Clinical supervisors’ experiences of midwifery students’ reflective writing: a process for mutual professional growth

ABSTRACT

Structured reflective writing during clinical placement has been shown to be valuable for students’ learning and for their personal and professional development. The aim of this study was to examine clinical supervisors’ experiences of midwifery students’ daily written reflections on their practice at birthing units. A qualitative study was performed, and data were analysed using content analysis. In total 17 midwives working as clinical supervisors in the South of Sweden were interviewed using both focus groups and individual interviews.

One main category ‘A process for mutual professional growth’, three categories and seven subcategories emerged from the analyses. The supervisors’ experience was that reflective writing facilitated individualized supervision and initiated a loop of reflection. The way students wrote their reflections affected the feedback and was an aid for the supervisor to be active and flexible. The process of using written reflections was considered as a tool for following the progress of the students and the process of learning but also developed the midwife in her supervisory as well as in her professional role. The supervisors called for more time allotted, better organizational support, and clearer instructions for how to write feedback.

KEYWORDS:

• Reflective practice
• clinical supervisor
• feedback
• midwifery
• reflective writing
• structured written reflection

Background

A significant portion of learning within health sciences education takes place during clinical placements. Supervision during clinical practice is central to midwifery education. Definitions of clinical supervision vary greatly but it can be conceptualized as a ‘formal professional relationship between two or more people in designated roles, which facilitates reflective practice, explores ethical issues, and develops skills’ (ACSA, 2015).

The use of reflections is a pedagogical strategy for integration of theory and clinical practice (Mann et al., 2009). When facilitating student midwives to become reflective professionals, priority must be given to training them in the art of reflective practice (Clynes & Raftery, 2008; Gallagher et al., 2017; Stenfors-Hayes et al., 2011). Reflection has been defined as ‘a careful examination and bringing together of ideas to create new insight through on-going cycles of expression and re/evaluation’ (Marshall, 2019, p. 411). Structured models for reflection are valuable for students during clinical practice (Gallagher et al., 2017) and joint reflection between students, mentors, and tutors can result in mutual learning (Mauri et al., 2019).

Reflection and reflective writing are also valuable for students’ professional learning as well as for their personal and professional development (Embo et al., 2014a; Embo & Valcke, 2017; Mann et al., 2009; Persson et al. 2018). Midwifery students have described reflective writing as a core component of learning (Bass et al., 2020). A literature review showed that reflective writing supports clinical reasoning skills, professional self-development and can facilitate learning (Bjerkvik & Hilli, 2019). Midwifery students’ daily written structured reflections have been shown to be a useful pedagogical tool to support students to be pro-active in their transition to midwifery competence (Ekelin et al. 2016). Prior to graduation, midwifery students had become aware of the importance of reflection for continuous professional development (Embo & Valcke, 2017).

Schön (1995) described two types of reflection: ‘reflection-in-action’ and ‘reflection-on-action’. Reflection on action stimulates students to ask for both oral and written feedback (Embo et al. (2014a). Supervisors can facilitate the development of students’ confidence by giving structured feedback and identifying gaps in knowledge (Embo et al., 2014b). Detailed feedback from a trusted, available, and qualified supervisor is central (Bjerkvik & Hilli, 2019; Persson et al. 2018) and learning is enhanced when feedback is facilitated by a supervisor in a trustful environment (Mann et al., 2009). The amount of feedback given to students in clinical practice is central to their learning (Clynes & Raftery, 2008). Ekelin et al. (2016) identified reflective writing and feedback as a means of communication between student and supervisor and showed that students called for constructive criticism and not only positive comments, a fact also recognized by Agius and Wilkinson (2014). The art of giving constructive feedback is about listening and asking without providing solutions and can be learnt and practiced when student and supervisor strive towards a common goal Chowdhury and Kalu (2004). By clarifying and explaining circumstances not always obvious to the student, the supervisor’s feedback provides additional knowledge to the student (Persson et al. 2018).

