ASM Clinical Instructions & Record Forms

  • Clincal Record FORMS
  • Clinicals Overview
  • Clinical Form Instructions
  • Rubric

Clinical Record Forms:

Duration of Clinical Experience minimum 2 years

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Clinicals in the role of "Observer":

Student Role: Observer

Preceptor Supervision of this Activity: None - No direct supervision required. Any witness can provide verification.

Demonstration Necessary for Credit: Physical Presence- The student's presence at the birth in any capacity.

Form #1: 10 Births as an Observer

NCM Clinical Record Form #1: 10 Births as an Observer

Must include 2 Planned Hospital Births -may NOT be IP Transports
This is the only clinical requirement that can be done prior to enrollment, and without the direct supervision of an NCM preceptor.  The student must attend 10 births in any setting in any capacity (observer, doula, family member, friend, beginning apprentice, etc.). Attendance may be verified by any witness who was present at the birth. These 10 Births may take place prior to OR during enrollment at NCM, but must be no more than 10 years prior to the student sitting the NARM Exam.  Observes completed prior to enrollment will not count towards the minimum 2 year time span requirement

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Clinicals in the role of "Assistant" or "Assistant Under Supervision":

Student Role: Assistant to Primary Midwife

Preceptor Supervision of this Activity: Direct Supervision. The preceptor must be physically present and in control at all times during the entire activity, must catalyze the important decision making processes, elicit the student’s rationales for her/his decisions, and oversee the student’s charting. Preceptors may ONLY sign off experiences which she/he personally directly supervised and witnessed.

Demonstration Necessary for Credit: Active Participation. The student must be actively involved in the clinical activity, including, but not limited to charting, hands-on assisting, & participation in management decisions.

Form #2: 25 Prenatals Exams as Assistant (including 3 Initial Prenatals) 

NCM Clinical Record Form #2: 25 Prenatals Exams as Assistant

A Prenatal consists of most of the following, but is not limited to: Preparation, chart review,  weight, blood pressure, pulse, Fetal Heart Tones, Baby's position, evaluation of size for dates, education and counseling for gestational age specific topics, any necessary labwork, education and counseling for any discomforts, evaluation for need for referral to social or medical resources, charting by SOAP method, cleanup, arrangement for next visit, filling out referral forms and lab slips. 
Estimated time per visit: 30 minutes.
(These must include at least 3 Initial Prenatals)
Initial Prenatal consists of most of the following, but is not limited to: The same items as a regular prenatal, PLUS intake interview, history (medical, gynecological, family) and a complete physical examination. These items may take place over several visits, but are counted by the student as one Initial Prenatal.
Estimated time per visit: 1 hour.
Form #3: 20 Births as Assistant

NCM Clinical Record Form #3: 20 Births as Assistant

A Birth as Assistant Under Supervision consists of most of the following, but is not limited to: Set-up, assistance to the midwife in whatever she requests, assisting the mother and her family, participating and learning about charting, evaluating pre-labor, practicing admission evaluation and admission procedures, keeping track of progress and normalcy of labor, practicing taking and charting vital signs, counting baby's heartbeat, practicing evaluating FHT, practice providing comfort measures, preparing and coaching mother for actual birth, preparing mother's partner to provide comfort measures or to participate in delivery, practice assisting with the birth and placenta, practice evaluating newborn response and vitals, practice assisting with newborn exam, evaluating the placenta for normalcy, practice with the establishment of immediate breastfeeding, assisting midwife with clean-up, sterilizing, repairing, restocking, re-ordering equipment, making plans for follow-up visit. At least 18 of these must be completed prior to beginning births as primary under supervision.
A MAXIMUM of 2 of these births may be IP Hospital Transports.
Estimated time per birth assist: 12 hours.

Form #4: 20 Newborn Exams as Assistant

NCM Clinical Record Form #4: 20 Newborn Exams as Assistant

A Newborn Exam consists of most of the following, but is not limited to: Apgar, gestational age assessment, reflexes, head to toe physical, application of erythromycin to the eyes and injection of vitamin K, metabolic screening, referral for hearing screening, referral for pediatric follow-up, weight and measurements, foot-printing, birth certificate, souvenir certificate for parents, registration for social security and Medicaid.
These exams must be done within 12 hours of the birth.
Estimated time per visit: 30 min.

