International Confederation of Midwivesʼ
Model Curriculum Outlines forProfessional Midwifery Education
ICM Resource Packet #1
Background & Curriculum Development Process

1 Introduction
The Need1
The global shortage of midwives and others with midwifery skills has been widely
recognised and discussed for many years. In 2005, for example, the World HealthOrganization (WHO) estimated that an additional 334,000 midwives were needed overthe next 10 years to provide skilled care for 72% of the childbearing women in 75
countries.2 There are still too few midwives and others with midwifery skills to meet thecontinuing challenge of the 52 million births per year that occur without a skilled
midwife present, many of which contribute to the 350,000 maternal deaths, 3 million
newborn deaths, and 2.6 million stillbirths that are occurring yearly.

Many global agencies have pushed for increasing the number of new midwives
graduating from existing programmes or establishing new midwifery programmes tomeet this challenge.3 However, midwifery education programmes vary widely incontent and quality within and across countries. The ICM took on the challenge toclearly define what is needed in pre-service education in order to prepare a fully© ICM June 20121

qualified midwife capable of improving the quality of care as well as reducing
unnecessary maternal and newborn deaths. The ICM challenge resulted in updating
the content and evidence base of the ICM Essential Competencies for Basic Midwifery
Practice, completed in 2010, that form the core content of a midwifery pre-service
program and establishing the ICM Global Standards for Midwifery Education,completed in 2010, that offer a framework for organizing and establishing a quality
midwifery pre-service education programme.

The next step in ICM’s leadership in midwifery education was the development of thisseries of resource packets that offer examples of Model Curriculum Outlines forProfessional Midwifery Education along with supportive information. The model
curriculum outlines include organizational frameworks for all the ICM basic
competencies within a three-year time frame for a direct entry programme and within
an 18-month time frame for a midwifery programme built upon prior health professional
education (post-registration). The curricula are competency-based in theirapproaches to teaching and learning. Many have suggested that the time frame ofthree years for a direct entry pre-service programme and 18 months for a
post-registration midwifery programme is unrealistic for some countries (too little forsome, too much for others). However, these time frames were agreed by consensus
and expert opinion in 2010, and now need to be further evaluated. “Evidence showsthat the opposite [to short courses with limited competencies] is needed to develop
midwifery competencies; namely, more competency-based teaching, more training inclinical settings, and better access to qualified staff.”4 It is anticipated that these ICM© ICM June 20122

documents will be used by midwifery educators, consultants, midwifery regulators,
researchers, and policy makers to strengthen midwifery pre-service education
throughout the world as a key strategy for saving lives and improving the health ofwomen and childbearing families.

Overview of Model Curriculum Outlines
The model curriculum outlines for professional midwifery pre-service or basic
education have been prepared by the International Confederation of Midwives (ICM)
within a series of four resource documents. The curriculum outlines and suggested
organization of content are based on the principles of adult learning5 and arecompetency-based6 in their design and teaching and learning strategies. The model
curriculum outlines are conceptually framed by the ICM Definition of the Midwife(2011)7, the ICM Philosophy and Model of Care (2008)8, and the ICM International
Code of Ethics for Midwives (2008).9 The curriculum outlines adhere to the ICM Global
Standards for Midwifery Education (2010)10 and include all the ICM Essential
Competencies for Basic Midwifery Practice (2010).11

Types of Midwifery Programmes
Generic midwifery (direct-entry)
The sample curriculum outline and suggested content areas in Resource Packet #2,
Appendix A.1., are generic to a three year direct entry midwifery programme following
completion of secondary education, at a minimum. The graduate, upon successful
completion of the required learning outcomes, would be a fully qualified12 midwife© ICM June 20123

eligible for registration and/or licensure to practice full scope midwifery. Therefore it
can be adopted by countries that do not yet have a professional midwifery education
programme. The midwifery curriculum outline and suggested content can also be
used by countries to review and update/strengthen an existing pre-service midwifery
programme so that graduates can meet the international definition of a midwife.13

Countries may find the suggested midwifery curriculum outlines helpful in expanding
the content of an existing programme using the additional competencies in order tomeet the changing health care needs of women and childbearing families in their areaof the world. If pre-service midwifery education in a given country is offered within adegree-granting institution of higher learning, there will most likely be additionalfoundational courses or courses outside the midwifery requirements needed for sucha degree. Such programmes will also often have additional education qualifications
and responsibilities for midwife teachers, such as doctoral preparation and/or
responsibility to teach non-midwifery courses such as research methodologies.

