EDUCATIONAL FRAMEWORK FOR PRIMARY MATERNITY SERVICES

 
EDUCATIONAL FRAMEWORK FOR PRIMARY MATERNITY SERVICES
EDUCATIONAL FRAMEWORK FOR
 PRIMARY MATERNITY SERVICES
 PART 2

 Draft for Consultation (Version 4)
 Issued 8 February 2010

 A Project co-sponsored by the National Health
 Workforce Taskforce and the Maternity Services
 Inter-jurisdictional Committee

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                 DRAFT FOR CONSULTATION (Issued 8 February 2010)

PROJECT TEAM
Professor Caroline Homer
Professor of Midwifery
University of Technology Sydney

Professor David Ellwood
Professor of Obstetrics and Gynaecology
Australian National University and the Canberra Hospital

Professor Sue Kildea
Professor of Midwifery
The Mater Hospital (Qld) and the Australian Catholic University

Professor Pat Brodie
Professor of Midwifery
Sydney South West Area Health Service and the University of Technology Sydney

Dr Austin Curtin
School of Health Services, Southern Cross University
Adjunct Senior Lecturer, University of Sydney
Sub Dean Northern Clinical School (Lismore)

Marnie Griffiths (Project Officer)
University of Technology Sydney

ACKNOWLEDGMENTS
We thank the members of the Steering Committee and Reference Group for their contribution
and commitment to this Project. We also thank the individuals and organisations who
provided comment and feedback on earlier versions of this document.
Core Competencies and Educational Framework for Maternity Services in Australia Project
                          DRAFT FOR CONSULTATION (Issued 8 February 2010)

TABLE OF CONTENTS
INTRODUCTION.................................................................................................................. 1
   Purpose ................................................................................................................................... 2
   Scope ...................................................................................................................................... 2
BACKGROUND ................................................................................................................... 2
DEVELOPING THE EDUCATIONAL FRAMEWORK ................................................................. 2
   Literature review ..................................................................................................................... 3
   Underpinning Principles ........................................................................................................... 3
   Educational principles .............................................................................................................. 4
   Primary Maternity Service Provider Attributes.......................................................................... 6
   Key Challenges ......................................................................................................................... 8
   Linking the Educational Framework with the Core Competencies .............................................. 8
   Consultation ............................................................................................................................ 9
THE EDUCATIONAL FRAMEWORK .................................................................................... 10
   Suggested process for curriculum development ...................................................................... 17
   Examples of strategies of delivery formats and assessment tools ............................................ 17
ACRONYMS ...................................................................................................................... 19
GLOSSARY OF TERMS ....................................................................................................... 20
REFERENCES ..................................................................................................................... 26
Core Competencies and Educational Framework for Maternity Services in Australia Project
                  DRAFT FOR CONSULTATION (Issued 8 February 2010)

INTRODUCTION

The Educational Framework for Primary Maternity Services provides Part Two of the Core
Competencies and Educational Framework for Maternity Services in Australia Project.
This document provides an overview of the Educational Framework. It identifies educational
principles that are broad and general and support the Core Competencies for Primary
Maternity Services Model. Suggested learning areas, objectives and assessment elements as
components for curricula relevant to the undergraduate, postgraduate, continuing professional
development, up skilling or return to practice learning needs of primary maternity service
providers are presented from an interprofessional approach to learning rather than a
profession specific approach for individual professional groups or individual learning
situations.

This project was co-sponsored by the Maternity Services Inter-jurisdictional Committee and
National Health Workforce Taskforce. The educational framework is to be read in
conjunction with the provider’s usual scope of practice and published practice standards.
This framework has been developed as a benchmark for the training, education and assessing
of professionals involved in maternity care and to inform the development of curricula for
providers of primary maternity services.

There are a range of health care professionals involved in maternity care. Three main
professional groups, obstetricians; midwives and GP obstetricians, provide core maternity
services. Many other health care professionals are also involved in maternity care, such as
anaesthetists, maternal, child and family health nurses, aboriginal health workers,
neonatologists, mental health professionals, dieticians, social workers and physiotherapists.
We are seeking comment and feedback from all health care professionals who are
involved in providing any aspect of maternity care as well as from consumers.

It is essential that every provider of maternity care (primary or otherwise) has at a minimum a
beginning level understanding of the specific health care needs of childbearing women, their
babies and families to ensure the quality and safety of maternity services in Australia.

The aims of the Educational Framework are to:

       provide a set of general educational principles to inform curricula development for the
       training, education and assessment of primary maternity care providers in Australia

       be consistent with and articulate with existing national frameworks and competency
       and education standards for primary maternity care providers in Australia

       promote and support increased opportunities for interprofessional collaboration and
       education for primary maternity service providers

       demonstrate that the core competencies for primary maternity services readily
       assimilate into current education frameworks/accreditation frameworks for education
       providers/relevant curricula

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Purpose
The purpose of this Educational Framework is to present education providers for primary
maternity services with a set of guidelines for success in developing and delivering core
primary maternity service provider group curricula based on an interprofessional approach to
learning and primary maternity service practice.

Scope
This Educational Framework has been developed for an array of core maternity service
providers who work in a range of primary maternity care settings across remote, rural and
urban Australia and their relevant education providers.

BACKGROUND

Initially, Part One of this project focused on the identification and development of Core
Competencies for Primary Maternity Services for the care of pregnant, birthing and
postpartum women who are considered to be of normal risk, that is, experiencing an
uncomplicated pregnancy, labour and birth and postnatal period. We recognise that women
with complex risks or needs need an additional level of care and support.

The Core Competencies include the needs and preferences of women, the promotion of
greater access to continuity of care and the fostering of collaborative working relationships
between providers of care. They identify key skills, knowledge, behaviours and attitudes
(competencies) required for core maternity service providers involved in the provision of
primary maternity care across remote, rural and urban Australia.