Form #5: 10 Postpartum Exams as Assistant

NCM Clinical Record Form #5: 10 Postpartum Exams as Assistant

A Postpartum Visit to Mother and Baby consists of most of the following, but is not limited to: Preparation, chart review for follow up on such things as the need for RhoGAM and ABO incompatibility, etc, check baby weight gain, physical assessment and vitals, assessment of lochia, counseling regarding breastfeeding/bottle-feeding, counseling and education for mother and family regarding nutrition for mother and baby, any necessary lab work, education and counseling for any discomforts, evaluation for referral to social and/or medical resources, evaluation of baby for dehydration, answering parent's questions, check health of umbilical cord and removal of clip if necessary, check healing of any stitches/ tears, evaluation for need for referral to social or medical resources, charting by SOAP method, cleanup, arrangement for next visit, filling out any necessary referral forms and lab slips. 
These visits must be done between 12 hours and 6 weeks following the birth. 
Estimated time per visit: 1 hour.

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Clinicals in the role of "Primary" or "Primary Under Supervision":

Student Role: Primary Midwife Under Supervision

Preceptor Supervision of this Activity: Direct Supervision. The preceptor must be physically present and in control at all times during the entire activity, must catalyze the important decision making processes, elicit the student’s rationales for her/his decisions, and oversee the student’s charting. Preceptors may ONLY sign off experiences which she/he personally directly supervised and witnessed.

Demonstration Necessary for Credit: Mastery. The student must demonstrate competent and confident provision of safe, evidence-based midwifery care for the individual Clinical Skills including: Etiology, sequelae, appropriate management and follow-up for the individual patient, appropriate times and reasons for consult and referral, access to relevant resources and information, complete, thorough and timely record keeping, appropriate, professional, and compassionate management of every task involved, receptiveness and responsiveness to patient's concerns, explanation of midwifery decisions and actions as they relate to possible outcomes and their wider impact, based on the Midwives Model of Care®.

Form #6: 30 Well Woman/Family Planning as Primary Under Supervision

NCM Clinical Record Form #6: 30 Well Woman/Family Planning as Primary Under Supervision

A well woman exam consists of most of the following, but is not limited to: Preparation, chart review, complete physical assessment including, but not limited to: Bimanual exam to screen for colorectal and endometrial cancer; pap smear; collection of samples for STIs; breast exam; and counseling on the following items: family planning; prevention and detection of STIs; nutrition and exercise relating to bone density; hormonal changes and physical and mental comfort measures relating to the interconceptual period and menopause; and attention to general social, physical and emotional well-being, charting, and cleanup.
Student mastery of the PAP smear/STI sample is required, though not every well woman exam must include a PAP smear.
Estimated time per visit: 30 min.

Form #7: 20 Initial Prenatals as Primary Under Supervision

NCM Clinical Record Form #7: 20 Initial Prenatals as Primary Under Supervision

An Initial Prenatal consists of most of the following, but is not limited to:  Preparation, chart review,  intake interview, history (medical, gynecological, family), complete physical examination, weight, blood pressure, pulse, Fetal Heart Tones, Baby's position, evaluation of size for dates, education and counseling for gestational age specific topics, any necessary labwork, education and counseling for any discomforts, evaluation for need for referral to social or medical resources, charting by SOAP method, cleanup, arrangement for next visit, filling out referral forms and lab slips. These items may take place over several visits, but are counted by the student as one Initial Prenatal.
Estimated time per visit: 1 hour.

Form #8: 55 Prenatals as Primary Under Supervision

NCM Clinical Record Form #8: 55 Prenatals as Primary Under Supervision

A Prenatal consists of most of the following, but is not limited to: Preparation, chart review,  weight, blood pressure, pulse, Fetal Heart Tones, Baby's position, evaluation of size for dates, education and counseling for gestational age specific topics, any necessary lab work, education and counseling for any discomforts, evaluation for need for referral to social or medical resources, charting by SOAP method, cleanup, arrangement for next visit, filling out referral forms and lab slips. 
Estimated time per visit: 30 min.

