International Confederation of Midwivesʼ
Model Curriculum Outlines forProfessional Midwifery Education

ICM Resource Packet #4
Teaching and Learning in a Competency-Based Curriculum

Introduction
This resource packet includes a discussion of teaching and learning strategies that
promote competency-based learning in midwifery education. It begins with an overview
of various adult learning theories and how they might be used to facilitate both theacquisition and demonstration of midwifery competencies needed by learners. The
second section includes an overview of competency-based education and the specificattributes of teachers and learners needed to make this type of education successful. A
brief discussion of teaching methods and learning activities that contribute tocompetency development is also included. Finally, the last part of this packet provides
some of the key qualifications and responsibilities of midwifery teachers and learners in acompetency-based programme.
Prior modules have focused on use of ICM core documents in curriculum design andprogramme planning along with examples of a curriculum plan and sample modules.
This packet is directed at teachers who are new to teaching or who have not had
experience in competency-based teaching and learning strategies. New teachers may
wish to review this resource packet prior to exploring the curriculum outline and content
plan for basic midwifery education. Experienced midwifery teachers may find this review
helpful as well.
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Throughout the following discussion, it is important to recognize that teaching andlearning in whatever type of curriculum require common goals, shared responsibility andaccountability between teachers and learners, and supportive or enabling environments
to maximize success in learning. “Effective learning is learning which is lasting andcapable of being put to use in new and differing situations.”1 The partnership between
learners and teachers as adults in a competency-based programme is based on mutual
trust and respect along with a shared commitment to providing the highest quality,
evidenced-based midwifery care.
1

How do adults learn?

Overview of Learning Theories
There are many theories that attempt to describe how individuals (child/adult) learn, bothformally and informally.2 The primary reason behind learning theories is an attempt tounderstanding the processes and complexities involved in learning; that is, how does
one gain knowledge, move to understanding the meaning of that knowledge, and thenacquire needed skills in order to demonstrate their learning? The most common learningtheories include behaviorism and constructivist/cognitivist learning. Others include thehumanistic and social learning theories. Each of these learning theories has specificcharacteristics that further define how individuals learn that have implications for how
teachers can facilitate learning. Refer to Appendix A: Learning and Teaching: A Dynamic
Partnership for a graphic representation of these learning theories and their key
strategies for learning. This diagram also reinforces that understanding how people learncreates expectations of both teachers and learning based on mutual respect.
Behaviourism or behaviorist learning requires some type of stimulus for the learner tolearn (respond).3 One of the interesting characteristics of this learning theory is the belief
that all behaviour can be explained without the need to consider internal mental states(thinking) – it is conditioned by a stimulus. That stimulus is usually some type of reward
such as teacher positive reinforcement or a positive grade/mark. This form of learning isquite valuable in a competency-based curriculum for skill development, especially in apractical laboratory setting. This form of learning is described as teacher-centred in that© I © ICM June 2012

	
  

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the teacher is interested in the changes they can see in observable behaviour, such as
demonstration of specific midwifery skills.
Constructivism and cognitivist learning requires that the learner become active indetermining how they will learn to think critically.4 The teacher cannot ‘see’ the thinking,but can use such activities as requesting that the learner give their plan of action withrationale before proceeding to care for a pregnant woman. Cognitivist learning is
described as learner-centred in that the learner is using internal thought processes todiscover new ways of using past knowledge and new knowledge to provide midwiferycare. When something learned in the past does not fit with the current situation, thelearner experiences ‘cognitive dissonance’ and must resolve this before continuing tolearn. Teachers build upon their understanding of how learners learn in order tocreate/select effective learning activities.
Humanistic theory suggests that learning occurs because the learner has a specific goal tolearn and to fulfill one’s potential in life; e.g., becoming a qualified midwife.5 The learnerhas set a goal for learning and is supported in meeting that goal (self-actualization) by
teachers who are facilitators or coaches rather than austere, wise or sage givers ofknowledge. Humanism focuses on human freedom, dignity and potential and believes thatpeople act intentionally based on their personal values. This belief is in contrast to the
behaviourism belief that learning occurs only in response to external environmental stimuli
or the cognitivist belief that discovering knowledge and constructing meaning from this
discovery is central to learning.
Social learning theory is based on beliefs that people learn from one another via
observation, imitation, and modeling requiring attention, memory and motivation.6 In many
ways it is a combination of behaviourism, cognitivism/constructivism, and humanism. It is
not in common use in midwifery education at this time.
Adult Learning
Knowles7 and others8 have attempted to define how adults learn and whether this learning
is different from their learning as children. Educationalists and psychologists theorized
many years ago that adults are internally motivated to learn as they have a life goal

