Focus on Delivery: – an innovation project on how to use structured reflection on clinical skills between practice and education

Background: Compared to other Nordic countries, Denmark has a high incidence of anal sphincter injury. Recent studies indicate that a strict focus on prevention of severe perineal trauma has decreased the incidence (1). This has resulted in changed clinical procedures in several Danish labour wards (2). It is, however, not clarified which of the multifaceted aspects of preventing perineal injury that might explain the decrease (3).
Aims: We hypothesized that the use of structured reflection on a clinical practice by midwives and midwifery students would increase both parts’ knowledge on how to prevent severe perineal injury. This paper describes midwives’ and students’ experiences of performing a structured reflection on clinical skills together.
Method: During a six week period in October 2015 midwives and students at Rigshospitalet (Copenhagen) used a Reflection Assessment Tool after having attended a delivery. The tool was developed based on five categories: communication, pace, ergonomic positions, perineal support in the chosen birth position and delivery of the shoulders, and five predefined questions guided an overall reflection upon practice. After a delivery a project midwife, who had attended the delivery, facilitated the midwife’s and the student’s structured reflection. Further, the project midwife held daily simulation workshops with midwives and students. Two focus group interviews with students and midwives were conducted and analyzed using content analysis.
Results and conclusion: Interviews revealed that structured reflection benefited the students’ learning process and improved the collaboration between student and midwife. Reflecting together helped both parts to a higher level of reflection, and the reflection became more equal. Students felt that the structured reflections helped them to gain multifaceted skills, and the project midwife supported the student’s learning process by facilitating an open reflection. Midwives reflected upon own practice in a new way, which stimulated new skills to bring to their professional acting.