Form #9: 25 Births as Primary as Primary Under Supervision 

NCM Clinical Record Form #9: 25 Births as Primary as Primary Under Supervision 

At least 18 Births as Assistant under Supervision must be completed prior to beginning this form.
15 births must include at least 1 prenatal. (5 must include full continuity of care and must additionally be recorded on NARM Continuity of Care-Practical Experience Form 200).
A MAXIMUM of 3 of these births may be Intrapartum Transports to Hospital.    
Births as Primary Under Supervision means that the apprentice demonstrates the ability to perform all aspects of midwifery care to the satisfaction of the preceptor, who is physically present and supervising the apprentice’s performance of skills and decision making. The apprentice is present for all stages of labor and delivery, and immediate postpartum, makes all clinical decisions for all stages of labor and delivery, and immediate postpartum, is able to articulate the rationales for these decisions, and charts or directs the charting of all stages of labor and delivery, and immediate postpartum.
Estimated time per birth: 24 hours.

Form #10: 20 Newborn Exams as Primary Under Supervision

NCM Clinical Record Form #10: 20 Newborn Exams as Primary Under Supervision

A Newborn Exam consists of most of the following, but is not limited to: Apgar, gestational age assessment, reflexes, head to toe physical, application of erythromycin to the eyes and injection of vitamin K, metabolic screening, referral for hearing screening, referral for pediatric follow-up, weight and measurements, foot-printing, birth certificate, souvenir certificate for parents, registration for social security and Medicaid.
This exam must be done within 12 hours of birth.
Estimated time per visit: 30 min.

Form #11: 40 Postpartum Exams as Primary Under Supervision

NCM Clinical Record Form #11: 40 Postpartum Exams as Primary Under Supervision

A Postpartum Visit to Mother and Baby consists of most of the following, but is not limited to: Preparation, chart review for follow up on such things as the need for RhoGAM and ABO incompatibility, etc, check baby weight gain, physical assessment and vitals, assessment of lochia, counseling regarding breastfeeding/bottle-feeding, counseling and education for mother and family regarding nutrition for mother and baby, any necessary lab work, education and counseling for any discomforts, evaluation for referral to social and/or medical resources, evaluation of baby for dehydration, answering parent's questions, check health of umbilical cord and removal of clip if necessary, check healing of any stitches/ tears, evaluation for need for referral to social or medical resources, charting by SOAP method, cleanup, arrangement for next visit, filling out any necessary referral forms and lab slips. 
These visits must be done between 12 hours and 6 weeks following the birth.
Estimated time per visit: 1 hour.

 

NARM SKILLS FORM

NARM SKILLS FORM

NARM Skills on this form must be completed as directed in Pam Weaver and Sharon Evans book, Practical Skills Guide for Midwifery. NARM Skills background is taught within the academic courses, but preceptor demonstration, student practice and evaluation of the student takes place in a clinical setting.  4 skills:(#'s 66,74,113,136) require the evaluation and verification of 2 different preceptors . Submit Photocopies of updated pages of the form to the College at the end of each trimester(Student keeps original). 

Estimated clinical time spent on each NARM Skill: 3 hours, 24 minutes.

NARM Form 200: Continuity of Care:

NARM Form 200: Continuity of Care:

All of these 5 Births as Primary under Supervision must include Full Continuity. Each must include 5 prenatals spanning 2 trimesters, the birth, newborn exam, and 2 postpartum exams.  Only approved NCM Preceptors may sign this form in the spaces marked "Witness."

MEAC Continuity of Care Documentation Form

MEAC Continuity of Care Documentation Form

This form must be filled out for each Continuity of Care listed on NARM form 200 Continuity of Care.

(Send these forms to NARM with your NARM Exam Application instead of client charts.)

This form may be filled with clinicals that have already been entered on NCM Primary Midwife under Supervision Forms #'s 7-11. (Please use NARM's official versions of these forms and read the instructions carefully, as these will be part of the student's NARM Exam Application). MEAC students are not required to submit Out of Country (OOC) Birth Sites Form 230 listed on Forms 200 and 204.

NARM Form 204: Out of Hospital Birth:

NARM Form 204: Out of Hospital Birth:

10 of the Births as Primary under Supervision must be in an out of hospital setting, and must occur within 3 years of taking the NARM Exam.   Only approved NCM Preceptors may sign this form in the spaces marked "Witness."