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(humanistic learning theory). They build upon prior life experiences that they bring to thelearning environment, and need support as they examine prior experiences and change
their thinking when needed to fit the midwifery role. Adults also need to be encouraged
and supported to take responsibility for their own learning. However, in order for adults tobecome active participants in their own learning, they need to know what it is that they are
expected to learn and demonstrate at the end of the educational encounter. Therefore,
adults need clearly defined expectations for learning (outcomes), suggested learning
activities, and repeated opportunities to think critically, reason morally, and make gooddecisions in their midwifery practice. Refer to the following text box for a summary ofcharacteristics of adult learners based on work of Knowles and Lieb9.
Taking responsibility for one’s own learning as an adult may be difficult for younger
students if they have not yet reached a mature understanding that they are responsible
for their own learning. This also implies that teachers need to encourage learners to takeon such responsibility and give them ample experiences to demonstrate their ability to doso.
Summary
Most teachers will teach others how they have been taught unless they reflect on whether
that approach is fitting for today’s world of fast-paced knowledge development and thecompetence expected of midwives. Generally speaking, teachers use a range of learningtheories in their teaching efforts, depending on the domain of learning (cognitive,
affective, psychomotor), the level of the student (novice, advanced beginner) and thelearning style of the learner. It is expected that teachers will know and understand alltypes of learning theory and learning styles in order to be effective in their teachingefforts.
When working with highly motivated adult learners, the teacher becomes more of a guideor facilitator of learning rather than one who tells the adult what to do. Facilitation oflearning can be compared to the approach to developing leadership; that is, the teacher
directs, coaches, supports learning, depending on the learner’s level of knowledge andconfidence.10 The final step in teaching adults is delegating direct care of women to theadult learner who is both competent and confident in their abilities to provide such care.
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What is competency-based education?

Competency-based education with its teaching and learning approaches has received agood deal of attention and support within the health professions in recent years.11
However, as with any newly emerging concept, there is no common definition being used
but there are some common elements. The most important of these elements is that thelearner must be engaged and active in all aspects of acquiring the knowledge, skills andprofessional behaviors needed to demonstrate practice in a specific discipline. In otherwords, competency-based education uses teaching and learning strategies that facilitate
the development and demonstration of competency.12 Other common elements include
the need to have a clear, evidence-based definition of the learning outcomes to be
demonstrated for performance of the professional role (i.e., the specific competencies).13
This clarity is vital to both teachers and students as it defines the expected outcomes oflearning without any ‘hidden’ agendas.14 Writing learning outcomes takes lots of practice
but is well worth the effort to learners and teachers.
The definition of competency-based education for the preparation of a fully qualified
midwife is a curriculum or programme of study that has as its primary learning outcomesthe acquisition and demonstration of all of the ICM Essential Competencies for Basic
Midwifery Practice.15 That is, competency-based education in midwifery uses the ICM
competency domains and their associated knowledge, skills, and behaviours (KSBs) as
the direct link between curriculum content and the expected outcome of learning - thepreparation of a fully qualified midwife ready for practice. These competencies also allow
for criterion-referenced assessment throughout the programme, eliminating potential
assessment bias from teachers or preceptors. The midwifery competency-based
curriculum is framed within the ICM Definition of a Midwife, Philosophy and Model ofCare, and the International Code of Ethics for Midwives.
Other aspects of competency-based education include attention to the learning needs
and patterns of adults, providing the time needed for the learner to acquire andrepeatedly perform or demonstrate the expected competencies (knowledge, skills,
professional behaviours) and creating a supportive/enabling environment for learning. All
health professions have a societal mandate to provide needed services to the public and© I © ICM June 2012

