EDUCATIONAL FRAMEWORK FOR PRIMARY MATERNITY SERVICES PART 2

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 accessuts Pty Limited PO Box 123 Broadway NSW 2007 Australia Tel +61 2 9514 1916 Fax +61 2 9514 1433 ABN 55 098 424 312 accessuts is a controlled entity of the University of Technology, Sydney

PROJECT TEAM Core Competencies and Educational Framework for Maternity Services in Australia Project 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.

TABLE OF CONTENTS Core Competencies and Educational Framework for Maternity Services in Australia Project 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

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 1 P a g e

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. 2 P a g e

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 Courses 1, RACGP Curriculum for General Practice 2, ACCRM Vocational Training Handbook 3, CDAMS Indigenous Health Curriculum Framework 4, NZCOM Education Framework 5, RANZCOG Curriculum Framework 6, and WHO Europe Midwifery Curriculum for Accredited Nurses 7, ACRRM Primary Curriculum Statements 8, 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. 3 P a g e

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 learners 1 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.) 4 P a g e

5 P a g e Core Competencies and Educational Framework for Maternity Services in Australia Project 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 reinforced 10-12. 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 satisfaction 10 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 respect 11. 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 contributions 10. This framework acknowledges the current dichotomy that exists between interprofessional learning and interprofessional practice. It is anticipated that this framework will promote the

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 womancentredness, continuity of care and carer 11. Learning is lifelong 2, 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). 6 P a g e

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. 7 P a g e

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 communication 13. 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: 8 P a g e

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 13. develop effective strategies to implement and support interprofessionalism and collaborative practice. Performance Elements/Outcomes Adopts effective styles and methods of communication and 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 Recognises the value of effective interprofessional relationships to achieve the best possible outcomes for the woman and her baby. Competency Standard 12. Develops effective strategies to implement and support interprofessionalism and collaborative practices. Competency Elements Knowledge Understands others roles. Understands when and who to refer to/consult with. Skills Recognises the role of other members of the health care team Adopts effective styles and methods of communication. Negotiates a collaborative care plan in consultation with the woman. Readily invites, acts upon, and offers, constructive feedback from peers and colleagues. Effectively manages change in a team environment. Attitude Appreciates the differing professional roles in maternity care. Acts to identify and respond to factors that facilitate or hinder interprofessional relationships. 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. 9 P a g e

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 Primary Maternity Service Provider (PMSP) will WOMAN CENTRED CARE PHILOSOPHY OF CARE 1. demonstrate a philosophy of care that is woman-centred, based upon the principles of primary health care and evidence-informed in every practice situation. 2. demonstrate respect, cooperation and collaboration in every interaction with all health care providers involved in primary maternity services to ensure the best outcomes for the woman and her baby. Performance Elements/Outcomes Provides individualised care that encompasses a woman s social, emotional, physical, psychological, spiritual and cultural needs and expectations. Relates the significance of past pregnancy experiences to a woman s current pregnancy. Provides unbiased and current information and evidence to assist the woman to arrive at the best decisions for her and her baby. Provides care that is culturally responsive, contextual, equitable, accessible, woman-centred and based on shared decision making. Works in partnership with the woman, her family and other support 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 10 P a g e

Domain Learning/Subject Area Learning Objectives The Primary Maternity Service Provider (PMSP) will Performance Elements/Outcomes life event for most women. PROFESSIONAL BODY OF KNOWLEDGE 3. apply maternity knowledge and profession specific skills to optimise maternal and newborn health outcomes. 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. Provides care that is based on relevant, evidence-based integrated knowledge of the human sciences, pregnancy, childbirth and postpartum/newborn period. 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 public health strategy. Provides care that considers and integrates the impact of a woman s 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. 11 P a g e

Domain Learning/Subject Area Learning Objectives The Primary Maternity Service Provider (PMSP) will Performance Elements/Outcomes 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 provide effective care for pregnant, birthing and postpartum women who are of normal risk. Provides care that integrates the physiological processes of normal pregnancy, birth and postpartum and the social, emotional, psychological and cultural needs of the woman and her family where pregnancy is 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 provide effective care when complications arise. Provides appropriate, timely and effective care where a woman or her baby has complex health needs and/or where complications, emergencies or urgent situations 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. 12 P a g e

