PhD research: How does grading students' practice affect midwifery?

By Billie Hunter and Sue Macdonald on 25 May 2018 Midwives Magazine Research Student midwives Midwifery

A subject lead for nursing and midwifery and lead midwife for education on their doctoral study.


To explore how grading students’ practice affects midwifery students, mentors and lecturers’ relationships, identity and authority.


The case study consisted of interviews – 51 students, 15 mentors, and five lecturers – who were recruited from three trusts and a university, complemented with data from student practice grades and practice assessment documents. The analytical framework drew on Basil Bernstein’s pedagogic codes using the concepts of classification and framing. This enabled an exploration of what counted as valid practice knowledge, teaching and learning in clinical practice, and evaluation of learning.


Different forms of midwifery knowledge were discussed at length and documented in the practice assessment documents. There was a strong classification of clinical skills, meaning these skills are explicit aspects of a midwife’s role. But communication and research skills had weak classification – for example, communication was reduced to ‘chat’ and research was described as ‘students’ work’. This may mean not all students understand their importance and the teaching of these skills was less visible in clinical practice.

The environment affected the structural and interactional practices. Students’ relationships with community mentors seemed more relaxed than with hospital mentors. This can be understood by framing. Strong framing is explicit control by the mentor, which sometimes limited students’ access to learning opportunities. Whereas weak framing, a relaxed hierarchy between the student and mentor, and student-led learning was preferred. Gaining access to learning enabled students to embody their developing midwifery identity. Conversely, having limited access negatively impacted on some students’ development.

Mentors reported that they generally liked awarding practice grades. The high grades seemed to increase the students’ confidence in their ability. However, it could be more difficult if a student didn’t meet the standards required. The mentors said that they found it difficult to award low grades, or refer grades, as they had built up a relationship with the student. Mentors had to assert their authority to refer students’ practice.


Almost all students were consistently awarded high practice grades. There was limited stratification of grades. Therefore, the grades have been interpreted as competence rather than performance of midwifery and symbolise acceptance into the profession. Understanding the complexity of the practice area and the types of discourses it produces is necessary to enable all students equal access to midwifery knowledge.

Sam Chenery-Morris is subject lead for nursing and midwifery and lead midwife for education at the University of Suffolk.