The Core Competencies have been used to guide the development of the general educational
principles and the Educational Framework. This framework aims to inform curricula
development and continuing professional development for primary maternity service
providers across Australia.

DEVELOPING THE EDUCATIONAL FRAMEWORK

To develop the Educational Framework, the assumptions that guided the development of the
core competencies were reviewed. These assumptions also represent the underpinning
principles of this Education Framework. They have been developed with relevance to the
current primary maternity service provider workforce group. Similarly as with the initial part
of the project, a set of general educational principles has been identified and relevant current
literature, together with professional curricula and frameworks for the accreditation of
education programs have been reviewed.

The purpose of the Education Framework is to provide a mechanism to ensure that the Core
Competencies can be met.

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Literature review

A search of documents related to curriculum for maternity services, accreditation frameworks
for maternity education and courses, and educational frameworks in health was undertaken. A
number of websites were also individually searched for documents related to midwifery and
obstetric registration, education standards and frameworks. These websites included those of
RANZCOG, RACGP, ACCRM, CDNM, CPME, CDAMS and ANMC as well as the NMRA
for each state and territory. The documents reviewed included the ANMC National
Framework for Accreditation of Nursing & Midwifery Courses1, RACGP Curriculum for
General Practice2, ACCRM Vocational Training Handbook3 , CDAMS Indigenous Health
Curriculum Framework4, NZCOM Education Framework5, RANZCOG Curriculum
Framework6, and WHO Europe Midwifery Curriculum for Accredited Nurses7, ACRRM
Primary Curriculum Statements8, and CPME Australian Curriculum Framework for Junior
Doctors (version 2.1)9.

The documents reviewed revealed a number of similarities in standards for education
programs and criteria for accreditation. These similarities included requirements for core
curriculum content to address relevant national professional competency standards and
demonstrate an incremental process of learning and a commitment to lifelong learning.

The curriculum documents were similar in themes and content. The emphasis of the majority
of curriculum documents was the development of skills for critical self reflection, the
integration of theoretical and clinical components appropriate to the professional practice
role, the roles and context of professional practice and the development of knowledge, skills
and professional qualities commensurate with the profession.

The Educational Framework recognises that different disciplines already have competency
standards and/or educational standards. The Core Competencies and Educational Framework
for Maternity Services aim to complement these rather than replace them. The framework is
to be considered in line with the individual provider groups’ usual scope of practice. In
addition, individual provider groups have their own competency based education and
assessment programs. Again, the framework aims to build on these but not over-ride them.

The framework is designed to be used to be in its entirety. However, we recognise that for
some provider groups and disciplines, different aspects of the framework may have more
application and relevance. Therefore, there is an opportunity to use components of the
framework to meet the needs of particular provider groups as appropriate.

This next section outlines the underpinning principles, the educational principles and the
provider attributes.

Underpinning Principles

       Pregnancy, labour, birth and parenting are significant and meaningful life events. All
       women and families have a right to access quality primary maternity care that is safe,
       feels safe and this should be reflected in the content and components of the curricula
       and its assessment processes. Some women will also need a higher level of care.

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          It is acknowledged that all women may experience a change in their health during
          their childbearing journey. The Educational Framework supports the primary
          maternity care provider to recognise when the pregnancy is more complex and ensure
          safe consultation occurs.

          Primary maternity services in Australia are provided by a number of different
          providers in a variety of settings. To address this, curricula should develop, value and
          support interprofessional learning and collaborative practice to assist in creating a
          competent and flexible workforce, ensuring safe primary maternity services that
          promote continuity of care and carer.

          Primary maternity services provide care that is individualised, evidence-informed and
          woman-centred. This should be valued and supported by the competency standards,
          curricula and continuing professional development activities.

          Primary maternity services need to be based upon the principles of primary health
          care. The curricula should reflect an understanding of primary health care principles
          and the particular needs of rural, remote and Indigenous Australia.

          The Educational Framework has been developed to complement, not replace,
          existing statements relating to education standards, continuing professional
          development and continuing competence produced by regulatory authorities and
          professional colleges.

          The Core Competencies for Primary Maternity Services and the Educational
          Framework are based on principles rather than identifying specific tasks for individual
          professional groups or settings. This should be reflected in the curricula learning
          areas, objectives and outcomes.

Educational principles

A number of general educational (and learning) principles have been identified:

          Primary maternity service providers are adult learners1
     This means that learning must value prior knowledge and skills by assisting learners to
     see connections between what they already know, have the skills to do and the new
     information provided. To achieve this, the reasons for primary maternity service provider
     participation in learning activities should be clearly articulated (e.g. for competency
     requirements, up skilling and continuing professional development) and the barriers
     reduced.
     Learning should be self directed and personal goal setting encouraged. Educational
     activities for primary maternity service providers should be applicable to real-life
     situations and relevant to practice (e.g. by stories that link theory to practice, and role play
     situations that offer opportunities to test out new skills and attitudes).

1
   Knowles suggests that adult learners like to be respected and direct and be actively involved their own learning and that
they learn best when they are able to connect their learning to their life experiences and have specific learning experiences
linked to specific goals. Adult learners need to see a reason for learning something and embrace the opportunity to apply
their knowledge to practical situations (Dunn, (2000). Theories of Learning, Oxford UK, Oxford Centre for Staff
Development and Learning.)

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   Learning activities that incorporate opportunities and time for skill development and
   consolidation should be valued. The primary maternity service provider should support
   learning and the fostering of professional relationships to enhance practice. Feedback
   should be sensitive and timely whereby errors are corrected and appropriate knowledge,
   skills and attitudes are reinforced10-12.