Domain Learning/Subject Area Learning Objectives The Primary Maternity Service Provider (PMSP) will PROFESSIONALISM EQUITY 7. establish links with the woman/her family/community that are culturally appropriate, respectful and responsive. Performance Elements/Outcomes Provides care that is courteous, respectful and culturally responsive to the needs, priorities and preferences of the woman and her family. Reflects on own personal beliefs in relation to the provision of care and acts appropriately to eliminate care that diminishes, demeans or 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 professional code of ethics relevant to own practice/maternity service provider group (as available). Provides care in accordance with relevant codes of ethics and professional conduct. Works collaboratively to address ethical issues and breaches of 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 IMPROVEMENT 9. use and evaluate current relevant evidence to inform practice. Provides individualised care that is informed by current relevant evidence. 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 13 P a g e

Domain Learning/Subject Area Learning Objectives The Primary Maternity Service Provider (PMSP) will Performance Elements/Outcomes 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 professional development and the professional development of others. Participates in regular reviews of own and others professional development and learning needs. 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 responsibility for own practice and actions. Provides care that adheres to own knowledge base, scope of practice and standards of practice/care expected of own maternity provider group. 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. 14 P a g e

Domain Learning/Subject Area Learning Objectives The Primary Maternity Service Provider (PMSP) will Performance Elements/Outcomes WORKPLACE MANAGEMENT AND LEADERSHIP 12. work effectively with, and between, organisations. Provides care that promotes a climate of reflection, critical thinking and 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 implement and support interprofessionalism and collaborative practice. Recognises the value of effective interprofessional relationships to achieve the best possible outcomes for the woman and her baby. Adopts effective styles and methods of communication and 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 AND SAFETY 14. develop, participate in and maintain effective strategies that contribute to, manage and improve Occupational Health and Safety (OHS) processes within the workplace. Provides care that complies with relevant OHS requirements and safe working practices that include risk management and risk/hazard reporting processes and the maintenance of OHS documentation/records appropriate to professional role. COMMUNICATION PATIENT/CLIENT COMMUNICATION 15. engage in effective patient/client communication to ensure optimal maternal and newborn health outcomes. Responds in a calm, confident and approachable manner when communicating with each woman and her family. Uses a range of interpersonal communication principles and processes and adapts communication to the needs of and a level suited to the 15 P a g e

Domain Learning/Subject Area Learning Objectives The Primary Maternity Service Provider (PMSP) will Performance Elements/Outcomes 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 COMMUNICATION 16. engage in effective, appropriate intra and interprofessional communication to ensure optimal maternal and newborn health outcomes. Provides care that demonstrates effective and collegial relationships and effective communication styles and methods of consultation, referral and handover with all other health care providers. Recognises and responds to factors that facilitate or hinder intra and 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. 16 P a g e

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 Clinical placements Communication and collaboration skill workshops Emergency drill workshops Face to face workshops Facilitated discussion Assignments Clinical assessments CPD program membership Discussion groups Emergency drills in practice Exams/quizzes 17 P a g e

Interactive multimedia e-activities Interprofessional online learning groups Interactive reflective e-activities Journals Lectures Mentoring Online facilitated discussion, learning programs and reflection Reflective discussions and questioning processes Role play using scenarios Self guided learning Simulation including practice and debriefing exercises Observation in practice Observed interactions Online self assessment Peer and/or practice review Portfolio maintenance Practice assessment Reflective journaling Self assessment Simulated testing stations 18 P a g e

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 19 P a g e

GLOSSARY OF TERMS Adult Learning 14 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 Baby Capability 15 Code of Ethics Code of Professional Conduct A state of mind or a feeling; disposition. When baby is used this also includes the foetus. 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. Public declaration of the beliefs and values of a profession and the members of that profession. Statement and description of required behaviours, responsibilities and actions expected of members of a professional body when acting in a professional capacity. Collaboration Collaborative Practice Community 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. Within the practice setting, collaboration is an interprofessional process for communication and decisionmaking 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. Used to describe people who share a sense of identity or 20 P a g e

have common concerns. Communities are not always within a neighbourhood or locally-based. Competence 17 Competent 17 Competency 17 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. The person has competence across all the domains of competencies applicable to profession or occupation, at a standard that is judged to be appropriate. 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 care 18 Continuity of carer 18 Continuing Professional Development Disease processes Domain Evidence informed practice Health care providers Consistent philosophy or organisational structure underpinning the care provided. Care by a primary maternity service provider whom the woman has previously met, feels she has developed a relationship with and believes she knows. To regularly update, develop and refine knowledge, skills and attitudes relevant to professional practice. Includes pathological physical problems/conditions that affect the health of pregnant women. An organised cluster of core competencies that characterise a central aspect of primary maternity care. The judicious use of the best evidence available so that the clinician and the woman and her family arrive at the best decision, taking into account, the needs and values of the individual patient. Refers to all health professionals and the ancillary services 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. 21 P a g e