Midwifery following other health provider preparation (e.g. nursing)
The sample midwifery education programme outlined in Resource Package #2,
Appendix A.2., can be adapted by countries that require completion of a nursing orother health care provider education programme prior to midwifery education. The
model curriculum outline is designed so that those health skills and knowledge gainedin a previous health provider education programme are identified and/or madepre-requisite to beginning the 18-month post-registration midwifery programme. The© ICM June 20124

post-registration midwifery programme is based primarily on the midwifery
competencies not included in a prior health professional programme.

The ICM Global Standards for Midwifery Education (2010) suggest that any
post-nursing/health provider programme in basic midwifery is a minimum of 18 months
in lengthi to allow sufficient opportunity for the learner to acquire and demonstrate all
the midwifery core competencies that could not be demonstrated upon entry to the
midwifery portion of the programme.

It is important to note that the competencies required for midwifery already acquired ina prior program of health provider study must be identified and demonstrated before
entry into the rest of the basic midwifery education programme. It is helpful if
post-health provider or post-registration midwifery programme teachers develop
challenge mechanisms that allow the applicant to demonstrate prior competencies(knowledge, skills and behaviours needed for midwifery practice.14

Other types of basic midwifery education programmes
At this time the ICM is not inclined to support any type of ‘integrated’ nursing andi

The time periods in the ICM Global Standards for Midwifery Education are based on expert opinion

and consensus. Currently there is no other type of evidence to suggest how long it takes an averagelearner to complete all the competencies. This fact allows some flexibility in design of an individual
programme provided there is substantial evidence all essential competencies have been met and thatthe graduates are competent and contributing to quality midwifery care after they complete thepre-service education programme.

© ICM June 20125

midwifery programme unless the midwifery content includes sufficient theoretical andsupervised midwifery practical experiences in a variety of settings so that eachgraduate is able to demonstrate all the ICM basic midwifery competencies. In general,
integrated programmes of nursing and midwifery do not have sufficient time andclinical resources to prepare individuals who are competent to practice full scope
midwifery and who have the confidence to take full responsibility for attending births
upon graduation. There may be some exceptions to this belief about integrated
programmes, and countries are urged to provide evidence that such a programme issuccessful in preparing a fully qualified midwife.
Definition of Key Words
This is the first of the four ICM resource packets. Each packet will be translated into
multiple languages for use internationally, beginning with English, Spanish andFrench. Therefore the choice of key words used throughout the documents requires
common understanding or meaning. Many words or terminology that will be used inthis document have already been agreed by ICM and can be found in Resource
Packet #3 as the ICM Glossary of Terms June 2011.
Organization of the Resource Packets
The four resource packets that comprise the ICM Model Curriculum Outlines forProfessional Midwifery Education include:
Packet #1: Background and the curriculum development process. This packet of
information provides the ICM framework for developing a pre-service midwifery
programme and an approach to understanding how to put a curriculum together (theprocess) along with related questions that need to be answered in order to meet the© ICM June 2012

6

ICM Global standards for midwifery education (2010).
Packet #2: Model midwifery curriculum outlines. This packet describes thesuggested placement of the required midwifery competencies with their associatedknowledge, skills, and behaviours (KSBs) within specific modules (instructional units)ii
for each year of the three year direct-entry midwifery programme (Appendix A.1.) as
well as a sample outline for programmes that admit post-registration health providers(Appendix A.2). Two sample modules are included to demonstrate how to construct a
module and to stimulate reflection on what content might be included. These modules
include exemplary or typical content (KSBs) from a given competency statement, but
not all those KSBs required by the ICM Essential competencies for basic midwifery
practice (2010). Please note that the division of competencies and KSBs into course
units or modules is based on reasoned decisions and preferences of the midwifery
teachers in a given programme.
Packet #3: Resource documents. This packet contains suggested resources that
relate to how to establish and teach in a competency-based pre-service midwifery
curriculum. The Packet includes helpful websites, along with the core ICM documents
to be used as references in designing or reviewing a basic midwifery education
program and suggested textbooks.

ii

The organization of the modules /course units by year found in Resource Packet #2 follows a logicalprogression (hierarchy) of learning from simple to complex, healthy to complications, basic knowledge
to application and complex thinking. The required content is in keeping with the ICM Essential
competencies for basic midwifery practice (2010). However, the titles of modules and content
placement are suggestions and may be moved around based on needs and preferences of anindividual country or educational unit/institution.