Evaluation of supervisors’ experience of students’ reflective writing and of the delivery of feedback has not been broadly reported but such knowledge may add important information to optimize use of students’ written reflections during clinical placements. Therefore, the aim of the present study was to examine how clinical supervisors experience midwifery students’ daily written reflections on their practice at birthing units.

Methods

Qualitative interviews were carried out and analysed in an inductive method with a descriptive design. Qualitative content analysis by Burnard (1991) was used. This method has its origins in grounded theory (Glaser & Strauss, 1967) and was developed to provide the researcher with a systematic and rigorous manner in which to generate and order categories that are close to the original material.

The writing of daily reflections and feedback

At a university in southern Sweden that is linked to five birth units, midwifery students are, since 2011, required to write daily structured reflections during their clinical practice, according to Gibbs’ model (Gibbs, 1988). The model includes a description of the situation, feelings in the situation, evaluation of what happened and how it happened, analysis of why it happened, and conclusions. In the conclusion, the reflection should result in a plan for how to act if the same situation should occur in the future (Gibbs, 1988). The reflections are used for supporting students’ learning and professional development and not for grading. Each student is supervised by two separate midwives and is required to reflect on each birth they have assisted and on special events that might not have culminated in an actual birth. By their written reflection they verbalize their thoughts.

Clinical supervisors are asked to give daily written feedback on the student’s written reflections, but no specific instructions are given. Supervisors are informed about provision of feedback during an information meeting about the course. Supervisors are asked to use templates, provided by the university, where they write their feedback. Written feedback was chosen because it enables students to return to the scenario and the feedback. Earlier research showed that supervisors’ feedback contained acknowledgement of the students’ reflections or comments with a didactic content and one-third of the reflections were signed without providing written feedback (Ekelin et al. 2016).

Settings and participants

At present, midwifery education in Sweden is based on a three-year university course leading to registration as a nurse followed by a further 18 months in the midwifery program.

The program entails a total of 90 ECTS of which 45 ECTS are assigned to clinical midwifery practice, including 17 weeks (three courses) at birth units. Clinical placements follow directly after the theoretical courses. All students have two personal supervisors during their placements. Respondents for the present study were recruited from each of the five birth units that are linked to the university. Information about the study was presented at a meeting for clinical supervisors. An e-mail to the clinical supervisors’ coordinator was thereafter sent with a request to distribute invitations for participation in the study to all midwifery supervisors at respective units. Interested supervisors were asked to contact the researchers for participation. The criterion for participation was experience of working with students’ written reflections. For practical reasons and due to supervisors’ wishes, both focus group and individual interviews were carried out; four focus groups and five individual interviews. In total 17 supervisors participated. The supervisors were between 40 and 65 years old and all of them had several years’ experience of supervision and use of written reflections at birthing units.

Data collection

Willingness to participate was expressed by email or by phone and written consent for participation was signed by each individual before the interviews. Those who wished to participate received further written and oral information from two of the researchers (ME and EP) in connection with the interviews. One focus group interview with three supervisors was carried out at the university, the others at their respective units. Duration of the interviews was between 25 and 60 min. The interviews were audiotaped with the respondents’ permission and thereafter transcribed verbatim. Citations are provided for each category with a number for each interview and respondent. In accordance with the narrative interview method, where interviews take the form of a conversation the interviews started with one open-ended question. What are your experiences of midwifery students’ daily written reflections on their practice?

Data analyses

Qualitative content analysis by Burnard (1991) commenced after each interview, by making notes regarding the topics raised in the interview. Thereafter, each transcribed interview was read and re-read carefully to familiarize the researchers with the content and further notes were made, before proceeding to the process of open coding. An example of the analysis process is presented in Table 1. Open coding generates headings that describe all aspects of the content. The codes were sorted into a list of preliminary sub-categories and then reduced into fewer and broader sub-categories and finally into categories and one overarching main category. During the process of coding, the researchers verified the analysis by constantly going back to the data for comparison. The researchers performed the analyses first independently and then comparatively, to further increase the validity of the results.