       Interprofessional learning that is based upon different professions working together in
       practice in respectful, collegial interprofessional relationships is a recommended
       strategy to ensure the best outcomes for women and their babies.
For the purposes of this document, collaborative practice encompasses working together to
facilitate better outcomes for women and their babies through respect, trust and teamwork
that utilises individual skills and knowledge to reach the highest of maternity care standards.
Definitions of interprofessional learning and interprofessional education and interprofessional
practice are varied, although a number of the key elements remain the same. For the purposes
of the Educational Framework for Primary Maternity Services the definitions for
interprofessional learning, interprofessional education and interprofessional practice as
defined by the Australian Learning and Teaching Council and Learning and Teaching for
Interprofessional Practice, Australia (L-TIPP) have been adopted. They are:

          Interprofessional learning (IPL): Learning that occurs through planned
           interprofessional education or spontaneous incidental interactions between
           members of two or more professions in the workplace or education settings 11.

Braithwaite and Travalgia (2005) and L-TIPP suggest that improved collaborative skills
through IPL enriches communication and trust between different healthcare professionals and
a greater understanding of roles thereby reducing the ‘silo’ effect existing between
professions and enhancing professional relationships, respect, collaborative skills and
improving job satisfaction10 11.

          Interprofessional education (IPE): Occasions when two or more professions
           learn from, with and about each other to improve interprofessional relationships,
           collaborative practice and the quality of care 11.

IPE is concerned with the knowledge, skills and attitudes (competency) required for
collaborative practice 10.

          Interprofessional practice (IPP): Occurs when two or more professions work
           together as a team with a common purpose, commitment and mutual respect11.
           For the purposes of this project this may also be referred to as collaborative
           practice.

IPP in the context of the maternity workplace is essentially focussed on maternity care
provider knowledge and understanding of the contribution of other disciplines to the care of
pregnant, childbearing and postpartum women, the skills to seek out, communicate with and
work with other maternity care providers, and the ability to value such contributions10.

This framework acknowledges the current dichotomy that exists between interprofessional
learning and interprofessional practice. It is anticipated that this framework will promote the

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achievement of a competent and flexible maternity workforce where care providers
understand and work with each other to make the best use of their professional knowledge,
skills and attitudes ensuring safe primary maternity services that promote woman-
centredness, continuity of care and carer11.

         Learning is lifelong2, firmly based in clinical practice situations and includes formal
         education, continuing professional development and informal learning experiences
         within the workplace.

Primary Maternity Service Provider Attributes
A generic description of Primary Maternity Service Provider attributes is useful as a guide for
education providers in the development and implementation of primary maternity service
provider curricula.

This generic description stems from the four domains of primary maternity care identified in
the Core Competencies for Primary Maternity Services Part 1. These domains include
women centred focus; professionalism; workplace; service provision; and communication.

Woman centred care
The primary maternity care provider (known as the ‘provider’ for the remainder of this
document) works in partnership with women to provide safe and effective care across the
interface between hospital and community; in any setting and is able to:
       comprehensively and accurately assess the needs of the woman and her baby.
       provide the woman with a comprehensive, honest and balanced perspective of options
        about her choices of providers for her maternity care.
       plan, implement and evaluate maternity care antenatally, during labour and birth and
        throughout the postpartum/newborn period.

The provider practises within a woman centred, primary health care framework and is
committed to seeing maternity care as a public health strategy, acknowledging the influence
of socio-cultural, spiritual, emotional and politico-economic factors on the life of the woman,
her baby and family.

The provider has the knowledge, skills and attitudes to provide primary maternity services
according to their provider group.

The provider integrates knowledge and evidence appropriate to their provider group and
recognises complications, high risk situations and responds in emergency situations with
appropriate and timely consultation and referral.

The provider understands the significance of past pregnancy experiences for the woman and
her family works collaboratively with other health care providers and community supports
when necessary.

2
  Lifelong learners take responsibility for their own learning and are prepared to invest time, money and effort in
training or education on a continuous basis. Both informal and formal learning experiences and opportunities are
valued and recognised for their personal and social as well as employment benefits (Department of Education
Science and Training (2003). Lifelong Learning in Australia: Commonwealth of Australia) .

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The provider recognises and supports women who experience domestic violence, or need
support with addiction, drugs or alcohol misuse and support health promotion activities
including smoking cessation.

The provider has the knowledge, skills and attitudes to inform, support, respect and
encourage a woman in her choice of feeding for her baby.

Professionalism
The provider has a sound knowledge of the Australian health care system and the role of
primary maternity services and complies with the relevant legislation and common law
applicable to their provider group. The provider provides care in accordance with national
policies, standards and guidelines and practice in accordance with relevant codes of ethics,
professional conduct and state and federal privacy obligations.

Acknowledging and advocating for the rights of the woman, the provider respects and
supports the woman’s right to be self-determining. Integral to this process is the ability to
enhance the dignity and integrity of others as well as understanding and identifying the
impact of their own culture, values and beliefs on the care provided.

The provider is accountable and responsible for their own practice and actions. The provider
recognises their own knowledge base, scope of practice and the standards of care expected.
The provider is able to identify unsafe practice. The provider is able to act appropriately and
consult and refers in a timely manner.

Understanding and valuing the analysis, synthesis and integration of evidence from multiple
sources, the provider demonstrates information literacy and uses research to inform practice,
policy, guidelines and decision-making.

The provider maintains competence through continual professional development, workplace
experiences and formal and informal educational opportunities. Lifelong learning is key to
continuing professional development, self appraisal and peer review. The provider is
reflective and can assess the self assess the effectiveness of their work.