© ICM June 20127

Packet #4: Teaching and learning in a competency-based curriculum. This packet
of information provides detail on adult learning processes and a variety of teaching
and learning strategies that can be used to promote the development of midwifery
competencies. This packet is offered for those individuals new to teaching midwifery
and/or new to teaching in a competency-based curriculum.
The resource packets may be viewed in any order. However, it is suggested that one
review Packet #1 to better understand the organization of content in #2, especially ifteachers are unfamiliar with curriculum development and the new ICM Global
standards for midwifery education (2010) or the updated ICM Essential competencies
for basic midwifery practice (2010).

Packet #3 provides some generic resources forteachers and needs expansion to include country-specific resources. Packet #4 is aself-contained module focused on how to teach in a competency-based curriculum
and may not be useful for experienced educators familiar with competency-based
education. This packet may be set aside if not needed or used during theestablishment of a new competency-based curriculum.

2

Midwifery Curriculum Development Process

The definition of a ‘curriculum’ used in this document is based on the ICM definition15
and refers to a series of discrete activities, carried out in a logical order or sequencethat culminates in a clear description of what learners are expected to know (theory)
and are expected to demonstrate (practice) at the time of completion of a midwifery
programme of study. Therefore, a midwifery curriculum begins with clear statementsof mission, philosophy and expected outcomes of learning, reflecting all three© ICM June 20128

domains of learning (cognitive, affective and psychomotor). The curriculum also
includes teaching, learning and assessment activities that facilitate the acquisition anddemonstration of the required midwifery competencies for beginning midwifery
practice in an ever-changing, complex, multicultural context. In other words, acurriculum is a dynamic process that reflects the midwifery profession’s responses tosocietal changes and the reproductive health needs of women and childbearing
families. An individual curriculum also reflects the beliefs and experience of midwifery
teachers and will vary in organization from country to country and within countries.16
A brief explanation of how to develop a cohesive curriculum, including the mostcommon elements, is offered for those who may not have had this experience before
or as a review for those well versed in the design and implementation of a midwifery
curriculum. Refer to Appendix A: Components of a Competency-Based Midwifery
Curriculum (Thompson 2011) for a graphic representation of the following discussion
designed to help one understand how each element of a curriculum fits together. It is
important to remember that development of a curriculum is a process. Though thegraphic representation appears linear and is intended to follow a logical progressionof development (e.g., programme outcomes flow from mission and philosophy),curriculum development/review also requires back and forth thinking and reflection toensure consistency of ideas, content, and expectations throughout. Curriculum
development has also been described as a spiral process with each year built upon
the prior year or content.17 It is also important to understand that however teachers
decide to put together their midwifery curriculum, the framework must be consistent
with the mission and philosophy statements of the institution in which the education© ICM June 20129

programme is based, must reflect the values and beliefs of the teaching group, andbe linked with current and future trends in midwifery practice.18
Mission and Philosophy
The first step in designing a midwifery curriculumiii is to gain consensus from all
midwifery teachers who will be a part on the programme on the mission andphilosophy that will frame not only what is taught but also how it is taught. A statementof mission describes the purpose of the education programme in one sentence,usually. It answers the questions:v “Why does this programme exist?”v “How will this programme be implemented (core values)?”v “Why is this programme important (passion) to society?”
One example of a mission statement is, “The purpose of this education programme isto prepare a competent midwife who will positively contribute to the health of womenand childbearing families in this country.” In addition, the mission statement needs toalso fit with the mission of the educational home where the programme will be/isoffered. For example, if midwifery preparation is offered within a university degree
programme, the mission will also reflect the importance of that degree or level of
preparation.iv
iii

Throughout this document, the term “curriculum” refers to the essential components that organize the content of a

midwifery programme and how they are implemented.
iv

It is important to realize ahead of time the level of support needed for introducing a basic midwifery programme into

a given educational home (institution). (Read over)If the educational home has little interest in midwifery, there may not sufficient support for sustaining a quality midwifery
offering.

