An Interprofessional Entrustment Framework for Midwife-Led Labor Ward Teaching in Oman: A Modified Delphi Study

Introduction: The labor ward is an important interprofessional setting for undergraduate obstetric education, where medical students work closely with midwives who contribute substantially to their clinical learning. However, this teaching role is often informal. In addition, what students should learn through midwife-led teaching and the level of supervision expected for these activities are often not clearly defined. This study, conducted in the Sultanate of Oman, aimed to establish consensus on intended learning outcomes (ILOs) for midwife-led labor ward teaching and the level of supervision expected of medical students at graduation, with the broader goal of strengthening the educational role of midwives and making more effective use of the labor ward as a workplace learning environment. Method: In June-August 2025, we conducted a three-round modified Delphi study with a multi-professional panel of 22 participants, including consultant obstetricians, obstetrics and gynecology faculty, midwifery educators, practicing midwives, and final-year medical students. We generated an initial ILO pool through a structured literature search and expert interviews. Panelists rated ILO suitability using predefined consensus criteria (≥80% agreement, median ≥4, interquartile range ≤1); in Round 3, they assigned expected supervision levels using a four-level scale ranging from observation only to independent performance. Results: Twenty of 23 proposed ILOs achieved consensus for inclusion. Consensus on supervision level (≥70% agreement on a single level) was reached for 14 of 20 ILOs. Most competencies were assigned to Level 2 (performance under direct supervision), consistent with the supervised participation model characteristic of undergraduate entrustment in safety-sensitive clinical environments. Higher autonomy levels (Levels 3-4) were assigned mainly to communication, patient-centered care, and professionalism outcomes. Greater variability was observed for higher-risk procedural activities, including episiotomy repair, neonatal resuscitation, and perineal assessment, for which no single supervision level reached consensus. These outcomes were therefore considered areas where expectations of student autonomy remained uncertain. Inter-rater agreement strengthened progressively across the three rounds, confirming iterative convergence. Conclusions: This study offers a consensus-based interprofessional framework that defines learning outcomes and supervision expectations for midwife-led labor ward teaching. The predominance of direct supervision highlights the safety-sensitive nature of labor ward learning. The model is intended to support structured and collaborative clinical education in the labor ward and should be interpreted in relation to this setting. Nevertheless, it may offer analytically transferable insights to comparable interprofessional clinical learning environments.