	
  

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therefore need to include social accountability in the educational process (relevance,
cost-effectiveness, equity, and quality).16 Competency-based education can be pursued
through various approaches to curricular design. Whatever the design, however, allcurricula need to be evidence-based and outcome focused and all teaching strategies
need to be matched to their learning domain (psychomotor, cognitive and affective).
In summary, competency-based education in midwifery, by definition, requires thatteachers as expert midwifery clinicians define in the competencies needed to practice asa fully qualified midwife based on the ICM Essential Competencies for Basic Midwifery
Practice 2012. Competency-based education thus implies that learners have limited
choice in what competencies need to be demonstrated. Learners do, however, havechoices in how they learn the required knowledge, skills, and professional behaviours(KSBs).
3

What is competency-based teaching?

Competency-based education requires competency-based teaching. Defining attributesof competency-based teaching are included in the following text box and come from avariety of sources.17 These teacher characteristics and expectations contribute to learner
success. They also demonstrate the shared responsibility of teachers and learners toreach the goal of a competent, fully qualified midwife.

Attributes of Competency-based Teaching
•
•
•
•
•
•
•
•
•

Understand how adults learn
Match principles of learning and teaching (Appendix B)
Facilitate, rather than control learning
Model humility, critical thinking, respect, competency & caring at all times
Support acquisition of knowledge, skills & professional behaviors in all learning domains (cognitive,
psychomotor, affective)
Promote & expect learner accountability for learning
Provide timely, specific feedback on learner progress beginning with learner self-assessment
Individualize learning experiences according to needs
Expect increasing complexity of performance as the learner progresses throughout the programme© I © ICM June 2012

	
  

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What teaching strategies are effective in facilitating competency

development?
Teaching strategies need to be matched to the domain of learning, as with any type of
curriculum. Some of the effective teaching strategies within a competency-based
curriculum, based on the attributes of competency-based teaching, include the following:
Psychomotor domain: Demonstrate the expected way to perform a given skill. Allow thelearner to practice for a while, and then ask for a return demonstration of that skill. Set up
models or create a simulation exercise in the practical laboratory where learners canhave repeated practice of skills with peers and/or teacher supervision. Arrange forsufficient practical experiences requiring skill performance with childbearing women
under direct supervision. Create a valid and reliable assessment tool for use indetermining competency in skill demonstration.
Affective domain: Create values clarification exercises for personal values. Provide aframework for a written analysis of a midwifery code of ethics or a comparison of healthprofessions’ codes of ethics. Structure opportunities for role play requiring recognition ofdiffering values and beliefs, with time for discussion of how these differences may affectone’s ability to provide midwifery care. Arrange for women of different races, ethnicity, or
socio-economic status to join with learner group to discuss different values and beliefs,
especially those related to health beliefs and practices. Create a valid and reliable
assessment tool for use in determining ethical midwifery practice, including integrity,
respect for all, maintaining confidentiality.
Cognitive domain: Develop case studies from actual midwifery practice requiring
discovery or problem-based learning to determine the most appropriate, evidencedbased approach to midwifery care. Focus early case studies on normal pregnancy orbirth, and later case studies on common complications of pregnancy or birth. Support
learner-led seminars, structure debates to address complex practical situations. Always
require that the learner provide their reasons (rationale) for their responses to knowledge
questions or care plans. Avoid the temptation to answer every learner question,
especially when the learner knows or should know the answer.
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Other strategies include self-study modules with suggested learning activities that thelearners can complete on their own prior to interaction with fellow learners and teachers.
It is important that teachers provide ample time for discussion/dialogue and clarificationof concepts to be learned. They also need to encourage/help the learner use their own
knowledge and ideas to find possible solutions to clinical situations. One of the mosteffective teacher strategies for guiding the learner to discover how to proceed or act iscalled Socratic questioning.18 The primary purpose of Socratic or higher orderquestioning is to encourage the learner to challenge how they are thinking, what they arethinking, and what revision of their thinking will lead towards their goal of becoming acompetent midwife.
All learning domains during midwifery practice: Select appropriate practical sites thatmatch learner needs and level of performance at the time. Use the midwifery care
process as the framework for clinical teaching and assessment, beginning with datacollection and moving through each of the steps of the process. In this way, the learneris ‘guided’ toward complete data collection before making a decision, and then basing aplan of care on that decision and the woman’s needs, carrying out the plan and finallydetermining if the results obtained were those that were wanted/needed.
Each of these teaching strategies are aimed at helping the learner develop new ways ofthinking about what they are learning, encouraging them in their discovery of new
knowledge and skills using critical thinking, and supporting their efforts to integrate thisnew learning into their practice as a beginning midwife. The teacher becomes a coach or
facilitator of learning, rather than an all-knowing sage telling the learner what to learn,
how to learn it, and what to do with the new learning.
5