Table 1. Examples of the process of analysis, one example from each category

Quotations	Codes	Subcategories	Categories	Main category
… it’s not always a direct answer to what she has written. And I can then also pose a question – finish with my comments what this question can lead to – when she has this to deal with – maybe think another time. (I 1)	Feedback that requires answers to questions leads to continued reflection for the student	An opportunity to create a loop of reflection	Facilitating individualized supervision	A process for mutual professional growth
-One can see how one’s supervision works when you read their reflections ….that I might need to change some of the things that I do … or that what I do is good. (I 1).	One can see how one’s supervision works and what needs to change	Development of the supervisory role	Advantageous for the supervising midwife
- I can’t see anything negative about it other than that it takes time. (I 7)	Requires time	Creating space and allotting time	Optimizing the prerequisites for reflection

Ethical approval and consent to participate

The study was planned in accordance with the ethical principles of Declaration of Helsinki. Swedish ethical regulations do not require ethical clearance for pedagogical research of the kind carried out here, since patients and health aspects are not involved. The purpose was to examine the usefulness of the didactic method described in this study and there was no focus on an individual’s responses. Informed written consent was obtained from all participants prior to interviews. All data were handled confidentially.

Findings

A process for mutual professional growth

The act of reflection was experienced by the supervisors as a mutual process in which it was valuable to work together with the students; to have a written and sometimes oral dialogue about the students´ written reflections that gave reciprocity. In general, the clinical supervisors were positive to written reflections.

… so I just give a few lead words and then it can begin.… I have a great belief in that conversation: both have to give and to take – it’s not sufficient that just one reflects – you have to do it together', (I5, R13)

The main category encompasses three categories comprised seven sub-categories. The supervisors were keen to work hard for the students’ individual supervision and professional growth and the effort they made generated professional development for themselves. This mutual process between supervisors and students required increased time and organizational support. The categories and sub-categories are shown in Table 2.

Table 2. Overview: main category, categories, and subcategories

Main category	Categories	Subcategories
A process for mutual professional growth	Facilitating individualized supervision	An opportunity to create a loop of reflection
		An aid to be active and flexible in giving feedback
		A tool for the supervisor to discern the progress of the student and the process of learning
	Advantageous for the supervising midwife	Development of the supervisory role
		Development of the supervisor’s own professional role
	Optimizing the prerequisites for reflection	Creating space and allotting time
		A need for clear instructions

Facilitating individualized supervision

To the midwives, the role of a supervisor meant that they had a responsibility for students’ professional growth. Through the use of written reflections, the supervisor was able to get to know the student as an individual and to understand how the individual reasoned in clinical situations, thus making supervision more centred on the individual. This was experienced as a good basis for satisfactory supervision where the supervisor could show her/his concern and commitment.

In fact, it’s quite exciting to see differences. Is she a very sensitive person or is she straightforward? … you change your way of giving feedback, for example. (I9, R17)

An opportunity to create a loop of reflection

The supervisors experienced written reflections as a foundation on which to base both written feedback and continuing discussion forming an ongoing loop of reflection. This gave them an implement to guide the student forward in the developmental process. Gibbs’ model of reflection was experienced as a useful tool. The structured reflection model was considered to help the student to make meaningful reflections.

Both oral and written reflections were perceived as necessary: neither one could replace the other. Written feedback rendered reflections valuable. Learning was enhanced by the requirement to reflect, not only during the situation but also afterwards and to verbalize their thoughts. The subsequent discussion reinforced the supervision, focusing on the individual student’s needs. It was often in the discussion that details, and subtleties were revealed.

here’s something that you’ve experienced that’s a little new for you or something that … now this happened again … and that’s how it is. You can find small things. I think these reflections [written] are good. (I5, R13)

The supervisors considered the discussions as valuable and important for the development of both tacit and evidence-based knowledge. They experienced discussions about emotions as particularly important for mutual professional growth: students were seen as courageous when they showed openness and wrote about their emotions.

I think that reflections are very exciting and in someway, necessary … it’s positive that we come together around this and discuss it. One has something to centre on. (I4, R12)

The supervisors expressed that it could be difficult for the students to be completely honest because of the state of dependence they were in. According to the supervisors, this could lead to omissions in writing and the reflections then became what the student thought the supervisor wanted them to write. Reflections could in this circumstance lose merit.