© ICM June 201210

The philosophy of any midwifery programme will generally reflect what the teachers
believe about 1) how adults learn, 2) how to facilitate learning in adults, and 3) how topractice midwifery.19 These three elements of the programme philosophy shouldreflect the partnership among learners, teachers, and the women seeking midwiferycare. Another way to explain the components of a philosophy statement is that aphilosophy of education looks inward to the parent discipline (midwifery competencies
and practice) and outward to educational practice (teaching and learning).
The first two parts of a philosophy statement are often viewed together. Most teachers
will teach others how they have been taught unless they reflect on whether thatapproach is fitting for today’s world of fast-paced knowledge development and thecompetence expected of midwives. It is possible that the way one has been taught in
the past will not fit today’s world of teaching and learning in midwifery. If teachers havenot thought about teaching and learning with adults, it is suggested that they review
the variety of learning theories to determine what they believe about adult learning andhow they can facilitate learning in adults. Refer to Resource Packet #4 for a review ofmajor theories of learning focusing on adults, competency-based teaching with adults,
and how to facilitate learning in a competency-based programme.
The midwifery teacher’s reflection on teaching begins with understanding that adults
learn differently from children; in other words, most adults want to be active
participants in their learning and not passive recipients of the teacher’s knowledge
and skills. The need for adult learning approaches is vital for midwifery education
given the high level of responsibility that an individual must take in their practice thatdemands evidence throughout the programme of study that they have taken© ICM June 201211

responsibility for their own learning (active participants) and demonstrated
accountability in independent decision-making. Midwifery practice requires criticalthinking and reflection, ethical accountability, and internal or self-motivation – key
characteristics of adult learning. An adult learning approach may be difficult toachieve initially for both learners and teachers who have not participated in such alearning environment previously, but the efforts are well worth the outcome of anautonomous midwifery practitioner.

The ICM Philosophy and model of midwifery care (2008)20 is an excellent resource
document that can be used by teachers to clarify what they believe about the practiceof midwifery and what they expect of the relationships among teachers, who areexpert midwives, learners, and the women seeking midwifery care. These beliefs
about midwifery practice have implications for the content of a midwifery
programme.21

For example, the ICM philosophy of midwifery care refers to birth as “anormal physiological process” that has implications for not only the content of thecurriculum but also the sequence of content (e.g., from normal to complicatedchildbearing). Another belief is that “midwifery care takes place in partnership withwomen.”

This speaks to the importance of expecting learners to understand thenature of the partnership with women as they learn to be midwives (described inpractical outcome statements). There is also a philosophical belief that refers to theneed for both art and science in midwifery care, provided within a holistic approach”grounded in an understanding of the social, emotional, cultural, spiritual,
psychological and physical experiences of women and based upon the best evidence© ICM June 201212

available.” Thus the curriculum with its expected learning outcomes must include abalance of science and art in the content of the programme.
It is the responsibility of midwifery teachers to clearly define their beliefs about thepractice of midwifery that they will be modelling22 and expect learners to embracethroughout the education programme. The exact wording may vary from programme
to programme, but the philosophy should reflect, at a minimum, the beliefs behind thecore ICM documents (definition of midwife, philosophy and model of care, code of
ethics, and competencies) in addition to what individuals teaching in the programme
want to add.
Programme Outcomesv
The midwifery programme outcomes reflect the expectations of competency needed
for successful completion of the programme of study. Thus the outcomes reflect
midwifery competence in reproductive health, prenatal, intrapartum, postpartum,
newborn and infant, and abortion-related care. Some programmes use a single
outcome statement such as, “Provides full scope, evidence-based, appropriate
midwifery care for women and childbearing families.” Other midwifery teachers want a
bit more detail in the programme outcomes in order to reflect curriculum threads orthemes throughout. These outcome statements might refer to use of critical thinking
and clinical reasoning, conducting oneself according to a code of moral behaviour,
practicing in accord with professional standards, or effective participation inv

Throughout this document the term “outcome” will be used instead of “objective” to define what is

expected of the learner in terms of knowledge, skills, or professional behaviour competencies. This term
is consistent with ICM Glossary of Terms (2011) and Global Standards for Midwifery Education (2010).
Midwifery teachers may elect to use the term ‘objective’ if that is more familiar to them.

