An evaluation of the effectiveness of an updated pre-service midwifery curriculum integrated with emergency obstetrics and newborn care in Kenya: a cluster randomised controlled trial

Abstract

Introduction Quality midwifery education is central to improving midwifery service delivery and maternal and newborn health outcomes. In many settings, midwifery educators insufficiently prepared for their teaching role and deficient curriculum compared to international standards affect the quality of midwifery graduates. This study assessed the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in Kenya. Methods A cluster randomised controlled trial (ISRCTN 14203188) in 20 midwifery colleges (12 intervention and 8 control colleges). Educators in both arms received training in teaching/EmONC skills to deliver the updated national midwifery curriculum, with those in the intervention arm receiving additional mentoring every three months after training for 12 months. Educators’ knowledge and confidence in EmONC/teaching skills was assessed before and after training and at 3, 6, 9 and 12 months. Teaching skills observations at baseline and endline in both study arms were also assessed using a checklist. Knowledge, confidence and three selected EmONC practical skills among final year midwifery students were assessed. Linear mixed effects models were used to evaluate the effect of intervention on educators and students. Results The intervention arm had 45 educators and 91 students while the control arm had 29 educators and 55 students in the study. Immediately after training educators’ knowledge improved (61.3–73.3%, p < 0.001) and confidence to teach EmONC (3.1 to 4.2 out of 5, p < 0.001) improved. No evidence of a difference in either knowledge or confidence was detected for period or study arm (p > 0.05). The observed teaching skill scores of educators in the intervention arm were significantly higher compared with those of controls at endline (mean difference, 16.5; 95%CI, 3.2–29.8, p = 0.02). Scores for students in the intervention arm were significantly higher than those in controls for knowledge (mean difference, 8.3 [1.6–15.0]) and the three skills assessed (mean difference (95%CI): 22.4 (10.8–33.9) for shoulder dystocia, 17.9 (2.0-33.9) for newborn resuscitation and 17.0 (8.0–26.0) for maternal resuscitation. Shortage of faculty and inadequate support in clinical placement were major challenges for quality midwifery education. Conclusion Knowledge and confidence of educators in teaching EmONC was improved immediately after training. Mentoring was effective in improving the quality of educators’ EmONC teaching skills. Students in intervention arm had higher performance in EmONC knowledge and skills. Institutional investments are needed for quality delivery of an EmONC-enhanced curriculum.