Midwifery Students' Experiences Obtaining Clinical Placements and Associations With Training Quality: "I Had to...

Hands-on clinical education is essential to midwifery training, yet the US system relies heavily on informal networks of clinical preceptors. Challenges in securing placements may affect students' preparedness and satisfaction with training, but empirical data are limited. This study examines how responsibility for and difficulty in securing clinical placements are associated with the early-career midwives' reports of the quality of their midwifery clinical education.

We conducted a national cross-sectional survey in 2024 of certified nurse-midwives (CNMs) and certified midwives (CMs) who received American Midwifery Certification Board certification between 2019 and 2024. The primary independent variable measured the process of finding a clinical placement, combining the responsibility for finding a placement (school vs student) with the difficulty of securing it. Logistic and linear regressions assessed associations with multiple measures of training quality, adjusting for age, race/ethnicity, degree type, year of certification, and number of placements. Open-ended responses were analyzed thematically.

Fewer than half of respondents (46.0%) reported that their school had primary responsibility for their placements, 37.8% arranged their own placements with difficulty, and 16.2% arranged their own placements without difficulty. Compared with other students, those who were able to find their own clinical placements without difficulty had higher-quality clinical education across all measured outcomes, including greater satisfaction, a greater sense of competence as a midwife, better clinical learning environments, and more positive perceptions of preceptor support and midwifery-aligned philosophy. Qualitative findings described high stress, lack of school support, and reliance on personal networks to secure placements.

The burden of finding clinical placements negatively affects student clinical training experiences. Variability and inequity in the current clinical placement system threaten the quality of midwifery education and, ultimately, the strength of the midwifery workforce. A structured, equitable, and formalized clinical placement system is needed to ensure consistent, high-quality midwifery education.