© ICM June 201213

interdisciplinary teamwork. For programmes that include other non-midwifery content,
there will be outcome statements reflecting that content, such as, “Completes a thesison an approved topic”.
It is suggested that there be relatively few programme outcomes as they are the final
expectations (highest level of performance) for successful completion of the
programme of study. Each module/unit of instruction/course will have more specificoutcomes relating to one or more of the programme outcomes. Similarly, each sub-unit
within a module may have even more detailed outcomes for the learner. Taken
together, all of the stated learning outcomes will help the learner achieve the overall
programme outcomes. Thus, the programme outcomes provide the broad framework
within which the rest of the programme details must fit.
Level OutcomesSome teachers find it helpful to describe learning outcomes by year of the
programme. For example, the outcomes for year 01 of a three year programme may
be quite specific to the science base needed throughout the programme andtherefore the level outcomes would relate to the sciences overall and would bebroader outcome statements than the specific module learning outcomes or theirsub-units (anatomy, physiology, epidemiology). The level outcomes are a subset ofthe programme outcomes, and are optional. If used, each level would have its own
outcomes with expectations for performance at the end of that level bycontent/practice area. It is not necessary to articulate level outcomes to have a
successful competency-based curriculum. Having such outcomes is the choice of the
midwifery teachers.

© ICM June 201214

Module/Unit of Study/Course Outcomes
Once the programme outcome(s) is/are agreed, it is time to consider how to divide thecontent, including practical experiences, into smaller units of study based on the levelof the learner (novice, advanced beginner) needed to meet the programme outcomes.
A generic midwifery programme uses the ICM Essential competencies for basic
midwifery practice (2010) to define the core content (knowledge, skills, behaviours)
needed. Programmes have the option to add additional competencies and content asneeded in their country. The division of the entire spectrum of content andclinical/practical experiences results in discrete units of study called modules orcourses or instructional units.vi The decision on what content goes where and the titleof each module rests with the midwifery teachers, and will vary from programme toprogramme and country to country.
Each of the modules require learning outcomes that are based on what the learnerneeds to know and demonstrate at a specific point/time in the programme in order toprogress towards midwifery competency in a given practice area and, subsequently,
in all practice areas. However, not every aspect of each outcome (KSBs) may beassessed (e.g. sample testing for theory).23 Generally speaking, a module willaddress a discrete area of practice, such as antenatal care. The composite of learning
outcomes from each of the modules should address the programme outcomes as
noted earlier (and not go beyond them).

vi

For purposes of simplicity in this document, the term “module” will be used throughout though eacheducation programme will use their own terminology for naming the unit of instruction. In addition,“learner” will be used instead of student to reflect adult learning principles.

© ICM June 201215

The timing and sequence of each module is based on the educational philosophy ofthe programme and the teachers’ understanding of what facilitates learning in adults.
In other words, the midwifery teachers need to decide the order (placement) of theseven competency statements and which KSBs should come first (simple to complex,
familiar to unfamiliar) to offer learners successful experiences in learning so they
continue to be motivated to learn more complex ideas and practices. This means thatthe overall midwifery competency statements may appear in all three years of a directentry programme, distinguished by the complexity of content, skills and behaviours
required at the end of each year of study.
Content and Course Descriptions
Each module needs to identify the knowledge, skills and behaviours (KSBs) needed tomeet the module outcomes. The essential principle is that learning outcomes andcontent need to match. It is helpful to have the outcomes and content defined before
actually writing the course description, which is an overall or general description ofmodule content.
Learning Activities and Teaching Methods
Once a module is created, it is time to select specific learning activities and teaching
methods that are consistent with the learning outcomes and required content thathave been clearly defined. The learning activities and teaching methods need to fit ormatch the learning domain (cognitive, affective, psychomotor). Refer to Resource
Packet #4 for more detail on specific teaching and learning activities in a competency
based programme by knowledge domain.

