Granularity of focus has consequences for scaffolding reflective learning, with immediate reflection on concrete events and reflection on long-term progress requiring different approaches. Learners appeared to prefer immediate reflection-on-action.

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Background: Clinical workplaces are hectic and dynamic learning environments, which require students to take charge of their own learning. Competency development during clinical internships is a continuous process that is facilitated and guided by feedback. Limited feedback, lack of supervision and problematic assessment of clinical competencies make the development of learning instruments to support self-directed learning necessary. Aims: To explore students' perceptions about a newly introduced integrated feedback and assessment instrument to support selfdirected learning in clinical practice. Students collected feedback from clinical supervisors and wrote it on a competency-based format. This feedback was used for self-assessment, which had to be completed before the final assessment. Methods: Four focus group discussions were conducted with second and last year Midwifery students. Focus groups were audiotaped, transcribed verbatim and analysed in a thematic way using ATLAS.ti for qualitative data analysis. Results: The analysis of the transcripts suggested that integrating feedback and assessment supports participation and active involvement in learning by collecting, writing, asking, reading and rereading feedback. Under the condition of training and dedicated time, these learning activities stimulate reflection and facilitate the development of strategies for improvement. The integration supports self-assessment and formative assessment but the value for summative assessment is contested. The quality of feedback and empowerment by motivated supervisors are essential to maximise the learning effects. Conclusions: The integrated Midwifery Assessment and Feedback Instrument is a valuable tool for supporting formative learning and assessment in clinical practice, but its effect on students' self-directed learning depends on the feedback and support from supervisors.

Please cite this article as: Embo, M., Valcke, M., Continuing midwifery education beyond graduation: Student midwives' awareness of continuous professional development, Nurse Education in Practice (2015), doi: 10.1016/j.nepr.2015.08.013. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT1 Journal: Nurse Education in Practice TitleContinuing midwifery education beyond graduation: student midwives' awareness of continuous professional development. KEYWORDSContinuous Professional Development, activities, undergraduate, midwives, reflection, midwifery practice ABSTRACTMidwifery education plays an important role in educating graduates about engaging in continuous professional development (CPD) but there is a lack of empirical research analysing student midwives' awareness of CPD beyond graduation. We aimed to explore student midwives' awareness of the need to become lifelong learners and to map their knowledge of CPD activities available after graduation. Therefore, forty-seven reflective documents, written in the last week of student midwives' training programme, were analysed in a thematic way. Content analysis confirmed student midwives' awareness of the importance of CPD before graduation. They mentioned different reasons for future involvement in CPD and described both, formal and informal CPD-activities. Respondents were especially aware of the importance of knowledge, to a lesser degree of skills-training and still less of the potential value of the Internet for individual and collective learning.Respondents perceived a need for a mandatory preceptorship. Supporting learning guides were highly valued and the importance of reflection on CPD was well-established. This could have resulted from an integrated reflective learning strategy during education.

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