The provider contributes to, and evaluates the learning experiences and professional
development of others and supports and mentors students.

Workplace
The provider supports effective management, risk management and leadership by fostering
and valuing reflection, critical thinking and service improvement. Identifying and responding
to factors that facilitate or hinder interprofessional relationships the provider works in
partnership with the woman to improve the woman’s maternity experience.

The provider forms part of the wider healthcare team and understands, recognises and
respects the roles of other members of the health care team. The provider invites, acts upon
and offers constructive feedback from peers and colleagues.

The provider supports safety in the workplace by understanding and complying with safe
working practices.

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Communication
The provider is competent in verbal and written communication and documents legibly
according to legal and professional guidelines. The provider engages in effective and
appropriate interactions with the woman as well as others with whom they interact on an
interprofessional and intraprofessional basis. The provider has knowledge of, value and uses
a range of interpersonal communication skills.

The provider supports and values effective and ongoing interprofessional learning as a tool
for successful interprofessional communication13.

The provider is reflective and able to communicate effectively with a woman in situations
where her choice is not consistent with reasonable primary maternity provider practice.
Providers need to consider how they would manage when a woman's choice is not consistent
with what is commonly seen as reasonable or evidence-based practice. The provider will
communicate effectively with the woman and her family and ensure that accurate
documentation of the discussions and decisions is made.

Key Challenges

The key issues that are challenging the development of this educational framework are the
need to accommodate a diversity of needs both from the perspective of level of preparation
(undergraduate, postgraduate, continuing professional development) and the different primary
care provider disciplines for which the framework is being developed. To address these key
challenges the Framework offers a broad rather than specific approach to curricula
development.

Determining what the competencies might look like in practice in order to be described as
measurable performance elements has also been challenging. This is because the core
competencies identified for Primary Maternity Services are broad, do not direct the setting in
which a service should be provided and are based on principles rather than identifying
specific tasks for individual professional groups. The performance elements/outcomes
described within the Educational Framework are therefore also broad, non specific in regards
to the setting they are to be measured within, and are based on principles rather than specific
tasks.

Linking the Educational Framework with the Core Competencies
The Core Competencies were used to guide the development of the Educational Framework
and the framework reflects and addresses the Core Competencies. This has been achieved by
ensuring the presence of the same domains for the Core Competencies and the Educational
Framework whilst altering the remaining titles, content and the perspective from which the
Competencies and Framework are expressed. These alterations have been undertaken to meet
the needs of context within each individual document.

An example of this is detailed in the table below:

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Table 1 Linking the Educational Framework and the Core Competencies
Educational Framework                                              Core Competencies
Domain     Workplace                                               Domain Workplace

Learning/Subject Area                  Teamwork                    Sub-Domain             Teamwork

Learning Objective                                                 Competency Standard

13. develop effective strategies to implement and                  12. Develops effective strategies to implement and
support interprofessionalism and collaborative practice.           support interprofessionalism and collaborative
                                                                   practices.

Performance Elements/Outcomes                                      Competency Elements
Adopts effective styles and methods of communication and           Knowledge
referral/consultation that recognises and respects the roles of      Understands others’ roles.
other members of the health care team.                               Understands when and who to refer to/consult with.
                                                                   Skills
Negotiates an appropriate plan of care in consultation with the      Recognises the role of other members of the health care
woman and other colleagues as needed.                                   team
                                                                     Adopts effective styles and methods of communication.
Invites and acts upon constructive feedback from peers and           Negotiates a collaborative care plan in consultation with
colleagues.                                                             the woman.
                                                                     Readily invites, acts upon, and offers, constructive
Offers constructive feedback to peers and colleagues when               feedback from peers and colleagues.
appropriate.                                                         Effectively manages change in a team environment.
                                                                   Attitude
Effectively negotiates change in a team environment                  Appreciates the differing professional roles in maternity
                                                                        care.
Recognises the value of effective interprofessional                  Acts to identify and respond to factors that facilitate or
relationships to achieve the best possible outcomes for the             hinder interprofessional relationships.
woman and her baby.                                                  Respects differences in views.
                                                                     Recognises the value of effective interprofessional
                                                                        relationships to achieve the best possible outcomes for
                                                                        the woman and her baby.

Consultation

The initial consultation commenced in November 2009. The Educational Framework was
reviewed a number of times by the project Steering Committee and Reference Group
representatives prior to being sent out to the regulatory and accreditation authorities for
health professionals with a direct or indirect stakeholder interest in this project for feedback
and comment. Feedback from these groups informed the development of this version
(Version 4) of the Educational Framework.

This Version is now presented for this planned broader public web based consultation
process. We are seeking comment and feedback from a wide range of health care
professionals and others who have involvement in maternity care as well as from
consumers.

The feedback received will be collated and will inform the development of the final
Educational Framework for Primary Maternity Services in Australia document.

The final Educational Framework and Core Competencies Model documents will be merged
into one document at the projects’ completion.

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THE EDUCATIONAL FRAMEWORK

This document provides an overview of the Educational Framework and identifies educational principles that support the Core Competencies
Model.

The Educational Framework identifies key learning areas, learning objectives, and performance elements required to be considered for inclusion
in undergraduate, postgraduate and continuing professional development programs for core maternity service providers involved in the provision
of primary maternity care across remote, rural and urban Australia. This Educational Framework has been developed based on adult learning
principles with a focus on interprofessional learning, the importance of lifelong learning and learning in practice based situations. This
Framework and its suggested components are to be considered for inclusion with curricula relevant to primary maternity service providers. The
Framework enables the Core Competencies for Primary Maternity Services to readily assimilate into current education frameworks/accreditation
frameworks for education providers/relevant curricula.