© ICM June 201216

Assessment & Evaluation Methodsvii
The most appropriate valid and reliable assessment methods of learner progress must
be included as essential components of the module, matched to the domain oflearning and content being evaluated. Timing of assessment, including learner
self-assessment, is an important decision made at the beginning of the module so thatboth learners and teachers know when to expect such assessment activities. Since
safe practice is one of the hallmarks of quality midwifery care, one of the assessment
criteria should always be that the learner knows what s/he knows, knows what s/hedoes not know, and seeks help appropriately. The other areas to assess include
evaluation of teacher effectiveness, course evaluation and periodic programmeevaluation by an external body, e.g. the regulatory authority in the country or aseparate accreditation body for midwifery education.
Successful Completion of Programme Outcomes
Successful completion of the midwifery education programme occurs when thelearner completes all the learning requirements and demonstrates competency in fullscope midwifery practice.
3 Key Decisions Related to the Design & Implementation of a Midwifery
Education Programmeviii
vii

Assessment is defined by ICM as the systematic process/procedure for collecting qualitative andquantitative data to measure, evaluate or appraise performance against specified outcomes orcompetencies. Some countries’ education authorities distinguish between assessment of learnerperformance and evaluation of courses and teachers. What is important is consistency in use of theterms.
viii

This document distinguishes between the terms “curriculum” and ‘programme” following the ICM

Glossary of Terms. Curriculum is “a systematic process that defines the theoretical and practical content© ICM June 201217

The final section of this first resource packet addresses many of key decisions needed
when designing or evaluating a competency-based programme. The decision-making
process is aligned with the ICM Global standards for midwifery education (2010) andCompanion guidelines (2011).
Basic considerations are posed in the Preface to the standards and include:• Type of programme: Direct entry or post health professional?
• Length direct entry programme:

3 yearsix or longer?

• Length post health professional programme: 18 months or longer?
• Entry level of students: Completion of secondary education or more?
Standard I: Organization and Administration• What is the most advantageous location/education home for the midwifery
programme in the country/region (goodness of fit)?
• To what extent does the midwifery programme reflect the social and politicalstructure of its educational home?
• What budget will be/is needed for the midwifery programme and where will theof an education programme and its teaching and evaluation methods.” A midwifery programme includes
the curriculum (defined course of study to prepare competent midwives), along with many otherdecisions related to length of study, admission criteria, teacher qualifications, costs of study, teaching
and learning strategies, evaluation and assessment methods, etc. See Section 3 of this document.

ix

ICM recognizes that setting minimum time (length) of any type of competency-based midwifery

educational programme, regardless of entry point, is an approximation. The actual time needed may varydepending on many factors within countries, such as availability of qualified midwifery teachers andsupportive practical learning sites. The time limits were based on global patterns of midwifery educationthat graduate fully qualified midwives agreed by ICM member associations.

© ICM June 201218

needed funds come from?
• Are there strategic/collaborative partners in the country who might help support the
programme financially and otherwise?
• Who will have control over the budget and expenditures?
• Who will direct the midwifery programme and does that person meet expected
qualifications?
• To what extent does the midwifery programme address national workforce needs?
Standard II:

Midwifery Faculty [Teachers, Preceptors]• How will the programme director determine whether all professionals teachingtheoretical content are competent in the areas they are teaching?
• How will the programme personnel determine whether all midwives teaching in the
programme are competent (up-to-date) in midwifery practice and legally recognized?
• What type of formal preparation for teaching is needed and/or provided forindividuals teaching (theory & practical) in the midwifery programme?
• How does the student/teacher ratio used in the programme allow time for each
student to be directly supervised by a competent midwifery clinical teacher/preceptor
so that they are observed demonstrating all the essential competencies (knowledge,
skills and behaviours) prior to completion of the programme?
• How are midwife teacher roles and responsibilities defined (theory & practical)
and how will teacher effectiveness be assessed/evaluated at regular intervals?
Standard III:

Student Body

• What informational materials (type, content) are needed to publicize the midwifery
programme to prospective applicants and to the community at large? Has a© ICM June 201219

needs assessment been completed?
• What are the eligibility requirements for applicants to the midwifery programme
and to what extent do they match the applicant pool?
• How many midwifery students can be accommodated by the midwifery
programme based on available human resources (teachers) and practicalplacement sites?
• What informational materials (type/content) are needed for individuals enrolled in
the midwifery programme?
• How can students, teachers and clinical preceptors benefit from the developmentof “communities of learning”24?
• How will the programme determine whether there are sufficient midwifery
practical experiences available in a variety of sites for each student enrolled?
• How does the midwifery programme plan to engage qualified practicing midwives
in the teaching and supervision of midwifery students in practical settings?
Standard IV: Curriculum• Does the design of the midwifery curriculum follow a logical process and reflect
the expected outcome of preparing a competent professional midwife? [Seecurriculum schemata in Appendix A]• Are all the ICM Essential competencies for basic midwifery practice 2010
included in the midwifery programme and can they be identified in a specificcourse/module/unit of study?
•