What is competency-based learning?

Competency-based learning is a way of structuring learning activities so that theindividual learner can meet a predetermined set of competencies. Given that adultlearners have a variety of ways of learning or learning styles,19 it is important for them torecognize that competency-based learning will require that they actually perform or do,rather than learn by observing. Observation, reflection and listening are important© I © ICM June 2012

	
  

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learning activities, but competency demonstration is the expected outcome for midwifery
education. The following text box summarizes the key attributes of competency-basedlearning.
Defining Attributes of Competency-Based Learningü Understand how one learns best (style)ü Understand exactly what is expected outcome(s)of learningü Take responsibility for one’s learningü Motivated to learn – goal orientedü Ethical person and practitioner
ü Critical thinker
ü Self-assess learning & performanceü Commitment to ongoing learning

6

What learning activities are effective in developing competency?

There are several learning activities common to health professional education that iscompetency-based. Examples of some of these activities follow by domain of learning.
Psychomotor domain: Review written description of a particular skill (text, handouts).
Take time for repeated practice of skills in the safety of a practical laboratory setting
using plastic models, simulation if available, or peers as patients supervised by teachers
until mastery of the skill is demonstrated. With permission of the childbearing woman,repeatedly perform the skill under direct supervision in the practice setting, obtaining
accurate results and with minimum discomfort for the woman. Some have found it helpful
to mentally repeat common procedures daily, such as steps needed to overcome
shoulder dystocia or perform an abdominal examination. Seek out practical experiencesthat allow one to increase confidence as well as competence in the skills required for
midwifery practice.
Affective domain: Review text for content on definition of values. Participate in selectedvalues clarification exercises for personal values provided by teachers (self-study orgroup work). Write up an analysis of a code of ethics for midwives (local or international)© I © ICM June 2012

	
  

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and share with peers and teachers. Reflect on how one’s personal values affect theirability to provide midwifery care for women from different cultures or races or those whoare not caring for their own health. For many learners, becoming a competent midwife
begins with observing positive role models of midwifery practice to reflect on: This is who
a midwife is. This is what a midwife does.
Cognitive domain: Competency-based learning requires high levels of critical thinking
and reflection (metacognition – thinking about thinking). Such skills are learned best withsome form of discovery-based learning20, a term preferred by midwifery educators incontrast to ‘problem-based’ learning.21 The goals of discovery or problem-based learning
include helping learners become active participants in and take responsibility for theirown learning, encouraging the development of critical thinking by supporting learners’
efforts to retrieve and retain knowledge and apply it in practice (rather than telling them
what to think or do), and creating learners who develop the habit of life-long learning inorder to stay current in practice. Teamwork is an essential component of this type oflearning as many learning activities are structured for groups of learners working together
to discover the best solution to a given need or problem in both theoretical and practicalwork.
Other cognitive learning activities creating and following an individualized learning plan,22
self-directed reading and completion of suggested activities that will add to one’s
knowledge and experience base, and self-directed use (browsing) of the world wide web
or internet and intranet (if available) for resources related to topics being learned.
Prepare for and lead seminar discussions. Keep a journal or log of progress in learning.
7

Caveats for Competency-Based Education

An important caveat to competency-based education is that practice-based learning
requires direct supervision and multiple opportunities for the learners to demonstrate
their competency in practice over a period of time. Often midwifery programmes will havea set minimum number of practical experiences mandated by the regulatory authority inthe country in order to graduate/complete the educational offering.23 Completing thisminimum number of experiences is not, however, a guarantee of competent practice.

