Process Mapping Midwifery Students’ Clinical Placement in Sierra Leone: Identifying Facilitators and Barriers

Practical sessions held in skills labs.

List of expected clinical competencies given to student.

Review of expectations for student performance and behavior during clinical placement is given.

School faculty assigns student clinical placement sites.

School faculty writes letter with student roster and objectives for clinical site.

Roster/objective letter is sometimes given to head of clinical site.

Sometimes the head of clinical site shares roster/objective letter with preceptors.

Sometimes schools call clinical sites to notify them of student roster/objectives.

Placement of students in rural community health centers is often delayed.

Students are sometimes oriented to clinical site.

Preceptors teach, support, and supervise students when time allows

• ○ Types of teaching, support, and supervision:

  • ▪ observation

  • ▪ return demonstration

  • ▪ asking questions to determine knowledge gaps

  • ▪ review and discussion of student documentation in patient chart

  • ▪ reflection/debriefing after clinic session

Midwifery school faculty sometimes visit clinical site to observe and support students.

Head nurse of the units sometimes informs preceptors of students’ clinical objectives.

Preceptors are assigned to one or more students.

Students are responsible for signing in and out of clinical to monitor daily attendance.

Preceptors assign students to a day or night shift.

Preceptors assign students to various locations in the clinic or hospital (e.g., postpartum unit, triage unit, operating theater).

Preceptors sign off on student’s clinical proficiency in student log book.

Students report to clinical placement site.

Staff “compromise”/ make deals with students.

Preceptors sometimes give feedback to school on student attendance and performance.

Students return to school.

Students prepare for exams.

Preceptors review and sign students’ log books/portfolio books.

Faculty review students’ log books/portfolio books.

School faculty and preceptors occasionally meet to discuss a student’s performance.

Students sometimes evaluate their clinical placement site.

Students are sometimes asked to recommend good preceptors.

Preceptors occasionally get feedback from students.

Adequate number of preceptors for midwifery students

A well-defined, standardized, national preceptorship program

Clear roles and responsibilities of a preceptor

Memorandum of understanding between midwifery schools and clinical sites

Standardized communication system between clinical facilities, preceptors, students, and schools

Timely update of policies and guidelines are communicated to preceptors

Students come to clinicals with their own equipment and consumables

Preceptors give training in educational theory

Schools and clinical sites hold students accountable for their actions

Having housing arrangements for students in rural community health centers

Standardized system for all students when they report to clinical placement

Preceptors have access to the school simulation lab to teach students

Office space for preceptors at clinical site

Supportive culture for preceptors

National Midwifery Procedure Manual to standardize midwifery education

Adequate time in clinical placement for students to meet learning objectives

Code of conduct for students and preceptors

Lack of clear communication between students, schools, preceptors, and clinical sites

Clinical rotations are too short to achieve clinical objectives

Limited physical space to accommodate students at clinical sites

Large numbers of students sent to the same clinical sites

Inadequate teaching, support, and supervision of students by preceptors

Inadequate teaching, support, and supervision of students by midwifery faculty

Lack of transportation for students to clinical sites

No housing for students in rural clinical sites

Unmotivated students

Unmotivated preceptors

Preceptors “compromise” with students in exchange for benefits or money

Preceptors not being up-to-date in clinical skills and evidenced-based protocols

Students and preceptors not following clinical objectives outlined by school

Students are not evaluated according to required competencies

Limited equipment, medications, and supplies (e.g., blood pressure cuffs, gloves)

Students are not punctual in arriving at clinical sites each day

Preceptors are not punctual in arriving at clinical sites each day

Preceptors lack ownership of preceptor assessment

Preceptors bullying students