16 Jul The Impact of Maternity Training
The sustained impact of maternity training on knowledge, confidence, and empowerment
Baby Lifeline and Baby Lifeline Training partnered with the University of Hull to carry out work investigating the impact of training specific to pertinent repeated issues in the labour ward and community. Although maternity training is regularly sign-posted as a remedy for adverse outcomes in maternity 1-11, there is little robust evidence looking at the impact, particularly the sustained impact, of specific training.
The results of the mixed method evaluation clearly demonstrate that training positively impacts upon the knowledge, confidence, and empowerment of frontline professionals in maternity. Not only was this demonstrated immediately post-course, but up to 3 months following the course. Knowledge increase remained statistically significantly different across both the CTG Masterclass and Childbirth Emergencies in the Community, even 3 months post-course; however, elements of the confidence questionnaire and the total scores for the empowerment questionnaire dropped after 3 months.
Sustained Knowledge and Confidence Increase
Across both the CTG Masterclass and Childbirth Emergencies in the Community there was a clear and sustained impact on knowledge and confidence scores following training. This was seen within individual delegate responses, but a wider implication for clinical practice was also reported within qualitative responses:
“I feel like I have learnt so much today and feel inspired to go back to our maternity unit and attempt to inform others of what we have learnt.”
“Thank you so much I am going with the confidence that I will practice safe obstetrics; deliver safe babies; and able to teach my colleagues in training”
“I will definitely approach my manager regarding the update of our planned homebirth proforma”
These qualitative data also highlight the importance of including expert-led external training in local trust training priorities. Local training builds teams, but external training standardises evidence-based best practice nationally and reduces the dangers of the “don’t know what you don’t know”.
Potential Cultural Barriers to Sustained Impact
In order to adhere to the Kirkpatrick model of training evaluation 12, we devised a measure with the University of Hull to investigate the impact of training on behaviour in the form of empowerment. Results showed that delegate empowerment increased immediately following training; however, this was not sustained after 3 months, unlike knowledge and confidence scores.
Whilst knowledge and confidence regarding the specific clinical elements (e.g. management of intrapartum hypoxia, shoulder dystocia) remained to be highly significantly different to pre-course scores for both courses, and remained to be so 3 months later, confidence in areas relating to wider topics did not; for example, confidence in “national guidelines” and the “wider clinical picture” relating to fetal monitoring. In addition, when looking at paramedic confidence, the sole question that was found to not be significantly different 3 months following Childbirth Emergencies in the Community related to communication in an obstetric emergency.
Some qualitative data collected highlight that application of knowledge could be restricted by local and national guidelines, and this could potentially impact on sustained empowerment:
“In our trust we have NICE guidelines and FBS, all the learning I did is contradicted. Now frustrated that we are unable to put into place the changes suggested.”
Comparatively, delegate empowerment to make changes immediately post-course was reportedly high:
“The course was exceptional to my learning and I feel it is invaluable to midwives and obstetricians. I feel more confident, knowledgeable and empowered to implement changes, regarding CTG interpretation and practice. Excellent.”
In order to enable sustained changes to clinical practice at a local and national level, quality training in pertinent areas needs to be repeated. In addition, whole teams should be trained together to create a shared language, knowledge, and a change in guidelines.
Despite training being repeatedly recommended to improve perinatal outcomes 1-11, Baby Lifeline’s Mind the Gap report shows that maternity training varies widely in how it is delivered, provided, and evaluated 13. This piece of work shows the potential impact expert-led, multi-professional training can have on frontline skills, confidence, and empowerment. The decline in empowerment and some wider aspects of confidence demonstrates a need to repeat this training to sustain improvements.
Read the research paper here.
- The Royal College of Obstetricians and Gynaecologists. Each Baby Counts: 2018 Progress Report. London : RCOG, 2018.
- Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2018
- Draper ES, Kurinczuk JJ, Kenyon S (Eds.) on behalf of MBRRACE-UK. MBRRACE-UK 2017 Perinatal Confidential Enquiry: Term, singleton, intrapartum stillbirth and intrapartum-related neonatal death. The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester: Leicester, 2017
- Magro, Michael. Five Years of Cerebral Palsy Claims. NHS Resolution, 2017.
- NHS England. National Maternity Review: Better Births. NHS England, 2016.
- O’Connor, Dan. Saving Babies’ Lives: A care bundle for reducing stillbirths. NHS England. [Online] March 21, 2016. https://www.england.nhs.uk/wp-content/uploads/2016/03/saving-babies-lives-car-bundl.pdf.
- The Royal College of Obstetricians and Gynaecologists. Each Baby Counts. London : The Royal College of Obstetricians and Gynaecologists, 2015.
- Kirkup, Bill. The Report of the Morecambe Bay Investigation. 2015.
- Draper, ES, Kurinczuk, JJ and Kenyon, S. MBRRACE-UK Perinatal Confidential Enquiry: Term, singleton, normally formed, antepartum stillbirth. Leicester : The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester, 2015.
- NHS Litigation Authority. 10 Years of Maternity Claims. London : NHS Litigation Authority, October 2012.
- Macintosh, Mary CM. The lessons of CESDI.. 1999, The Obstetrician & Gynaecologist, pp. Vol. 1 No. 2: 13-17.
- Kirkpatrick DL, Kirkpatrick JD. Evaluating training programmes: the four levels. 3rd ed. San Francisco, CA: Berrett‐Koehler; 2006.
- Baby Lifeline: Ledger, S, Hindle, G and Smith, T. Mind the Gap 2018: An Investigation into Maternity Training for Frontline Professionals Across the UK. Baby Lifeline, 2018.