Domain                        Learning/Subject Area              Learning Objectives – The                    Performance Elements/Outcomes
                                                                 Primary Maternity Service Provider
                                                                 (PMSP) will…

                              PHILOSOPHY OF CARE                 1. demonstrate a philosophy of               Provides individualised care that encompasses a woman’s social,
WOMAN CENTRED CARE
                                                                 care that is woman-centred, based            emotional, physical, psychological, spiritual and cultural needs and
                                                                 upon the principles of primary               expectations.
                                                                 health care and evidence-informed
                                                                                                              Relates the significance of past pregnancy experiences to a woman’s
                                                                 in every practice situation.                 current pregnancy.

                                                                 2. demonstrate respect,                      Provides unbiased and current information and evidence to assist the
                                                                 cooperation and collaboration in             woman to arrive at the best decisions for her and her baby.
                                                                 every interaction with all health
                                                                 care providers involved in primary           Provides care that is culturally responsive, contextual, equitable,
                                                                 maternity services to ensure the             accessible, woman-centred and based on shared decision making.
                                                                 best outcomes for the woman and
                                                                                                              Works in partnership with the woman, her family and other support
                                                                 her baby.                                    people in planning, implementing and evaluating care through
                                                                                                              pregnancy, birthing and the transition to parenthood.

                                                                                                              Provides and supports continuity of care.

                                                                                                              Reflects on care provided and responds to feedback to continuously
                                                                                                              improve practice.

                                                                                                              Promotes childbirth as a normal, physiological process and a significant

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Domain         Learning/Subject Area              Learning Objectives – The                    Performance Elements/Outcomes
                                                  Primary Maternity Service Provider
                                                  (PMSP) will…
                                                                                               life event for most women.

                                                                                               Respects the right of the woman to determine her own pregnancy, birth
                                                                                               and postnatal care needs while ensuring she has appropriate and
                                                                                               accurate information on which to base her decisions.

                                                                                               Works collaboratively with other clinicians and health professionals.

                                                                                               Acknowledges the potential for adverse outcomes at times and
                                                                                               minimises risk.

               PROFESSIONAL BODY OF               3. apply maternity knowledge and             Provides care that is based on relevant, evidence-based integrated
               KNOWLEDGE                          profession specific skills to optimise       knowledge of the human sciences, pregnancy, childbirth and
                                                                                               postpartum/newborn period.
                                                  maternal and newborn health
                                                  outcomes.                                    Recognises and refers in a timely manner when pregnancy, childbirth
                                                                                               and postpartum/newborn period are no longer a normal, physiological
                                                                                               and or psychological process or care at a higher level is required.

                                                                                               Performs history-taking, physical examination, assessment and
                                                                                               screening and referrals.

                                                                                               Is confident in own knowledge and evidence and uses this to support
                                                                                               the needs and preferences of the woman. This includes her choice of
                                                                                               infant feeding.

                                                                                               Recognises and addresses limitations and deficits in own knowledge
                                                                                               and practice.

                                                                                               Develops a sound knowledge of relevant pharmacology and related
                                                                                               issues.

                                                                                               Develops the ability to critically analyse health care outcomes.

                                                                                               Is confident in finding and critiquing research into relevant maternity
                                                                                               related issues.

               SERVICE PROVISION                  4. promote maternity care as a               Provides care that considers and integrates the impact of a woman’s
                                                  public health strategy.                      social determinants of health on her health and the health of her family

                                                                                               Recognises, acknowledges and responds appropriately to a woman’s
                                                                                               social, emotional, physical, psychological, spiritual cultural and
                                                                                               economic influences.

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Domain         Learning/Subject Area              Learning Objectives – The                    Performance Elements/Outcomes
                                                  Primary Maternity Service Provider
                                                  (PMSP) will…
                                                                                               Promotes health care practices that address inequalities in health.

                                                                                               Responds appropriately in situations where there is domestic violence,
                                                                                               or for women who need support with addiction to drugs and/or alcohol.

                                                                                               Is confident in own knowledge around public health issues, including
                                                                                               national health priorities and preventative heath

                                                                                               Recognises preventative health opportunities and acts upon these to
                                                                                               promote health and wellbeing.

                                                                                               Recognises the role and value of community-based self-help (mutual
                                                                                               support) organisations in antenatal and postnatal care.

                                                  5. demonstrate the capacity to               Provides care that integrates the physiological processes of normal
                                                  provide effective care for pregnant,         pregnancy, birth and postpartum and the social, emotional,
                                                                                               psychological and cultural needs of the woman and her family where
                                                  birthing and postpartum women
                                                                                               pregnancy is of normal risk.
                                                  who are of normal risk.
                                                                                               Maintains up to date practical skills and knowledge concerning the care
                                                                                               of the woman and her baby considered of normal risk.

                                                                                               Manages the practical antenatal, birthing and postpartum care of the
                                                                                               woman and her baby who are considered of normal risk.

                                                                                               Provides the woman with a balanced perspective of options for infant
                                                                                               feeding and supports her choice.

                                                  6. demonstrate the capacity to               Provides appropriate, timely and effective care where a woman or her
                                                  provide effective care when                  baby has complex health needs and/or where complications,
                                                                                               emergencies or urgent situations arise.
                                                  complications arise.
                                                                                               Maintains currency, competency and capability in the management of
                                                                                               complications, emergencies or urgent situations.

                                                                                               Demonstrates ability to remain woman centred when complications arise

                                                                                               Works collaboratively with other clinicians and health professionals..

                                                                                               Provides emergency care, stabilising and transferring as soon as
                                                                                               practicable.

                                                                                               Considers the needs of the woman’s family where appropriate
                                                                                               throughout an emergency situation.

