Mid Sweden University

This thesis explores the self-perceived confidence of Swedish midwifery students in performing essential clinical competencies at the completion of their education. The research is based on the questionnaire; Confidence of Midwifery Students on Selected Midwifery Competencies at Completion of the Education (COMICE), adapted for the Swedish context as COMICE-S.

Aim: The overarching aim of this thesis was to explore Swedish midwifery students’ professional confidence in basic clinical midwifery skills, with a particular focus on the factors influencing confidence development and the role of clinical supervision and teaching methods. Furthermore, the thesis aimed to psychometrically evaluate the COMICE-S questionnaire in a Swedish educational context.

Method: Study I, A quantitative study, measuring midwifery students’ confidence in antepartum, intrapartum, postpartum, and newborn care, and is measuring each item midwifery students are expected to manage. Study II: A quantitative study, validating and testing the COMICE-S instrument in a Swedish context. Study III: A mixed method study, focusing on supervision and learning methods in intrapartum care. Study IV: A qualitative approach, analysing comments from midwifery students on factors that decreased or increased confidence during clinical practise.

Findings: The validation and testing of the questionnaire showed that the instrument was suitable in the Swedish context. Swedish midwifery students are confident in handling normal pregnancy and birth; however, they need more training in complicated pregnancy and birth. The clinical environment affects professional confidence, structured supervision, and teacher-led sessions are of importance, particularly when followed by simulations. Qualitative findings with newly graduated midwives support the results and suggest a need for extended or alternative educational pathways.

Conclusion: The thesis demonstrates that while Swedish midwifery students feel confident in managing normal care, there is a need to strengthen educational strategies to better prepare the graduating midwives for complex clinical situations. The findings offer valuable insights for the continued development of midwifery education.