The supervisor could lift questions that the student had not reflected on. In this way, the supervisors expressed that they guided the student forward enabling them to pose questions in the conversation about the student’s experiences that could provide security in the professional role. Reading through reflections together with the student could help identify students’ strengths and limitations, which facilitated continued support for the mutual process.

Some supervisors expressed that the potential worth of reflections was fully realized first after feedback was given and that reflection without feedback could result in uncertainty for the student whether she/he was on the right track.

Supervisors suggested that in learning and practising reflection, students acquired a valuable instrument for the future.

And if one learns this as a student, one uses it later on also. (I6, R14)

An aid to be active and flexible in giving feedback

The way in which the student wrote reflections influenced the way in which the supervisor gave feedback. Some students wrote questions to their supervisors in their reflections, which were useful for verbal feedback. Supervisors reported that their feedback was made easier when the student wrote in a clear manner. When a student neglected the act of reflection and instead simply wrote a report of a situation, there was a risk that the feedback given would also focus on the reported situation. The act of reflection was thereby lost and the benefit to the student’s progress was also lost. It was stressed that, in order to attain a positive outcome, the supervisor must be active. Written feedback could be given in the form of constructive ideas or questions to the student but also merely consist of confirmation to the student that she/he had reflected on important issues. Supervisors could at times comment on what they thought the student had forgotten to reflect on.

I have probably started out from the student’s questions and her/his reflections and mostly commented on the - then probably written something based on what I experienced but the two are entwined in some way. (I3, R9)

The supervisors considered that both written reflection and feedback were important for all students but that students who showed clinical weakness required extended feedback. It was at times difficult to provide feedback to those students who had difficulty in reflective writing. To convey that the profession is complex, without ‘black and white’ answers and at times no right or wrong action was important. The supervisors experienced that this was difficult for the students to accept and that written and verbal feedback supported their understanding. An open climate between the student and supervisor was necessary for optimal feedback.

The most important factor according to the supervisors was to enable the student to grow and to enable this, it was important that written feedback was both constructive and given in a positive tone.

Then I try to comment on the positive things first, after that I give a little “think about this next time”. I think that’s good.… Feedback … written. For both the student and myself. (I8. R16)

A tool for the supervisor to discern the progress of the student and the process of learning

The supervisors stated that in the written reflections they could clearly identify where in the process of learning the student was and how changes in the reflections indicated how the student was developing her/his role.

I think one can see what kind of things they find important.…

Sensitivity towards the couple … it’s difficult to learn things like that, but one can develop that side of oneself. Because it’s both your own feelings and the couple’s feelings and the situation that comes with reflection. (I3, R9)

Reflections were seen as a tool for students to summarize and capture salient points in a specific situation. This ability developed gradually and at a different pace for each individual. The supervisors expressed that it was necessary to practice reflection in order to learn the skill. The reflections could be looked upon by the supervisors as either principally a tool for writing about emotions and thoughts or as a tool for the development of obstetrical knowledge.

Written reflections made apparent the student’s true understanding but also when learning had not occurred; for example, when the student repeatedly reflected on the same thing. Through these observations. the supervisor could support the student to develop their professional role, which was seen as an important aspect. Reflections could also provide guidance in which practical situations the student needed more practice.

… when it’s descriptive one gets a little confirmation of having reached the student with ones knowledge. It feels important. When you see how the students lift themselves into professionalism … the process of midwifery education … when they progress towards their goal the whole time. You see this clearly in these stories. (I9. R17)

The supervisors pointed out that it could be difficult for students to reflect in relation to evidence at the beginning of their education but towards the end of the course written reflections could be a good way to see if the students connected what they had read in scientific papers with their practice and how they worked according to evidence or why exceptions were sometimes made.

It’s clear that students must reflect on “what are we doing, why do we do this and how can we do things better” so that we use the least possible number of interventions for mother and baby so that it will be a normal birth with a healthy mother and baby. (I1, R2)

Advantageous for the supervising midwife

The midwives experienced written reflections as a way of developing their role as supervisors. They also spoke of how written reflections and feedback had helped their own professional development.