What evidence-based teaching and learning strategies are used in the

programme and are they consistent with principles of adult learning and© ICM June 201220

competency-based education?
•

What is the ratio of theoretical to practical learning experiences and how will the

programme demonstrate the effectiveness of this ratio?x•

What type of multidisciplinary content, such as pharmacology, and learning

experiences (e.g., learning with obstetricians) are included in the midwifery
programme and are the teachers advised about specific content needed by midwifery
students?
Standard V:•

Resources, facilities and services

What is/should be included in written policies about environmental safety andwell-being measures for students and teachers?
•

How will programme personnel determine whether they have sufficient teaching

and learning resources, including access to evidence-based references, mannequins
and charts, qualified teachers, preceptors, and practical learning sites?
• What type of administrative agreements between programme and practical sites
are needed to allow student midwives to learn in a given site?
Standard VI:

Assessment Strategies• What type of assessment methods will be/are being used to determine student
learning of knowledge, psychomotor skills, professional behaviours, and criticalx

The ICM standards require at least 50% of time spent in the midwifery programme will be inclinical/practical sites supervised by qualified midwifery teachers. At least 40% of time spent must betheoretical, with the remaining 10% decided by faculty based on country needs. For example, somecountries have limited clinical/practical experiences for each student so may need to add morepractical time for each student to achieve competency. Other countries may have specific burdens ofdisease or environmental conditions that the midwifery student needs to study, so more theory might be
included.

© ICM June 201221

thinking that leads to appropriate decision-making?
• How will/is assessment of student learning be integrated with performance andprogression throughout the programme?
• What strategies will be/are employed with individuals who are having learning
difficulties and is there a time limit that must be met to be considered success inlearning?
• What criteria will be/are used to determine successful completion of the midwifery
education programme?
• What plans will be/are in place for regular assessment of the curriculum andexternal review of programme effectiveness?

Summary
Once the midwifery teachers have discussed the curriculum process and reachedconsensus on the questions posed for programme development and others asneeded, it is time to begin the design of individual modules with learning outcomesand expected KSBs in each. The ICM Resource Packet #2 describes two model
curriculum outlines with suggested organization of content into modules andassignment of each of the seven ICM Competency statements and specific KSBs by
year or month of the programme. It is important to realize that these are examples of
how to organize midwifery competencies and KSBs. There are many different,
plausible ways to organize a midwifery programme that allow an individual learner toachieve midwifery competency. The main point is that midwifery teachers need to fully
understand the components of curriculum and programme development, and make

© ICM June 201222

reasoned decisions for their choices based on current evidence-based educational
standards.

1

PMNCH. Knowledge Summary 14: Save lives: Invest in Midwives. Retrieved on April 18, 2012, fromhttp://portal.pmnch.org/knowledge-summaries/ks14
2

WHO. World Health Report 2005. Geneva: WHO

3

UNFPA/ICM. State of the World’s Midwifery Report 2011. New York: UNFPA.

4

PMNCH. Knowledge Summary 14: Improving competency-based education.

5

ICM Glossary of Terms. “Adult learning involves active participation of a mature student in learning

based on life goals and building upon/incorporating prior learning and life experience.” The Hague:
ICM, 2011. Knowles M.
6Andragogy in action. San Francisco: Jossey-Bass, 1984.

Fullerton JT, Gherissi A, Johnson P, Thompson JB. Competence and competency: Core concepts forinternational midwifery practice. International Journal of Childbirth 1 (1) 2011.
DOI:10.1891/2156-5287.1.1.4

Sportsman S. (2010). Competency education and validation in the

United States: What should nurses know? Nursing Forum 45 (3), 2010, p. 141-142. ICM Glossary ofTerms 2011: Competency-based education includes teaching, learning and assessment activities thatare sufficient to enable students to acquire and demonstrate a pre-determined set of competencies as
the outcome of learning.” The Hague: ICM.
7ICM. Definition of Midwife 2011. The Hague: ICM.