This form may be filled with clinicals that have already been entered on NCM Primary Midwife under Supervision Forms #'s 7-11. (Please use NARM's official versions of these forms and read the instructions carefully, as these will be part of the student's NARM Exam Application). MEAC students are not required to submit Out of Country (OOC) Birth Sites Form 230 listed on Forms 200 and 204.

NARM Form 102: Birth Experience Background

NARM Form 102: Birth Experience Background

Use the births from forms #1, 3 and 9 to fill in this form.
Please note: on this form in the line "Number Observed," list the births from Form #1:10 Births as an Observer. 
In the line, "Number Active Participant," list the births from Form #3: 20 Births as an Assistant under Supervision. 
In the lines, "Number Primary under Supervision" and "Number Primary/Co-Primary" use Form #9: 25 Births as Primary Under Supervision, divided in the following way:  In the spaces for "Number Primary Under Supervision," list 20 of these births with a maximum of 2 IP transports. In the spaces for "Number Primary/Co-Primary," list the remaining 5 of these births with a maximum of 1 IP transport.

Form #12: CLINICAL REQUIREMENTS SUMMARY SHEET

NCM Clinical Record Form #12: CLINICAL REQUIREMENTS SUMMARY SHEET

Use this form to summarize completion of all NCM and NARM clinical requirements.

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ASM Clinical Experience Requirements:

Clinical Timeframe: Clinical Requirements must span at least 2 years under the supervision of the student's approved NCM preceptor

 

Required Clinicals:

Hours/visit

Required

Hours

Credits

Observes:

 

 

 

Births as Observer

N/A

10

N/A

N/A

Assists Under Supervision:

 

 

 

Initial Prenatal Assists

1 hour

3

3

0.10

Prenatal Assists

30 minutes

22

11

0.37

Birth Assists

12 hours

20

240

8.00

Newborn Exam Assists

30 minutes

20

10

0.33

Postpartum Exam Assists

1 hour

10

10

0.33

Primaries Under Supervision:

 

 

 

Well Woman/Family Planning

30 minutes

30

15

0.50

Initial Visits

1 hour

20

20

0.67

Prenatal

30 minutes

55

27.5

0.92

Birth as Primary

24 hours

25

600

20.00

Newborn Exams

30 minutes

20

10

0.33

Postpartum Exams

1 hour

40

40

1.33

NARM Continuity of Care

N/A

5

N/A

N/A

NARM Out of Hospital Births

N/A

10

N/A

N/A

SUB TOTALS:

 

 

986.50

32.88

NARM Clinical Skills

 

 

517.50

Credits in Academics

CLINICAL TOTALS:

 

 

1504.00

32.88

Conversion to semester credit hours:  30 clinical contact hours = 1 credit hour

General Instructions for Clinicals:  Each NCM Clinical Record Form lists the scope of the skill, the student role, the type of preceptor supervision required, the skill demonstration by the student necessary for the student to receive credit, and any other special requirements.  The Student records completion of clinicals on the NCM Clinical Record Forms.  Include student name on each form. Entries should be made in Chronological order and printed clearly. The Preceptor must sign, not initial, every line.   Students should not start a new page for each form each trimester, but should fill a master of each form. Student participation at clinicals is at the discretion of the preceptor.

Trimesterly Reporting of Completed Clinicals to NCM: Student submits photocopies of updated forms at the end of each trimester to document progress, and retains the original forms to continue filling-in.  All clinical submissions must be accompanied by a Student-Preceptor Evaluation Form for each preceptor.

Guidelines for Verifying Documentation of Clinical Experience: The Student and Preceptor must follow the guidelines in NARM's Candidate Information Bulletin (CIB) online, including but not limited to the following: Student's and Preceptor's care at the encounter must be reflected on the client's chart via name or initials, in case of audit.   The Student must have access to the original client charts for all births and procedures documented.  The original client charts shall be kept by the preceptor. Client confidentiality must be protected by identifying them on these Clinical Record Forms with a unique client code under “Client # or Code,” to reference the client chart, using one code for each client pregnancy.

Order of Completion:  At least 18 of the 20 Births as Assistant (Form #3) must be completed prior to beginning Births as a Primary Midwife under Supervision (Form #9).  The rest of the forms do not need to be completed in any specific order and it is up to the discretion of the preceptor as to whether the student is competent enough to act as Primary Midwife under Supervision  at clinicals.  All forms need to be completed prior to applying for permission to take the NARM Exam.