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Adults learn at different rates and in different ways24, so 20 attended births may besufficient for one learner to demonstrate a safe beginning level of performance of this skill
while another will require 50 births to meet the same learning outcome. This is theprimary reason why competency-based education must include direct observation ofcompetency demonstration over time. There is also value in observing learner’s provisionof midwifery care in a variety of settings and types of clients to move the learner’s criticalthinking and reasons skills beyond a single approach to midwifery care.
Other caveats related to teaching and learning apply to any type of professional
education, competency-based or otherwise. For example, a learner without the capability
to learn and/or demonstrate competence cannot complete a midwifery programme.
Likewise, it is impossible to force any person to learn, so lack of motivation to learn mostoften results in learners dropping out of midwifery programmes, especially if they fear the
responsibilities of being a practicing midwife. In addition, sometimes those learners
without confidence in their own abilities do not make good midwives (they often leave theprofession within a short period of time).25
8Qualifications & Responsibilities Of Midwifery Teachers

The ICM has defined the basic qualifications of midwifery teachers in two documents todate. The first document is the 2008 Position Statement, Qualifications and competenciesof midwifery teachers.26 The second ICM document that defines the qualifications andresponsibilities of midwifery teachers is the Global Standards for Midwifery Education(2010), Standard II.2 for the midwife teacher and Standard II.3 for the midwife clinicalpreceptor/clinical teacher.27
Essential Qualifications
The majority of teachers within a midwifery programme should be midwives. These
midwives primarily teach midwifery content and supervise students in practical settings.
In order to do this, it is expected that the midwifery teachers will:•

Be competent in all areas of midwifery practice, and specifically up-to-date inareas they are teaching© I © ICM June 2012

	
  

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•

Be legally recognized to practice as a midwife in the country•

Have formal preparation for teaching28•

Demonstrate a commitment to life-long learning and maintaining their midwifery
theoretical and practical competenceCore Responsibilities
The core responsibilities of midwife teachers and preceptors include:•

Teaching and practicing in accord with professional ethics and standards, and theunique needs of women and childbearing families in the country•

Promoting evidence-based midwifery practice at all times•

Understanding ones’ own values and beliefs related to teaching and learning•

Providing a safe, supportive environment for learning based on mutual trust andrespect and maintaining confidentiality of student concerns and records•

Using a variety of teaching methods that promote critical thinking and active
participation of the students in their learning and self-assessment of progress inlearning.

•

Directly supervising students in practical settings in order to continue theirteaching and assessment responsibilities.

•

Being open to conflicting ideas and opinions•

Assisting learner to connect current information to broader concepts•

Collaborating with other professionals a members of the health care team•

Making learning fun!

Midwife teachers may also take on responsibility for non-midwifery courses in the
curriculum, such as basic human anatomy and physiology, pharmacology or research. In
addition, non-midwife teachers may provide essential content in the midwifery
programme, such as basic science, public health, or communication content. Each
teacher responsible for content in a midwifery programme must be prepared to teach© I © ICM June 2012

	
  

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such content and up-to-date (competent) in the theoretical foundations of the content.
Non-midwife teachers also need to be guided by programme personnel to understand
how what they are teaching fits in the curriculum and what midwifery students need toknow to enhance their learning to be competent midwives.
SummaryThis resource packet was designed as a reference document for new teachers and those
who may not be familiar with competency based teaching and learning. Comments arewelcomed by the ICM Education Standing Committee on its usefulness and edits arewelcomed. These comments can be sent directly to the International Confederation to
Midwives at the following address: d.byrne@internationalmidwives.org

	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
   	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
1