8ICM. Philosophy and Model of Care 2008. The Hague:ICM.

9ICM. International Code of Ethics for Midwives 2008. The Hague: ICM.

10ICM. Global Standards for Midwifery Education 2010. The Hague: ICM.

11

ICM. Essential Competencies for Basic Midwifery Practice 2010. The Hague: ICM.

12ICM Global Standards for Midwifery Education 2010 define a “fully qualified midwife” as an individual

educated and trained to proficiency in all the ICM basic competencies; in other words, a person whomeets the 2011 ICM Definition of a midwife. This terminology does not include others who may use thetitle ‘midwife’ but who are not able to demonstrate all the ICM basic competencies and who may or may
not be legally recognized in a given country.
13

ICM. International Definition of the Midwife. The Hague: ICM, 2011.

14

Accreditation Commission for Midwifery Education (ACME). The knowledge, skills, and behaviours

prerequisite to midwifery clinical coursework. Silver Spring, MD: ACNM, revised 2005.
15

ICM. Glossary of Terms June 2011. The Hague: ICM, p. 5. It reads, “Curriculum is a systematic© ICM June 201223

process that defines the theoretical and practice content of an education programme and its teachingand evaluation methods.”
16

Many midwifery programmes place their curriculum outlines and course descriptions on the internet.

For example, one can view the Seattle Midwifery School direct-entry curriculum atwww.seattlemidwifery.org/midwifery-eduation/curriculum-overview/ or the nurse-midwifery anddirect-entry midwifery programmes at SUNY-Downstate Medical Center, NY atwww.downstate.edu/CHRP/midwifery/curriculum_intro.html

Other midwifery programmes throughout

the world are most willing to share what their midwifery curriculum outline is. However it is important tounderstand that simply taking another’s midwifery curriculum without understanding how it is put
together and why can result in less than optimal programme in one’s own country.
17

RCM WHO Collaborating Centre/MANM Preparation Programme for Midwives (Macedonia).

Midwifery 3 year curriculum. London:RCM, September 2011, p. 12.
18

Boland D. Developing curriculum: Frameworks, Outcomes and competencies, p. 142. Chapter 9 inBillings DM & Halstead JA. Teaching in nursing: A guide for faculty 3rd Edition. St. Louis: Sanders.
19

Thompson JE, Kershbaumer RM, Krisman-Scott MA. Educating advanced practice nurses andmidwives: From practice to teaching. New York: Springer Publishing Company, 2001. Chapter 4:
Educational philosophy and adult learning, pp. 47-56.
20

ICM. The philosophy and model of midwifery care, 2008. The Hague: ICM.

21

Walsh D. In Downe S, Byrom S, Simpson L (ed). Essential midwifery practice: Leadership, expertiseand collaborative working. London: Wiley-Blackwell, 2011.
22

Bluff R, Holloway I. The efficacy of midwifery role models. Midwifery 24: 301-309, 2005.

23

Atherton JS. Teaching and Learning; Objectives 2011. [On-line: UK] retrieved 27 March 2012 fromhttp://www.learningandteaching.info/teaching/objectives.htm
24

Holland K, Lauder W. A review of evidence for the practice learning environment: Enhancing thecontext for nursing and midwifery care in Scotland. Nurse Education Practice, 2012.

© ICM June 2012

24

	
  	
  	
  	
  	
  

	
  

Appendix A
Components of a Competency-Based Midwifery Curriculum*

MissionPhilosophy

Level
Outcomes

Programme
Outcomes

Course**Outcomes

CourseOutcomes

CourseOutcomes

CourseOutcomes

CourseOutcomes

Content***

Each course/module
consists of

CourseDescription

Learning
Activities*Basedon
Kershbaumer,
Scott (2001)
Educatingpractice
midwives.
Springer.

Thompson,Krisman-

Theory/Class

Outcomes

Assessment/
Eval. Methods

Student

Clinicaladvancednurses
and
New
York:

Joyce E. Thompson, DrPH,
RN, CNM

Teaching
Methods

Outcomes

Theory/Class

ClinicalOutcomes

Outcomes

International
Education
Consultant
in
Nursing,
Midwifery, & Ethics**course=module***minimum content = ICM
Essential
Competencies
2010

Successful Completion = Programme Outcomes Met

Program

Teacherr