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Core Competencies and Educational Framework for Maternity Services in Australia Project
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Domain            Learning/Subject Area              Learning Objectives – The                    Performance Elements/Outcomes
                                                     Primary Maternity Service Provider
                                                     (PMSP) will…
                                                                                                  Provides care that is courteous, respectful and culturally responsive to
                  EQUITY                             7. establish links with the                  the needs, priorities and preferences of the woman and her family.
PROFESSIONALISM
                                                     woman/her family/community that
                                                                                                  Reflects on own personal beliefs in relation to the provision of care and
                                                     are culturally appropriate,
                                                                                                  acts appropriately to eliminate care that diminishes, demeans or
                                                     respectful and responsive.                   disempowers women’s identity and/or wellbeing.

                                                                                                  Provides care that actively promotes strategies that seek to provide
                                                                                                  outreach services to those disadvantaged by distance / race / religion or
                                                                                                  disability.

                  ETHICS                             8. adhere to and promotes the                Provides care in accordance with relevant codes of ethics and
                                                     professional code of ethics relevant         professional conduct.
                                                     to own practice/maternity service
                                                                                                  Works collaboratively to address ethical issues and breaches of
                                                     provider group (as available).               confidentiality and privacy.

                                                                                                  Provides honest and comprehensive information to the woman including
                                                                                                  when things do not go to plan.

                                                                                                  Protects the woman from involvement in different/conflicting professional
                                                                                                  positions and practices by providing unbiased information from all
                                                                                                  viewpoints

                                                                                                  Supports the woman to take responsibility for her own health and that of
                                                                                                  her baby.

                                                                                                  Supports the woman to identify and evaluate her own needs and those
                                                                                                  of her baby when planning for appropriate and effective maternity care
                                                                                                  and infant feeding choice.

                                                                                                  Provides care that encourages the woman and her community to be
                                                                                                  involved in maternity service development, improvement and evaluation.

                  PERFORMANCE                        9. use and evaluate current                  Provides individualised care that is informed by current relevant
                  IMPROVEMENT                        relevant evidence to inform                  evidence.
                                                     practice.
                                                                                                  Supports the woman to make decisions for her care and that of her baby
                                                                                                  by providing her with timely, appropriate and meaningful evidence where
                                                                                                  needed.

                                                                                                  Respects the woman’s right to choose different options and care
                                                                                                  pathways

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                           DRAFT FOR CONSULTATION (Issued 8 February 2010)

Domain         Learning/Subject Area              Learning Objectives – The                    Performance Elements/Outcomes
                                                  Primary Maternity Service Provider
                                                  (PMSP) will…

                                                                                               Participates in data collection and reporting as a mechanism to measure
                                                                                               performance and health outcomes.

                                                                                               Uses research, evidence and practice guidelines for own professional
                                                                                               practice and the provision of safe maternity care

                                                  10. continuously enhance own                 Participates in regular reviews of own and others professional
                                                  professional development and the             development and learning needs.
                                                  professional development of others.
                                                                                               Provides care that is based upon up to date skills, knowledge, attitudes
                                                                                               and experience.

                                                                                               Supports and embraces opportunities for interprofessional learning and
                                                                                               collaboration.

                                                  11. demonstrate accountability and           Provides care that adheres to own knowledge base, scope of practice
                                                  responsibility for own practice and          and standards of practice/care expected of own maternity provider
                                                                                               group.
                                                  actions.
                                                                                               Accepts responsibility and accountability for care provided and provides
                                                                                               that care according to national strategic frameworks, policies, standards,
                                                                                               guidelines, relevant legislation and common law.

                                                                                               Supports and encourages debriefing, multidisciplinary review regular
                                                                                               audit processes, and open disclosure policies to address unsafe
                                                                                               practice.

                                                                                               Supports, participates in and maintains intra-and inter- professional
                                                                                               collaboration and multi-disciplinary collegial networks.

                                                                                               Respects the right to autonomous practice of each maternity provider
                                                                                               group as regulated health professionals.

                                                                                               Readily initiates activities and delegates as appropriate in accordance
                                                                                               with relevant policies, guidelines and scope of practice.

                                                                                               Maintains appropriate professional boundaries within the episode of
                                                                                               care.

                                                                                               Concludes the professional relationship in a timely and appropriate
                                                                                               manner.

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                            DRAFT FOR CONSULTATION (Issued 8 February 2010)

Domain          Learning/Subject Area              Learning Objectives – The                    Performance Elements/Outcomes
                                                   Primary Maternity Service Provider
                                                   (PMSP) will…

                MANAGEMENT AND                     12. work effectively with, and               Provides care that promotes a climate of reflection, critical thinking and
WORKPLACE
                LEADERSHIP                         between, organisations.                      continual service improvement to continually enhance the woman's
                                                                                                maternity care experience.

                                                                                                Supports others through mentoring and clinical supervision.

                                                                                                Recognises and manages change processes in the healthcare/maternity
                                                                                                care environment.

                                                                                                Seeks knowledge to support effective management, risk management
                                                                                                and leadership.

                TEAMWORK                           13. develop effective strategies to          Recognises the value of effective interprofessional relationships to
                                                   implement and support                        achieve the best possible outcomes for the woman and her baby.
                                                   interprofessionalism and
                                                                                                Adopts effective styles and methods of communication and
                                                   collaborative practice.                      referral/consultation that recognises and respects the roles of other
                                                                                                members of the health care team.

                                                                                                Negotiates an appropriate plan of care in consultation with the woman
                                                                                                and other colleagues as needed.

                                                                                                Invites and acts upon constructive feedback from peers and colleagues.

                                                                                                Offers constructive feedback to peers and colleagues when appropriate.

                                                                                                Effectively negotiates change in a team environment.