Credit: Simply being present at or participating in a clinical activity does not guarantee that a student will be given credit for it. The Preceptor will only sign off a clinical when the student has demonstrated the minimum required skill competency level to the preceptor's satisfaction, as appropriate for the individual skills as defined on each clinical record form for each entire clinical experience (Active Participation for Assists vs. Mastery for Primaries).  With the exception of 10 Birth Observes, work done prior to enrollment, or with someone who is not the student’s official NCM preceptor at the time the work was done will not be eligible to satisfy program requirements. Students may submit additional clinicals beyond NCM requirements.  These extra clinicals and clinical contact hours will be listed on the student transcript; however credit is only given for required clinicals.

Birth Experience in Specific Settings:  Of all the births a student attends during training (as Observer, Assistant, or Primary Midwife under Supervision), at least 2 must be planned hospital births (these cannot be intrapartum transports but may be antepartum referrals) and 5 must be home births.

Out of Country Clinicals: When completing NARM Exam application materials, NCM students are not required to submit Out of Country (OOC) Birth Sites Form 230 listed on NARM Forms 200 and 204.

Time Frames: Clinical Experience documented on these forms must span at least 2 years. NCM begins counting these two years with the date of the first clinical entered on forms #1-11 that occurred during enrollment and under the direct supervision of an approved preceptor.  All clinicals must occur within 10 years prior to the student's passing the NARM exam, and 10 of the experiences reported on NARM Out of Hospital Birth Documentation Form 204 must take place no earlier than 3 years prior to the NARM exam.

Direct Supervision: (Required for all clinicals, except for the “10 Birth Observes”).The preceptor must be physically present and in control at all times during the entire activity, must catalyze the important decision making processes, elicit the student’s rationales for her/his decisions, and oversee the student’s charting. Preceptors may ONLY sign off experiences which she/he personally directly supervised and witnessed.

Active Participant/Participation: (This is the required demonstration of competence necessary for student to receive credit for all Clinicals as “Assistant.”) The student must be actively involved in the clinical activity, including, but not limited to charting, hands-on assisting, & participation in management decisions. As an assistant the student will learn through active involvement to perform the clinical skills of a midwife during all stages of pregnancy, labor, delivery and postpartum mother and newborn care. Student readiness for serving as Primary Under Supervision at a clinical exam or birth is at the discretion of the supervising preceptor, and may require more than the minimum number of experiences as Assistant Under Supervision listed on the forms.                                                          

Mastery: (This is the required demonstration of competence for all NARM Skills and Clinicals the student attends as “Primary Midwife under Supervision.”) The student must demonstrate competent and confident provision of safe, evidence-based midwifery care for the individual Clinical Skills including: Etiology, sequelae, appropriate management and follow-up for the individual patient, appropriate times and reasons for consult and referral, access to relevant resources and information, complete, thorough and timely record keeping, appropriate, professional, and compassionate management of every task involved, receptiveness and responsiveness to patient's concerns, explanation of midwifery decisions and actions as they relate to possible outcomes and their wider impact, based on the Midwives Model of Care®.

Instructions for completing Clinical Record Forms

General Instructions: Write Student name on each form. Please list clincals in Chronological order and print clearly. The Preceptor must sign, not initial, every line.   Please continue to use each form until it is complete.

Trimesterly Reporting to NCM: Student submits photocopies of updated forms at the end of each trimester to document progress, and retains the original forms to continue filling-in.  All clinical submissions must be accompanied by a Student-Preceptor Evaluation Form for each preceptor.

Guidelines for Verifying Documentation of Clinical Experience: The Student and Preceptor must follow the guidelines in NARM's Candidate Information Bulletin online, including but not limited to the following: Student's and Preceptor's care at the encounter must be reflected on the client's chart via name or initials, in case of audit.   The Student must have access to the original client charts for all births and procedures documented.  The original client charts shall be kept by the preceptor. Client confidentiality must be protected by identifying them on these Clinical Record Forms with a unique client code under “Client # or Code,” to reference the client chart, using one code for each client pregnancy. 