Development of the supervisory role

Supervision was a learning situation for the supervisor. The students’ reflections triggered supervisors’ own reflections, calling for them to reflect on what had occurred and this in turn helped develop their supervision. At times, their own reflection included note-taking and comparison with the students’ written reflections. The mutual nature of reflective writing was demonstrated by receiving direct feedback from the students on their supervisory role which was appreciated but difficult to get.

It’s exciting, because it’s fun sometimes to ask the students if they have feedback for the supervisor, but it’s a shame because they almost never have … and it’s probably because of being in this position of power. (I9, R17)

The supervisors spoke about reflecting about their own feedback, which changed and developed their feedback over time. The ‘master/apprentice’ situation changed during the joint reflection with the student so that the focus was on what they had done and why. Supervisors’ experience was that even if the student followed the supervisor’s example, the written reflections caused them to go deeper and to process the situation.

Development of the supervisor’s own professional role

The supervisors perceived reflections as having a pedagogical value for themselves in their work as midwives. The students’ written reflections stimulated the supervisors’ reflections about concrete events in their daily work. When students reflected on scientific evidence the supervisor was under pressure to do the same, which they found enriching and broadening for both the student and the supervisor. Even those with many years of experience found that written reflections stimulated them to reflective practice.

- It’s enlightening to take care of students. (I2, R4)

- To really think about everything I do either by intention or through some kind of feeling … I have to reflect … why am I doing this … and it’s not always so easy (I2, R6)

Optimizing the pre-requisites for reflection

In order for reflections and ensuing written feedback to be of value it was important that organizational pre-requisites and clear instructions for students and supervisors were in place.

Creating space and allotting time

Although the supervisors had a positive opinion about the value of reflective writing, they wished that there had been time allotted to the writing and giving of feedback. If the supervisor was short of time, the quality of the feedback could be affected. They expressed that it was a case of prioritization and organization.

It’s an organisational question too … that one has space for this … that it is equally important to get the woman through the birth, write the records and then reflect (I4, R12)

As time progressed and the student had mastered more duties the supervisors could identify those students who experienced time stress because of the increased number of written reflections

If it’s part of the education, there has to be time allotted, it depends how important it is. How important is it for us and how important is it for them? (I1, R2)

A need for clear instructions

A clear explanation of the reflection process was called for. Gibbs’ process of reflection was seen as important, but it was made clear that instructions were necessary regarding the fact that the student need not answer all the questions for each reflection but was allowed to reflect about the most important issues for each situation. The supervisors expressed that the university had an important role to play in encouraging the students to write their reflections as soon as possible after the event.

Suggestions were presented about changing the order of the questions in Gibbs’ process of reflection: to start with ‘what did you learn?’ and ‘could you have done something differently?’ or ‘what did you do well?’ and ‘what could you have done better?’ instead of a description of the situation. These suggestions were in order to focus on the student’s learning. It was suggested that the questions in Gibbs’ process could also be useful for the supervisor and perhaps other keywords to help them with their written feedback.

… questions to the supervisor, in some way.”what did you think about this birth?”, “what positive/negative comments can you give the student?” … it would have been a help for me. (I3, R8)

The supervisors would have liked both training and concrete examples in order to understand what was expected of them when giving written feedback. There was a relationship between understanding what was expected, understanding the aim and the gain provided by reflective writing.

It could be difficult for the supervisors to know both what to write and how to vary what they wrote. The supervisors needed help to find examples of the correct words and tone to express themselves. Since the students varied in their ability to write reflections, the supervisors suggested that the students should also be given training in how to write. They suggested that the students could be encouraged to write questions to the supervisor in their reflections, which would aid their feedback.

