Acquisition of competence: An analysis of clinical teaching and learning of midwifery at Kamuzu College of Nursing

Introduction: Malawi has one of the highest maternal and neonatal mortality rates globally. In response a competence-based education (CBE) approach in midwifery education was introduced at Kamuzu College of Nursing (KCN). KCN adopted the International Confederation of Midwives’ seven essential competencies for basic midwifery practice to produce professional midwives. However, there are reports that the performance of the graduates is below standard. Purpose: To explore the clinical teaching and learning practices utilized by midwifery lecturers and students at KCN in preparation of students for effective midwifery practice. Design: A sequential qualitative study was conducted at KCN in Malawi. Data were collected from multiple sources for triangulation. Purposive sampling was used to select a sample of six senior midwives and six educators in first phase. In the second phase, 26 student midwives, and five graduates from KCN, and for comparison, four graduate midwives from another local institution, Mzuzu University (Mzuni). Face to face semi structured interviews were conducted in the first phase. In the second phase focus group discussions were conducted to collect data from the students and graduates from KCN, and face to face interviews were used for Mzuni graduates to obtain participants’ accounts of the phenomenon. Timetables, the curriculum and students’ clinical assessment forms were checked to verify data from respondents. Using NVivo software, a thematic analysis approach was used for data analysis. Findings: Findings reveal that learning is compromised. Although the curriculum document indicates that the program is competence based, teaching and learning methods, and assessment of students’ clinical learning are inconsistent with CBE, including learning theories such as cognitive load, situated learning, psychomotor skill learning and experiential learning theory. There is paucity of resources, poor infrastructure, and poor personal relationships. Conclusion: The study portrays a negative impact of introducing change using top management as a change agent.