                OCCUPATIONAL HEALTH                14. develop, participate in and              Provides care that complies with relevant OHS requirements and safe
                AND SAFETY                         maintain effective strategies that           working practices that include risk management and risk/hazard
                                                                                                reporting processes and the maintenance of OHS
                                                   contribute to, manage and improve
                                                                                                documentation/records appropriate to professional role.
                                                   Occupational Health and Safety
                                                   (OHS) processes within the
                                                   workplace.

                PATIENT/CLIENT                     15. engage in effective                      Responds in a calm, confident and approachable manner when
COMMUNICATION
                COMMUNICATION                      patient/client communication to              communicating with each woman and her family.
                                                   ensure optimal maternal and
                                                                                                Uses a range of interpersonal communication principles and processes
                                                   newborn health outcomes.                     and adapts communication to the needs of and a level suited to the

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                           DRAFT FOR CONSULTATION (Issued 8 February 2010)

Domain         Learning/Subject Area              Learning Objectives – The                    Performance Elements/Outcomes
                                                  Primary Maternity Service Provider
                                                  (PMSP) will…
                                                                                               individual to communicate effectively with each woman and her family.

                                                                                               Recognises and addresses barriers to effective communication by
                                                                                               utilising resources that promote and enhance understanding i.e.
                                                                                               culturally appropriate information, resources and healthcare interpreters.

                                                                                               Legibly documents decisions, actions and evaluation of outcomes.

               PROFESSIONAL                       16. engage in effective, appropriate         Provides care that demonstrates effective and collegial relationships and
               COMMUNICATION                      intra and interprofessional                  effective communication styles and methods of consultation, referral and
                                                                                               handover with all other health care providers.
                                                  communication to ensure optimal
                                                  maternal and newborn health                  Recognises and responds to factors that facilitate or hinder intra and
                                                  outcomes.                                    interprofessional communication.

                                                                                               Respects differences in communication styles.

                                                                                               Uses communication skills to negotiate compromise where differences
                                                                                               exist in professional opinions and recommendations for healthcare
                                                                                               choices.

                                                                                               Recognises respects and values collaborative practice and
                                                                                               ongoing/effective intra and interprofessional communication.

                                                                                               Uses a range of strategies to communicate effectively with other health
                                                                                               care providers particularly where there is a transition from one care
                                                                                               provider or care provider group to another.

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                    DRAFT FOR CONSULTATION (Issued 8 February 2010)

Suggested process for curriculum development

The fundamental outcome of this project is to develop a flexible competency and educational
framework for primary maternity services that increases opportunities for interprofessional
collaboration, teamwork and education. It is anticipated that this framework will act as a
benchmark for training, education and assessment of health professionals involved in primary
maternity services.

To this end, a whole of (primary maternity service) workforce commitment to implementing
this framework and its guidelines is encouraged along with the embedding of this
commitment and the goals and outcomes of the educational framework into strategic
documents, curriculum maps and program outcome and participant attribute statements.
Additionally, it is anticipated that providers of primary maternity service provider education
will work together to provide education that enables the competencies to be met. This process
of horizontal integration means that the common goals that different disciplines and
professions hold will be integrated and accommodated within individual curricula.

The following six steps offer a means of integrating this framework into primary maternity
service provider curricula and educational programs

1. engage, encourage and participate
2. embed commitment
3. review current curriculum in terms of content of framework
4. identify where and include framework components in current curricula
5. ensure vertical integration with all primary maternity service provider curricula
6. identify processes and tools for evaluation

Examples of strategies of delivery formats and assessment tools

A number of proposed strategies that may assist in the achievement of the Performance
Elements/Outcomes identified in the Educational Framework are provided in the table below.
Additionally, suggestions of suitable assessment tools with which to measure the success of
the delivery format and hence the Performance Elements/Outcomes are also provided in the
table below.

These proposed strategies are intended to provide a guide only, as it will be the education
provider who decides on the delivery format and assessment tools most suitable to their
particular circumstances. Health professional disciplines have their own strategies of delivery
and means of assessment and these should be utilised as appropriate.

Table 2 Proposed Strategies to assist in the achievement of Performance Elements/Outcomes
         Examples of Suitable Delivery Format                   Examples of Suitable Assessment Tools

Case Studies                                                         Assignments
Clinical placements                                                  Clinical assessments
Communication and collaboration skill workshops                      CPD program membership
Emergency drill workshops                                            Discussion groups
Face to face workshops                                               Emergency drills in practice
Facilitated discussion                                               Exams/quizzes

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Core Competencies and Educational Framework for Maternity Services in Australia Project
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Interactive multimedia e-activities                                   Observation in practice
Interprofessional online learning groups                              Observed interactions
Interactive reflective e-activities                                   Online self assessment
Journals                                                              Peer and/or practice review
Lectures                                                              Portfolio maintenance
Mentoring                                                             Practice assessment
Online facilitated discussion, learning programs and                  Reflective journaling
reflection                                                            Self assessment
Reflective discussions and questioning processes                      Simulated testing stations
Role play using scenarios
Self guided learning
Simulation including practice and debriefing exercises

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                 DRAFT FOR CONSULTATION (Issued 8 February 2010)

ACRONYMS

RANZCOG - Royal Australian College of Obstetricians and Gynaecologists

RACGP - Royal Australian College of General Practitioners

ACCRM, -Australian College of Rural and Remote Medicine

CDNM - Council of Deans of Nursing and Midwifery,

CPMEC - Confederation of Postgraduate Medical Education Councils

CDAMS - Committee of Deans of Australian Medical Schools

ANMC - Australian Nursing and Midwifery Council

NMRA - Nursing Midwifery Regulatory Authorities

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                   DRAFT FOR CONSULTATION (Issued 8 February 2010)

GLOSSARY OF TERMS

Adult Learning14             Andragogy (adult learning) is a theory that holds a set of
                             assumptions about how adults learn. Andragogy emphasises
                             the value of the process of learning. Knowles identified the
                             six principles of adult learning outlined below.