Discussion

Results showed that the process of reflective writing and the provision of feedback were experienced by the supervisor as a process for mutual professional growth with value for both student and supervisor. Previous research by Mauri et al. (2019) showed that reflections enabled mutual learning and engagement in a context of respect. Fox et al. (2019) showed that both the student and the supervisor must be equally engaged and active in the critical reflection process in order to develop their critical reflective capacity. In the present study supervisors indicated that students’ reflective writing and their own feedback, developed themselves personally, as professional midwives and as supervisors, a fact also mentioned by Sukhato et al. (2016).

In our study, the supervisors indicated that structured writing gave a better base for the reflection process than reflections without structure and that reflections presented according to Gibb’s model (1988) were an important tool for facilitation of individualized supervision, which Gallagher et al. (2017) also pinpointed. However, Gibb’s model starts with a description of the situation which, according to the supervisors, sometimes results in students focusing too much on the situation rather than on their own reflection. A different order of questions as well as a structured model for feedback was suggested; Gibbs´ model of reflection was not specifically developed for reflective learning within midwifery. A recently published study introduced the ‘Bass Model’; a reflective model designed to facilitate midwifery students’ holistic personal learning skills (Bass et al., 2020). The Bass model was not developed for daily written reflections during clinical placements but components such as ‘storytelling, deep listening, creative narratives, and critical reflective conversations’ could be incorporated into the Gibbs reflective model. The benefit of reflective writing as a core component of learning is also shown by Bass et al. (2020). Previous research, coupled with findings in the present study provides a growing body of evidence for reflective writing as a way of learning. The act of writing has been claimed to encourage a deep learning (Davies, 2012).

Supervisors stressed the importance of understanding where the student was on the trajectory towards midwifery competence; individualized supervision demanded an understanding of each student’s specific needs and adjustment of the feedback provided. This resulted in the start of a loop of development arising from students’ written reflections, where written feedback and oral discussions complemented each other. Reading students’ written reflections before giving their own written feedback helped supervisors to provide individual feedback. Embo et al. (2014b) showed that reflective students stimulated their supervisors to give more feedback.

Supervisors pointed out that it might be difficult for students to be honest because of their dependency on the supervisors. Without honest reflection, feedback lost its main value. In those situations, trust, a good relationship, and good communication were paramount. Embo et al. (2014a) showed that students also shared this experience: honest reflections and good communication were essential for learning. Establishment of a respectful learning environment is necessary for fruitful feedback (Ramani & Krackov, 2012) and reflective writing in a safe learning climate also facilitates students’ adaptation to management of complex clinical situations (Wald et al., 2019). Supervisors indicated that a positive tone and secure communication could optimize the students’ development and learning. Students are motivated by critical comments presented in a considerate and encouraging tone (Agius & Wilkinson, 2014) and feedback should be formulated as a question, be given in a positive tone and individualized to the student (Dekker et al., 2013).

Our results show that supervisors required more knowledge about the reflection cycle and about how to write feedback. Though the supervisors were positive to both written reflections and written feedback, some disadvantages to reflective writing were mentioned: it required effort, was at times difficult and time consuming. It is necessary for the success of this important innovation that added education and instructions are provided for supervisors on how to write in a constructive and supporting way. It is also important that time for this work is allotted in the organization. The supervisors wished to be evaluated by the students but found it troublesome because of the students’ state of dependency. According to Sukhato et al. (2016) supervisors could have a feeling of insecurity about their own teaching competencies. To train supervisors in giving adequate and constructive feedback is a challenge for the educational institution as well as the clinic. It may be beneficial to provide supervisors with short written instructions regarding the application of Gibbs’ model (1988) since our respondents expressed a need for structure. According to Hattie and Timperley (2007), feedback should answer three major questions: Where am I going? How am I going? and Where to next? Encouraging supervisors to include these three components in their feedback might also strengthen the loop of reflection. These questions correspond to Gibb´s model of reflection ‘what did you learn?’ and ‘could you have done something differently?’ or ‘what did you do well?’ and ‘what could you have done better?’ Implementation of these questions in practical instructions to supervisors may be challenging but possible and may fill the supervisors’ needs.

