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Dr Elaine Jefford

Teaching of clinical reasoning skills inconsistent, researchers say

The failure of university curriculums to teach clinical reasoning and decision-making skills may be limiting the safety and effectiveness of midwifery in Australia, research has found.

Researchers Dr Elaine Jefford and professor Kathleen Fahy at Southern Cross University set out to investigate how midwives make decisions and what factors affect their processes. The pair found there was a great deal of variation in the processes governing midwife case management.

The study involved 26 practising midwives from various services across Australia each providing two clinical narratives – one outlining something the midwife deemed an example of good clinical reasoning and the other an example of poor clinical reasoning. Jefford, who said the study was the first of its kind in the world, then assessed the narratives against a decision-making framework she devised.

The study concluded that midwifery regulatory authorities should revise professional decision-making frameworks to reflect analytical clinical reasoning explicitly. It also determined that bodies overseeing midwifery education should introduce clinical reasoning into midwifery curriculums for teaching and assessment.

“In Australian universities and around the world, there are no standards on how or where in the curriculum to teach clinical reasoning or decision-making skills to students of midwifery or how to refine these skills,” Jefford said. “These inconsistencies undermine the effectiveness and application of midwifery education in practice, as well as hindering a midwife’s professional autonomy and the discipline generally. Ultimately, the health and safety of women and babies are compromised.”

The Australian College of Midwives has endorsed the study and is understood to be investigating how its outcomes might complement the college’s National Midwifery Guidelines for Consultation and Referral.

Jefford said she was now collaborating with other researchers to develop an online learning package focusing on clinical reasoning and decision-making for students of midwifery. She said she hoped the package would provide a “structured, comprehensive and transparent theoretical and philosophical approach to decision-making processes and their application to midwifery”.

Listen below to hear more about the research from Jefford.

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