an external audience, for example. Can we use poetry in education in relation to developing professionalism and contribute to an understanding of how and why poetry taps into the emotional? So what do you think? So we'd be really interested in having some time to hopefully have a bit of discussion and if anybody's getting questions or comments, I know the auditor is there as well, but we'd be really interested in hearing, particularly if you've got any experiences of using either poetry or creative performance type methodology in research within healthcare, or whether you feel it has get value or to the contrary, if you feel it doesn't have value, but we'd be really interested to hear your thoughts, but thank you for listening. Thank you. Thank you so much, Moira and Tom for that brilliant presentation. Thank you, that was really engaging and very thought provoking as well. I think we all know that midwifery as a profession is both an art and a science, and just like what you talked about, you know, the connection between the art and science is not always strong. So thank you for using an art-based approach, you know, for your research. There were some comments as you were presenting, and some of them were just to thank you, you know, for using poetry as an approach, for your study. There was this comment about power over versus power from within, and I know you talked about it yourself in terms of okay, control doesn't have to be controlling, and we know that some people don't feel that they are in control unless they are controlling, so what are your thoughts around that comment? Yeah, that's a great comment because power is something that can be easily abused and power that can be used inappropriately, and I think what we try, and I'm speaking from the perspective of being a midwifery educator, we try to instill in our students the sense that we are there as a companion on a birth journey, we are there to support that woman in that experience, and we are not there to control that experience, or control decisions, or control the environment, or control we are there as a support, as a facilitator, as a companion, and I think that's not always what students will see in practice, and there's a disconnect there that causes attention, and students find that quite difficult and come back and tell stories, and yes, there might be situations where the midwife has to take a measure of control in an emergency, for example, and give direction, but ultimately we need to always remember that the power lies with the woman, it doesn't lie with us. And do you think students feel controlled by the more senior midwives in a way that's dominating and not necessarily helped? I think that's another key strand of it, is that they feel that their future is in the hands of someone else, that someone holds power over them, so in order to survive, it's comply with that and be subservient to that, which is an abuse of power in itself, and we are trying to support students to develop into autonomous accountable professionals in the future, and if they feel the only way that works, and they see it work, is that someone is controlling that, not just to control the midwife, but also exerting control over the woman, and that's obviously not what midwifery is about, it's about with women, it's not to be used in other ways. Thank you, thank you so much. There are some comments also, Buki is saying this is so emotional, thanks so much for your presentation. Linda asked a question, how did the students feel about being haxed to write poetry? Well, we were in control, we didn't ask the students to write, we let the students speak, and I captured their words myself in real time, fortunately I typed quite quickly, and we can compare what I captured with what they actually said on the audio recording, so I think it takes some, I guess it's some skill and some insight into what's being said, it's quite difficult to do in some ways, I think I felt quite brave doing it, and I guess that's also why I felt emotional, so you open yourself, you are vulnerable in that, so yes they didn't write, but they spoke, and I think when you listen to voices of people talking, for me it comes as poetry, so does that answer your question, Linda, I hope it does. Yeah, thank you. Joe has shared an insight into using a creative approach as well for Bachelor of Edwifery program students in their first year and third year, so I think a lot of researchers are beginning to look at this innovative approach, much more in various parts of the world, she described how they had creative freedom and they can use dance or models or books or artwork to show their insight into their midwifery journey, so thank you so much Joe for sharing that, so we talked about the fact that she loved the way of using poetry to explore experiences of students, so thank you Selling for your comments. Nikki Grace has added an insight into the presentation as well, she said it's wonderful to hear the emotional aspects of midwifery acknowledged and student perspectives highlighted, some of the findings are sad, I have used poetry as a reflective tool at workshops and I'm currently researching for a PhD in creative writing, I think what your session Mora and Tom has done is to you know spark this interest you know with people with researchers and I hope that we can also take this discussion you know beyond this session and beyond the conference, so please feel free to reach out to Tom and Mora, I think their contact details at the beginning of the of the of the slide, I can see a lot of maybe discussions going on after the conference and a lot possibly some collaborations as well, so thank you so much for all your insight, I think maybe another comment that people may want to ask also is that when you are talking about you mentioned you know the number of students that you had and if people want to ask in terms of what do you think are the maybe the pros and the cons, if you have maybe bigger number of students maybe larger participants, would that still be feasible or what are your thoughts in terms of if you have more students? I've used this in a different context to capture the voices of it was more than 12, 12 to 15 doctoral students talking about their challenges in terms of tackling methodology, epistemology, this sort of thing and I just sat at the side and captured some of what was being said and I can't present this because I did it in the moment it was sort of spontaneous and I reflected back all their all their feelings and challenges that they were having and went around the room almost pointing to them and it made us it made was a really good contact and I must say the the lecturer who'd invited me and really didn't expect that was surprised delighted and it really encouraged me I think it depends on the moment I think what is important is not to expect too much but to open yourself to the possibility and it you know it may be that it doesn't work some of the time I've been fortunate but yeah and I think just on that as well from a midwifery perspective I think there is a that midwives have got a creative soul so I think this does lend itself really nicely to to exploring views of not just midwifery students but midwives themselves I think there is there is something in there that when we started the conversation the conversation just flowed and you know what was captured and turned into poetry when you watch the students responses to hearing their words spoken back to them in captured poetry and I think it adds a level of emotion that you don't get from just reading the poetry actually having someone recite that poetry with faster pace when it's dealing with that the notion of the fast midwife and that's the cattle type beats with it and then the spaces for pause and reflection so that you can think about it as you go it was just really incredibly powerful but I think it is that that whole idea of the art and science that we're referring is just so fundamental and that it is there and you know so whether it would work in the same way with nursing students with other I don't know but as Moira illustrated you know those doctoral students thinking about philosophy epistemology it does require engagement from the individuals you're speaking to but I think them having that experience of of their voicing captured in poetry is quite incredible thank you thank you so much that's very insightful there has been a request that you should please put your details in the chat box so if you don't mind I'm doing that I'm Tom and Moira that'll be very very useful thank you Selina said Lenny comes from making connections and poetry is a royal way to do that so thank you so much for that comment