                                        Adults are internally motivated and self-directed
                                        Adults bring life experiences and knowledge to
                                        learning experiences
                                        Adults are goal oriented
                                        Adults are relevancy oriented
                                        Adults are practical
                                        Adult learners like to be respected

Attitude                      A state of mind or a feeling; disposition.

Baby                         When baby is used this also includes the foetus.

Capability15                 Capability is viewed as the sum of expertise and capacity.
                             Capability extends the concept of competence to include the
                             ability or capacity to apply the necessary knowledge, skills
                             and attitudes to a range of complex and changing settings.

Code of Ethics               Public declaration of the beliefs and values of a profession
                             and the members of that profession.

Code of Professional         Statement and description of required behaviours,
Conduct                      responsibilities and actions expected of members of a
                             professional body when acting in a professional capacity.

Collaboration                An active and ongoing partnership, often between people
                             from diverse backgrounds, who work together, and to
                             cooperate with other members of the health care team,
                             including medical officers, midwives, students, social
                             workers, allied health professionals and unregulated health
                             care workers.

Collaborative                Within the practice setting, collaboration is “an
Practice                     interprofessional process for communication and decision-
                             making that enables the separate and shared knowledge and
                             skills of care providers to synergistically influence the
                             client/patient care provided"16. Collaborative practice is then
                             both patient-centred and team-based; and maximises the
                             strengths and skills of each contributing health and social
                             care worker to increase the quality of patient care 15.

Community                    Used to describe people who share a sense of identity or

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                 DRAFT FOR CONSULTATION (Issued 8 February 2010)

                           have common concerns. Communities are not always within
                           a neighbourhood or locally-based.

Competence17               Encompasses a combination of skills, knowledge, attitudes,
                           value and abilities and the ways in which those attributes are
                           observable that underpin effective and/or superior
                           performance in a profession or occupational area.

Competent17                The person has competence across all the domains of
                           competencies applicable to profession or occupation, at a
                           standard that is judged to be appropriate.

Competency17               Competency within health gains its meaning within a
                           professional context. Competency as used in this document
                           represents core elements of professional performance (skills,
                           knowledge, behaviours, attitudes and values)) from a
                           primary maternity service perspective that underpin effective
                           professional/occupational performance at an identified level.

Competency Element Sub-sections of competencies describing key aspects of each
                   competency unit.

Continuity of care18       Consistent philosophy or organisational structure
                           underpinning the care provided.

Continuity of carer18      Care by a primary maternity service provider whom the
                           woman has previously met, feels she has developed a
                           ‘relationship’ with and believes she ‘knows’.

Continuing                 To regularly update, develop and refine knowledge, skills
Professional               and attitudes relevant to professional practice.
Development

Disease processes          Includes pathological physical problems/conditions that
                           affect the health of pregnant women.

Domain                     An organised cluster of core competencies that characterise a
                           central aspect of primary maternity care.

Evidence informed          The judicious use of the best evidence available so that the
practice                   clinician and the woman and her family arrive at the best
                           decision, taking into account, the needs and values of the
                           individual patient.

Health care                Refers to all health professionals and the ancillary services
providers                  that support them. This includes midwives, nurses,
                           obstetricians, general practitioners, Aboriginal Health
                           Workers and allied health staff including social workers and
                           mental health providers and anaesthetists.

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Core Competencies and Educational Framework for Maternity Services in Australia Project
                  DRAFT FOR CONSULTATION (Issued 8 February 2010)

Interprofessional
learning19                 A tool for successful interprofessional communication in
                           which life long learning, adult learning principles and an
                           ongoing, active learning process, between different cultures
                           and health care disciplines is embraced to enable two or
                           more professions learn with, from and about each other to
                           improve collaboration and the quality of care.

                           IPE is more than common learning, valuable though that is
                           to introduce shared concepts, skills, language and
                           perspectives that establish common ground for
                           interprofessional practice. It is also comparative,
                           collaborative and interactive, a test-bed for interprofessional
                           practice, taking into account respective roles and
                           responsibilities, skills and knowledge, powers and duties,
                           value systems and codes of conduct, opportunities and
                           constraints. This cultivates mutual trust and respect,
                           acknowledging differences, dispelling prejudice and rivalry
                           and confronting misconceptions and stereotypes. -

Interprofessionalism13 Interprofessionalism improves healthcare outcomes. Defined
                       as the provision of comprehensive health services to patients
                       by multiple health caregivers who work collaboratively to
                       deliver quality of care within and across settings.
                       Interprofessionalism requires that health care providers
                       know about the roles of other professional groups and are
                       able to work with other professionals, in the context of a
                       team where each member has a clearly defined role.
                       Knowing about and working with other professional groups
                       may also be represented as a framework which allows for the
                       recognition of the commonalities, distinguishing
                       (complementary) and collaborative features of different
                       roles.

                           Interprofessional working is not about merging the practice
                           boundaries between the professions and trying to create a
                           generic care worker. It is instead about developing
                           professionals who are confident in their own core skills and
                           expertise, who are fully aware and confident in the skills and
                           expertise of fellow health and care professionals, and who
                           conduct their own practice in a non-hierarchical and
                           collegiate way with other members of the working team, so
                           as to continuously improve the health of their communities
                           and to meet the real care needs of individual patients and
                           clients.

Knowledge                  The confident understanding of a subject with the ability to
                           use it for a specific purpose when appropriate.

Open Disclosure            The open discussion of incidents that result in harm to a

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