Order of Completion:  At least 18 of the 20 Births as Assistant (Form #3) must be completed prior to beginning Births as a Primary Midwife under Supervision (Form #9).  The rest of the forms do not need to be completed in any specific order and it is up to the discretion of the preceptor as to whether the student is competent enough to act as Primary Midwife under Supervision  at clinicals.  All forms need to be completed prior to applying for permission to take the NARM Exam.

Credit: The Preceptor will only sign off a clinical when the student has demonstrated the minimum required skill competency level (Active Participation vs. Mastery) to the preceptor's satisfaction, as appropriate for the individual skills as defined on each clinical record form for each entire clinical experience.  With the exception of 10 Birth Observes, work done prior to enrollment, or with someone who is not the student’s official NCM preceptor at the time the work was done will not be eligible to satisfy program requirements. Students may submit additional clinicals beyond NCM requirements.  These extra clinicals and clinical contact hours will be listed on the student transcript, however credit is only given for required clinicals.

Birth Experience in Specific Settings:  Of all the births a student attends during training (as Observer, Assistant, or Primary Midwife under Supervision), at least 2 must be planned hospital births (these cannot be intrapartum transports but may be antepartum referrals) and 5 must be home births.

Time Frames: Clinical Experience documented on these forms must span at least 2 years.  All clinicals must occur within 10 years prior to the student's passing the NARM exam, and 10 of the experiences reported on NARM Out of Hospital Birth Documentation Form 204 must take place no earlier than 3 years prior to the NARM exam. 

Out of Country Clinicals: When completing NARM Exam application materials, NCM students are not required to submit Out of Country (OOC) Birth Sites Form 230 listed on Forms 200 and 204.

NARM Continuity of Care-Practical Experience Form 200 and NARM Out of Hospital Birth Documentation Form 204.  These forms may be filled with clinicals that have already been entered on NCM Primary Midwife Under Supervision Forms #'s 7-11. (Please use NARM's official versions of these forms and read the instructions carefully, as these will be part of the student's NARM Exam Application). MEAC students are not required to submit Out of Country (OOC) Birth Sites Form 230 listed on Forms 200 and 204.

NARM Birth Experience Background Form 102-Use the births from forms #1, 3 and 9 to fill in this form. Please note: on this form in the line "Number Observed," list the births from Form #1:10 Births as an Observer.  In the line, "Number Active Participant," list the births from Form #3: 20 Births as an Assistant Under Supervision.  In the lines, "Number Primary Under Supervision" and "Number Primary/Co-Primary" use Form #9: 25 Births as Primary Under Supervision, divided in the following way:  In the spaces for "Number Primary Under Supervision," list 20 of these births with a maximum of 2 IP transports. In the spaces for "Number Primary/Co-Primary," list the remaining 5 of these births with a maximum of 1 IP transport.

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Student Role: Observer
Preceptor Supervision Required: No supervision-Any witness can provide verification.
Student Demonstration necessary to receive credit: Presence-The student's presence at the birth in any capacity.

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Student Role: Assistant to Primary Midwife 
Preceptor Supervision Required: Direct Supervision - The preceptor must be physically present and in control at all times during the entire activity,must catalyze the important decision making processes, elicit the student’s rationales for her/his decisions, and oversee the student’s charting. Preceptors may ONLY sign off experiences which she/he personally directly supervised and witnessed.
Student Demonstration necessary to receive credit: Active Participation-The student must be actively involved in the clinical activity, including, but not limited to charting, hands-on assisting, & participation in management decisions. 

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Student Role: Primary Midwife under Supervision
Preceptor Supervision Required: Direct Supervision - The preceptor must be physically present and in control at all times during the entire activity,must catalyze the important decision making processes, elicit the student’s rationales for her/his decisions, and oversee the student’s charting. Preceptors may ONLY sign off experiences which she/he personally directly supervised and witnessed.
Student Demonstration necessary to receive credit: Mastery-The studentmust demonstrate competent and confident provision of safe, evidence-based midwifery care for the individual Clinical Skills including: Etiology, sequelae, appropriate management and follow-up for the individual patient, appropriate times and reasons for consult and referral, access to relevant resources and information, complete, thorough and timely record keeping, appropriate, professional, and compassionate management of every task involved, receptiveness and responsiveness to patient's concerns, explanation of midwifery decisions and actions as they relate to possible outcomes and their wider impact, based on the Midwives Model of Care®.

 

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