Pritchard A. Ways of learning: learning theories and learning styles in the classroom 2nd Edition.
London: Routledge, 2009. Preface, p. x.
2
Pritchard A. Ways of learning: learning theories and learning styles in the classroom 2nd Edition.
London: Routledge, 2009. Innovative Learning. Learning theories. Retrieved 3-30-2010 from:http://www.innovativelearning.com/teaching/learning_theories.html
Billings DM, Halstead JA. Teaching in nursing: A guide for faculty 3rd Ed. St. Louis, MO: Saunders, 2009.
Chapter 12 by M. Vandeveer, From teaching to learning: Theoretical foundations, pp. 189-226.
3
Originators and important contributors to this theory include John B. Watson, Ivan Pavlov, B.F. Skinner,
E.L. Thorndike. Retrieved April 19 from www.learning-theories.com/behaviorism.html
4
Cognitivism and Constructivism. Retrieved April 19, 2012, from www.learning-theories.com Originatorsof Cognitivism include Merrill-Component Display Theory, Reigeluth, Gagne, Briggs, Wager & Bruner,
Schank and Scandura. Originators of Constructivism include Vygotsky, Piaget, Dewey, Vico, Rorty, andBruner.
5
Humanism. Retrieved April 19, 2012, from www.learning-theories.com The key proponents of thistheory were Abraham Maslow (hierarchy of needs), Carl Rogers (Freedom to Learn), and Malcolm
Knowles (Andragogy).
6Social Learning Theory. Retrieved April 19, 2012, from www.learning-theories.com The originator ofthis theory was Albert Bandura who also felt that social learning describes the ‘ocnituous interaction
between cognitive, behavioral, and environmental influences.
7
Knowles M. Andragogy in action. San Francisco: Jossey-Bass, 1984.
8
Merriam s & Caffarella R. Learning in adulthood. San Francisco: Jossey-Bass, 1991. Mezirow J.
Fostering critical reflection in adulthood. San Francisco: Jossey-Bass, 1985. Pritchard A. Ways oflearning: learning theories and learning styles in the classroom 2nd Edition. London: Routledge, 2009.
Innovative Learning. Learning theories. Retrieved 3-30-2010 from:http://www.innovativelearning.com/teaching/learning_theories.html
Billings DM, Halstead JA. Teaching in nursing: A guide for faculty 3rd Ed. St. Louis, MO: Saunders, 2009.
Chapter 12 by M. Vandeveer, From teaching to learning: Theoretical foundations, pp. 189-226.
9
Lieb S. Principles of adult learning, 1991. Retrieved April 19, 2012 from the world wide web under“adult learning.”
10Hersey P, Blanchard K. The Hersey-Blanchard Situational Leadership Theory. Retrieved April 19,
2012 from www.mindtools.com/pages/article/newLDR_444.htm This model of leadership development
has been used in some midwifery education programmes to help clinical teachers understand how their© I © ICM June 2012

	
  

