A Study On The Effect Of Case-based Learning Applied In Midwifery Courses For Undergraduate Nursing Students

Objective: To design the feasible cases and case-based learning procedures basing on the indicator system in midwife core competencies that can be implemented effectively in the essential midwifery curriculum for undergraduate nursing students.To evaluate the effect of case-based learning methods and to propose improvement suggestions for its practical application in the midwifery courses of undergraduate nursing students.Methods: Based on the indicator system in midwife core competencies,consecutive and integrated cases were compiled,and the case-based learning plan was designed to follow the continuous development of pre-pregnancy,pregnancy,childbirth,postnatal,neonatal,productive health and public health care,from normal cases to complex and abnormal cases,after which students proceeded with clinical visits,compiling and analyzing cases themselves,constructing their systematic midwifery theories.In this non-randomized historical controlled trial,with convenience group sampling technique,a total of 82 undergraduate nursing students in the third grade were selected,out of which,as the control group,40 students from the 2014 enrollment received conventional lectures of midwifery courses including Maternal and Neonatal Care from September 2016 to January 2017,and Midwifery from March2017 to June 2017,while 42 students from the 2015 enrollment received case-based learning of the midwifery courses from September 2017 to June 2018.Students from both groups gave their informed consents to participate in the study.At the end of the Midwifery course semesters,the Midwife Core Competency Scale(MCCS),Self-Rating Scale for Self-Directedness in Learning(SRSSDL),Chinese version of the Critical Thinking Disposition Inventory(CTDI-CV)and comprehensive examinations were utilized to measure and compare the learning effect.Purposive sampling was employed to conduct 15 semi-structured interviews and 42 reflectivejournals analysis with students participating in the case-based learning in order to further understand the learning experience of the students.Results: 1.Quantitative data analysis results:(1)After performing the case-based learning in midwifery courses,the total MCCS score of the case group,as well as the scores of the pre-pregnancy care,pregnancy care,intrapartum care,postpartum care,and neonatal care were statistically higher than those of the control group(P<0.05).The MCCS differences between pre-lesson and post-lesson of the midwifery courses in the case group were significantly higher than those of control group in the total score and the pre-pregnancy care,pregnancy care,intrapartum care,and postpartum care scores(P<0.05),but data indicated no statistically significant difference in the scores of neonatal care and public health care dimensions(P>0.05).(2)After performing the case-based learning in midwifery courses,the SRSSDL total score of the case group,as well as the scores of the learning strategy,learning evaluation and interpersonal skills were statistically higher than those of the control group(P<0.05),while no statistical difference was found in learning consciousness and learning behavior(P>0.05).The SRSSDL differences between pre-lesson and post-lesson of the midwifery courses in the case group were significantly higher than those of control group in the total score and the scores of learning consciousness,learning strategy,learning behavior,learning evaluation and interpersonal skills(P<0.05).(3)After performing the case-based learning in midwifery courses,the CTDI-CV total score of the case group,as well as the scores of the truth-seeking,analyticity and systematicity were statistically higher than those of control group(P<0.05).The CTDI-CV differences between pre-lesson and post-lesson of the midwifery courses in the case group were significantly higher than those of control group in the total score and the scores of the truth-seeking,analyticity,systematicity,and self-confidence(P<0.05).There was no statistically significant difference in the scores of openmindedness,inquisitiveness and cognitive maturity dimensions(P>0.05).(4)At the end of the Midwifery semesters,differences of the comprehensive examination and the objective written test scores between the two groups were notstatistically significant(P>0.05),while the difference in the subjective written test score was statistically significant(P<0.05).2.Qualitative data analysis results: After processing,analyzing and integrating the qualitative data of case-based learning students,three themes(preparation for professional midwifery practice,personal development and growth,difficulties and challenges)and 8 sub-themes were extracted.Qualitative research results supported and complemented quantitative data analysis results.Conclusion: The case-based learning design of the midwifery courses in this study has favorable applicability and feasibility,which can effectively improve the midwife core competence,self-directed learning abilities,critical thinking abilities and comprehensible application of midwifery theories for undergraduate nursing students.The establishment of the comprehensive abilities and transferable skills of undergraduate students derived from the case-based learning process will construct a solid foundation for their clinical midwifery practice.It is suggested that case-based learning be implemented in midwifery curriculum for baccalaureate students.