Strengths and limitations

Interaction between participants in focus group interviews is a methodological strength (Krueger & Casey, 2009); however, the combination of both focus group interviews and individual interviews may provide complementary strength, by allowing respondents a choice: they were not obliged to express their opinions in a group. A further strength of the study is that all clinics in the up-take area were represented in the data collection. In order to increase confirmability, the researchers performed analyses first superlatively and then comparatively. Even though the nature of midwifery and supervisory techniques may vary in different clinical settings, the results might be transferable to other contexts where written reflections are used in a clinical setting.

A major limitation of this study is the possibility of selection bias. The supervisors who choose participation might have shared a common interest in pedagogics. Supervisors who were uninterested in the use of written reflections might be underrepresented amongst the respondents and this possible bias might have been further influenced by the fact that the respondents were familiar with the researchers as teachers, which can have affected their decision not to participate. Still, critical comments concerning the use of written reflections are visible in the results.

Conclusions and implications

The results suggest that reflective practice using daily structured written reflections, as in this study, is viewed by supervisors as valuable not only for students but also for clinical supervisors themselves. Supervisors’ feedback on students’ written reflections initiates a reflective process in the supervisor, which develops both the supervisory role and also supervisors’ own midwifery skills; mutual learning and professional development are enhanced. Written reflections were seen as an important tool for facilitating individualized supervision. The results showed that supervisors required increased knowledge about reflective writing and a structured model for giving feedback. To succeed in this, instructions and organizational pre-requisites should be provided.

Ethical Approval

The study was planned in accordance with the ethical principles of Declaration of Helsinki. Swedish ethical regulations do not require ethical clearance for this kind of pedagogical research not involving patient and health aspects. The purpose was to examine the usefulness of the didactic method described in this study and no interest were at the individual level. Informed written consent was obtained from all participants prior to interviews. All data were handled confidentially, and quotations are presented with codes.

Acknowledgments

The authors wish to thank all supervisors who kindly agreed to participate in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by ALF (Governmental Funding of Clinical Research within the National Health Service) Faculty of Medicine, Lund University, Sweden.

Notes on contributors

M. Ekelin

Maria Ekelin, PhD, RNM is an Associate Professor at the Institution for Health Sciences at Lund University, Sweden. She is the Program Director for the Midwifery Program. Her doctoral thesis from 2008 was entitled “Parents’ expectations, experiences and reactions to a routine ultrasound examination during pregnancy”. Her research thereafter has been within two fields; Midwifery care and pedagogics in Midwifery education.

L.J. Kvist

Linda J. Kvist, PhD, MScN, RM, RN is Associate Professor at the Institution for Health Sciences at Lund University, Sweden. She is a registered nurse and midwife and has worked in Midwifery education for over a decade. Her doctoral thesis from 2006 was concerned with care and treatment of women with lactational mastitis. She has supervised students in 38 masters’ theses and two doctoral candidates who have both successfully defended their theses. She is part of an international research group that aims to describe the human milk microbiome from geographical and anthropological perspectives.

L. Thies-Lagergren

Li Thies-Lagergren, PhD, Mmid, RM is Adjunct Lecturer at the Institution for Health Sciences at Lund University, Sweden. She is, since 1996 a registered midwife. She has worked for more than 25 years as a clinical midwife within labour and birth. Her doctoral thesis from 2013 studied upright birth positions and in a randomized controlled trial she scrutinized a birth seat in relation to instrumental birth, obstetrical and maternal outcomes. Since 2014 Li has shared her working hours equally between clinical Midwifery and Midwifery education. She has supervised students in many masters’ theses and is currently supervisor to two doctoral candidates. She is part of a national research group that aims to scrutinize delayed cord clamping in compromised infants (the SAVE study).

E.K Persson

Eva K Persson, PhD, RNM is Associate Professor and senior lecturer at the Institution for Health Sciences at Lund University, Sweden. She is a registered nurse and midwife and has worked in Midwifery education since 1996. In her doctoral thesis from 2010 she developed an instrument “Parents Postnatal Sense of Security (PPSS)” which has since been translated to several languages and used in international studies. Her research in recent years has centered on Midwifery care and pedagogics in Midwifery education.