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teaching style (directive, coaching, supporting or delegating) needs to match learner maturity (newlearner with little knowledge or confidence, increased confidence but still lack some KSBs, have KSBs
by lack confidence, have KSBs and confidence) for continued success in demonstrating competency.
11
Albanese MA, Mejicano G, Mullan P, Kokotailo P, & Gruppen L. Defining characteristics of educationcompetencies. Medical Education 42: 2008, pp.248-255. Du Toit R, Palagyi A & Brian G. The
development of competency-based education for mid-level eye care professionals: A process to foster
an appropriate, widely accepted and socially accountable initiative. Education for Health 23: 2010, p. 2.
www.educationforhealth,net/ Frank JR, Snell LS, Ten Cate O, Holmboe ES, et al. Competency-based
medical education: theory to practice. Medical Teacher 32:2010, pp. 638-645. Molenaar WM, Santing A,
Van Beukelen P, et al. A framework of teaching competencies across the medical education continuum.
Medical Teacher 31: 2009, pp. 390-396. Meyer-Adams N, Dorsey CJ, Potts MK, et al. How to tackle theshift of educational assessment from learning outcomes to competencies: One program’s transition.
Journal of Social Work Education 47 (3): 2011, pp. 489-507. Mukhopadhyay S & Smith S. Outcomebased education: Principles and practice. Journal of Obstetrics and Gynecology 30 (8): 2010, pp. 790794. Sportsman S. Competency education and validation in the United States: What should nurses
know? Nursing Forum 45 (3): 2010, pp. 140-149.
12
Fullerton JF, Gherissi A, Johnson PG, Thompson JB. (2011). Competence and competency: Core
concepts for international midwifery practice. International Journal of Childbirth 1(1). 2011.
DOI:10.1891/2156-5287.1.1.4
13
Op cit. Fullerton, et al., p. 6-7.
14
Op cit., du Toit et al, p. 5.
15
ICM. Essential competencies for basic midwifery practice 2010. The Hague: ICM
16
Op cit. de Toit et al., pp. 3-4.The authors described relevance as the way training (education) can be
structured to address needed competencies, cost-effectiveness as the way resources can best be
employed to make biggest impact on individual needs for professional care, equity as the best way tostructure the educational offering to ensure access, and quality as the way the program is structured,using evidence-based data and appropriate technology that allows practitioners to meet the
population’s expectations, social and cultural needs for a given service
17
Knowles MS, Holton EF, Swanson RA. The adult learner 6th edition. Boston: Elsevier, 2005. Thompson
JE, Kershbaumer RM, Krisman-Scott MA. Educating advanced practice nurses and midwives. New
York: Springer Publishing Company, 2001. Chapter 4: Educational philosophy and adult learningtheories, pp. 47-56. Brookfield SD & Holst JD. Radicalizing learning: Adult education for a just world. San
Francisco: Jossey-Bass, 2011. Chapter 2: Understanding adult learning, pp. 2 – 42. This chapter isgood overview of the ways adults learn in contemporary societies. They include transformative learning,self-directed learning, and critical reflection.
Brookfield SD. Becoming a critically reflective teacher. San Francisco: Jossey-Bass, 1995. Chapters 13: What it means to be a critically reflective teacher, Becoming critically reflective: A process of learningand change, and Learning to know ourselves: The value of autobiography, pp. 1-70.
Parker PJ. The courage to teach. San Francisco: Jossey-Bass, 1998. Chapter 1: The heart of a teacher:
identity and integrity in teaching, pp. 9-33.
Paul R. Critical thinking, moral integrity, and citizenship: Teaching for the intellectual virtues, 1993.
http://www.criticalthinking.org/resources/articles/ct-moral-integrity.shtml
18
http://changingminds.org/techniques/questioning/socratic_questions.htm This website provides
concrete examples of the types of questions that can be used to 1) clarify concepts, 2) probe
assumptions, 3) probe rational and evidence, 4) question viewpoints and perspectives, 5) probe
implications and consequences, and 6) question the questions.
19
Overview of Learning Styles. Retrieved April 19, 2012, from www.learning-styles-online.com The stylespresented in this site include aural, visual, logical, verbal, physical, solitary and social styles. David Kolb
designed a Learning Style Inventory to help individual identify their dominant learning style.
20
Postmontier B. Discovery-based learning: Student manual. Philadephia: University of Pennsylvania
School of Nursing 2008.
21
Barrows H, Tablyn R. Problem-based learning. An approach to medical education. New York:
Springer 1980. Creedy D. Problem-based learning in nurse education: An Australian view. Journal ofAdvanced Nursing 17: 1992, pp. 723-727. Frost M. An analysis of the scope and value of problembased learning in the education of health care professionals. Journal of Advanced Nursing 6 (4): 1996,
pp. 1047-1053.

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22

Li ST, Tancredi DG, Co JP, West DC. Factors associated with successful self-directed learning using
individualize learning plans during pediatric residency. Acad Pediatr 10 (2): 2010, pp. 124-130.
23
Op cit., Fullerton, et al, p. 7-8.
24Knowles M. et al Associates. (1984). Andragogy in action: applying modern principles of adulteducation. San Francisco: Jossey-Bass, 1984. Thompson JE. Principles of teaching and learning. 2010
handout.
25
Op cit., Fullerton et al., p. 9. Knowles MS, Holton EF, Swanson RA. The adult learner 6th Edition.
Boston: Elsevier, 2005.
26
ICM. Qualifications and competencies of midwifery teachers 2008. The Hague: ICM.
27
ICM. ICM Global standards for midwifery education, 2010. The Hague: ICM, pp. 1-2.
28
Thompson JE. Competencies for midwifery teachers. Midwifery 18: 2002, pp. 257-258.

