Effectiveness of a novel midwifery preceptor program on midwives' competence and confidence in Sierra Leone: A...

Sub-Saharan Africa faces some of the highest maternal mortality rates globally and the greatest shortage of midwives. Strengthening midwifery education and clinical training is one of the most impactful interventions to reduce maternal mortality. Global reports cite lack of investment in educators, limited skills and knowledge in contemporary teaching methods, and limited clinical experience for students as key barriers. To address these gaps, a six-month, low-dose, high frequency midwifery preceptor course was developed and piloted in Sierra Leone. This study aims to evaluate the program's effectiveness in strengthening preceptors' clinical and precepting competence and confidence. Between 2023 and 2024 two midwifery schools in Sierra Leone participated in this novel intervention, each with n = 10 midwife preceptors (N = 20). A pre-post-test design was used to evaluate participants at the end of the intervention (6-months). Twenty-five assessments were used to evaluate participants including: written competency test, objective structured clinical examinations (OSCEs), self-assessments of competence and confidence, direct clinical observation, and student evaluations. Written competency tests had significant statistical improvement from pre- to post-assessment (p < 0.0001). All OSCEs had significant statistical improvement from pre- to post-test. The largest mean difference was for incomplete abortion/manual vacuum aspiration (mean: 45.76, SD: 15.47) while the smallest mean difference was in repair of perineal tears (mean: 9.26, SD: 11.91). Self-assessed clinical confidence and competence were also significant with average median scores increasing 1.42 points (IQR: 0.86, p = 0.002) and 0.75 points (IQR: 0.77, p = 0.0005) respectively. Self-assessed precepting competence significantly improved with average median scores increasing 1.32 points (IQR 0.80, p = 0.0002). Direct clinical observations had no change and student evaluations improved slightly pre- to post-test. Participants showed statistically significant improvements in clinical and precepting competence and confidence. This midwifery precepting program may be a useful intervention in strengthening midwifery education and maternal healthcare in a region with the highest burden of maternal mortality.