The impact of clinical placement site, community clinic versus tertiary hospital, on midwifery students' clinical learning experience in Sierra Leone: A cohort study

Background: Many factors influence midwifery students’ clinical learning experience (CLE); however, little is known about the impact the type of clinical placement site - either clinic or hospital - has on a student’s experience. Methods: : The aim of this study was to examine how clinical placement site, clinic or hospital, impacts students’ CLE in Sierra Leone. A 34-question survey was given to midwifery students attending one of four public midwifery schools in Sierra Leone. Median scores were compared for survey items by placement site using Wilcoxon tests and the relationship between clinical placement and student’s experience were assessed using multilevel logistic regression. Results: : Two-hundred students (hospitals students = 145 (72.5%); clinic students = 55 (27.5%) across Sierra Leone completed surveys. Most students (76%, n=151) reported satisfaction with their clinical placement. Students placed at clinics were more satisfied with opportunities to practice/develop skills (p=0.007) and more strongly agreed preceptors treated them with respect (p=0.001), helped improve their skills (p=0.001), provided a safe environment to ask questions (p=0.002), and had stronger teaching/mentorship skills (p=0.009) than hospital students. Students placed at hospitals had greater satisfaction in exposure to certain clinical opportunities including completing partographs (p<0.001); perineal suturing (p<0.001); drug calculations/administration (p<0.001) and estimation of blood loss (p=0.004) compared to clinic students. The odds of students spending more than 4 hours per day in direct clinical care were 5.841 (95% CI: 2.187-15.602) times higher for clinic students versus hospital students. There was no difference between clinical placement site in regards to number of births students attended (OR 0.903; 95% CI: 0.399, 2.047) or number of births students managed without a preceptor/clinician present (OR 0.729; 95% CI: 0.285, 1.867). Conclusion: The clinical placement site, hospital or clinic, impacts midwifery students’ CLE. Clinics offered students significantly greater attributes of a supportive learning environment and access to direct, hands-on opportunities for patient care. These findings may be helpful for schools when using limited resources to improve the quality of midwifery education. Trial registration: N/A