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ICM Resource Packet #4: Appendix A
Appendix A

Learning & Teaching: A Dynamic Partnership*
How people learn
THEORIES
Behaviorist
Cognitivist

Stimulus-Response

Operant

Conditioning

SocialLearning

Humanist

Self-actualization

Andragogy 	 Emancipatory

	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
 
Perception/Insight

Expectations ofTeachers

Discovery

MutualRespect

Observation Environment

Expectations ofLearners

Teacher behavior/roles

Teaching Methods

Learner behavior/roles

Learning Styles

Successful Learning
Successful Teaching*JET 10/10
JET rev. 4/12

© ICM June 2012

ICM Resource Packet #4: Appendix B
Appendix B
THE ʻMATCHʼ OF PRINCIPLES OF LEARNING & TEACHINGi
1. Learning requires active participation of the learner: The teacher must
engage the learner as an active participant (avoid the ʻtellingʼ mode)

2. Learning is more effective when it occurs in response to perceived needs oflearner: The teacher guides, supports, coaches the learner to anincreased level of self-direction, pointing out connections between what
is being learned and the learnerʼs goal of becoming a professional
midwife

3. Learning requires understanding: The teacher must be an effective
communicator, present ideas and concepts clearly, offering alternative
explanations and checking for understanding frequently
4. Learning takes time: The teacher needs patience and highly developed
skills of listening, watching, & waiting along with knowledge of ʻnormalʼ
progression from novice to advanced clinician© ICM June 20121

5. Learning is enhanced when one moves from familiar to unfamiliar, the simple
to the complex: The teacher selects learning experiences that build uponprior learning and experience, gradually assigning more complex
content/clinical experiences based on progress of individual learner

6. Learning proceeds at different rates, in different ways, and with different
patterns, including periodic plateaus: The teacher uses appropriate
teaching methods that fit learner needs, patterns of learning, progressand expected learning outcomes
7. Learning is retained longer when it is put to immediate use: The teacher
offers frequent and timely exposure to learning situations that reinforce
what is being learned
8. Learning is enhanced by repetition: The teacher provides multiple
opportunities to apply knowledge, perform psychomotor skills, anddemonstrate professional behaviors© ICM June 2012

2

9. Learning must be reinforced: The teacher encourages self-evaluation oflearning with validation of positive outcomes and correction of errors
10. Learning requires known performance outcomes: The teacher set
boundaries of safe practice, defines and reviews expected outcomes oflearning, and supports learner achievement of these outcomes
11. Learning is affected by emotions, physical and mental health: The teacher
understands the variety of human responses to anxiety and stressassociated with learning and creates an environment for learning that iscalm, respectful, and tolerant of differences.

12. Learning is easier when the learner sees progress and is successful: The
teacher assists each learner to evaluate own progress, validates theself-assessment, and celebrates progress with the learner
13. Learning is facilitated by ideas more than facts: The teacher encourages
critical thinking, reflection, principled action, and alternative
approaches for midwifery care supported by sound rationale

14. Self-directed learning and accountability are learned behaviors: The
teacher knows when to step in, step back, and step out, offering
multiple opportunities for learner to be accountable for own learningand self-directed in his/her approach to midwifery care
15. Learning must be satisfying to the learner to maintain motivation: The
teacherʼs primary responsibility is to teach others how to learn,modeling and reinforcing continued learning and enthusiasm “to know”
more© ICM June 2012

3

	
  
i

Prepared by Joyce E. Thompson, DrPH, RN, CNM, FAAN, FACNM in 2012 based on ongoingteaching and publication: Thompson, Kershbaumer, & Krisman-Scott (2001). Educating Advanced
Practice Nurses and Midwives. New York: Springer Publishing Company.

© ICM June 20124