Vietnam national competency standards for midwifery: A Delphi study

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This study aims to develop the competency standards for midwifery in Vietnam by using a Delphi process. Methods The draft midwifery competency standard was initially developed based on a literature review. Midwives and professionals working with midwives completed a two-round Delphi survey to evaluate the relevance of standards of competence on a four-point Likert scale. The criteria with consensus of under 80% were revised and included in the second round. 75 participants were in the first round and 72 participants were in the second round. Phase 3 was led by the Ministry of Health to finalize the consensus on the midwifery competency standards in Vietnam. Results The research results indicated that midwifery competency was mostly rated as quite relevant or higher (over 80%). Some standards were removed, and some were included in the second round of the Delphi process. The final competency standards were issued with 4 areas (midwifery professional practice; care management; midwifery management; professional development), 11 standards and 44 criteria; along with the general skills of midwifery. Conclusions The study developed a midwifery competency standard in Vietnam. These competency standards are consistent with the perceptions of the International Confederation of Midwives and the domestic midwifery context. The higher education institutions, employers, policy makers and midwives themselves benefit from this developed midwifery competency standards. Future research needs to be conducted to validate midwifery competency standards in clinical settings for further responses. 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F1000Research 2024, 12 :981 ( https://doi.org/10.12688/f1000research.138350.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] Tung Thanh Le 1 , Anh Tuan Truong 1 , Thanh Van Vu 1 , [...] Ha Thi Viet Tran 1 , Huong Thi Thanh Pham 1 , Huong Thi Thanh Nguyen 1 , Anh Thi Lan Mai https://orcid.org/0000-0003-2487-7766 1 Tung Thanh Le 1 , Anh Tuan Truong 1 , [...] Thanh Van Vu 1 , Ha Thi Viet Tran 1 , Huong Thi Thanh Pham 1 , Huong Thi Thanh Nguyen 1 , Anh Thi Lan Mai https://orcid.org/0000-0003-2487-7766 1 PUBLISHED 21 Feb 2024 Author details Author details 1 Nam Dinh University of Nursing, Nam Dinh city, 420000, Vietnam Tung Thanh Le Roles: Conceptualization Anh Tuan Truong Roles: Data Curation Thanh Van Vu Roles: Formal Analysis Ha Thi Viet Tran Roles: Investigation, Methodology Huong Thi Thanh Pham Roles: Project Administration, Resources Huong Thi Thanh Nguyen Roles: Validation, Writing – Original Draft Preparation Anh Thi Lan Mai Roles: Resources, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the QUVAE Research and Publications gateway. Abstract Background After nearly a decade, Vietnam’s basic midwifery competency standards need to be updated to effectively implement midwives, enhance the quality of midwifery human resources to meet the requirements of integration of countries in the region and around the world. This study aims to develop the competency standards for midwifery in Vietnam by using a Delphi process. Methods The draft midwifery competency standard was initially developed based on a literature review. Midwives and professionals working with midwives completed a two-round Delphi survey to evaluate the relevance of standards of competence on a four-point Likert scale. The criteria with consensus of under 80% were revised and included in the second round. 75 participants were in the first round and 72 participants were in the second round. Phase 3 was led by the Ministry of Health to finalize the consensus on the midwifery competency standards in Vietnam. Results The research results indicated that midwifery competency was mostly rated as quite relevant or higher (over 80%). Some standards were removed, and some were included in the second round of the Delphi process. The final competency standards were issued with 4 areas (midwifery professional practice; care management; midwifery management; professional development), 11 standards and 44 criteria; along with the general skills of midwifery. Conclusions The study developed a midwifery competency standard in Vietnam. These competency standards are consistent with the perceptions of the International Confederation of Midwives and the domestic midwifery context. The higher education institutions, employers, policy makers and midwives themselves benefit from this developed midwifery competency standards. Future research needs to be conducted to validate midwifery competency standards in clinical settings for further responses. READ ALL READ LESS Keywords Vietnam, national competency, midwives, midwifery competency, midwifery management Corresponding Author(s) Anh Thi Lan Mai ( [email protected] ) Close Corresponding author: Anh Thi Lan Mai Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Thanh Le T et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Thanh Le T, Tuan Truong A, Van Vu T et al. Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] . F1000Research 2024, 12 :981 ( https://doi.org/10.12688/f1000research.138350.2 ) First published: 15 Aug 2023, 12 :981 ( https://doi.org/10.12688/f1000research.138350.1 ) Latest published: 21 Feb 2024, 12 :981 ( https://doi.org/10.12688/f1000research.138350.2 ) Revised Amendments from Version 1 The authors greatly appreciate the valuable comments and suggestions of reviewer number 1. We have rewritten and responded to reviewer number 1 as follows: 1. We have rewritten the introduction because there are still some unclear points and the importance of the research problem has not been stated. 2. We have rewritten the method section because we have not clarified the research object, selection criteria and research ethics. 3. We provided feedback and edits to the results and discussion section to clarify recommendations for the study. 4. An Acknowledgments section has been added to this version. The authors greatly appreciate the valuable comments and suggestions of reviewer number 1. We have rewritten and responded to reviewer number 1 as follows: 1. We have rewritten the introduction because there are still some unclear points and the importance of the research problem has not been stated. 2. We have rewritten the method section because we have not clarified the research object, selection criteria and research ethics. 3. We provided feedback and edits to the results and discussion section to clarify recommendations for the study. 4. An Acknowledgments section has been added to this version. To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table. READ REVIEWER RESPONSES Introduction In 2014, with the support of the United Nations Population Fund (UNFPA), the Ministry of Health, in collaboration with the Vietnam Midwives Association, developed the National Competency Standard for Midwives in Vietnam to meet the country’s maternal and child health care requirements ( Vietnam Ministry of Health, 2015 ). Through the competency standards, training institutions have developed midwifery training programs, contributing to enhancing the quality of midwifery human resources. However, after nearly a decade, the National Competency Standard for Midwives in Vietnam needs to be reviewed and supplemented to effectively enhance the quality of midwifery and meet the needs of midwives requirements for the integration of countries in the region and around the world. In addition, the International Confederation of Midwives (ICM) has recommended that competencies need to be updated continuously and in a timely manner as the evidence on health and clinical practice has evolved rapidly and health care needs to change ( ICM, 2018a , b ). In Vietnam, Midwifery is a profession with a long history of development with the first training institution being the Indochina Midwifery School. Then, there were many other institutions across Vietnam training midwifery, including intermediate and college levels. In 2013, there were some universities that started training midwives at university level. Since then, most of the trainers involved in the training are university level midwifery lecturers and a part of the specialties are obstetrics and paediatrics. In 2014, the Vietnam Midwifery Association released a set of National Competency Standards for Midwives in Vietnam, marking an important milestone in the practice and training of midwifery in Vietnam. The ICM has a mission to support the Association of Midwives and develop the midwifery profession globally by supporting midwives to work independently to give the best care to pregnant women and their families. They support safe childbirth and improve the health of women, babies and families. ICM has worked closely with other international organizations to develop and continuously update the international midwifery competency standards, in which the latest competency standards were updated in 2019 ( ICM, 2019 ). The ICM defines competence as the knowledge, skills and behaviors required by midwives to practice safely in any setting ( ICM, 2013 , 2017 , 2018a , b , 2023 ). Some other countries have defined the concept of midwifery competence as representing the quality of practice, intergrated knowledge, skills and attitudes in midwifery practice ( Yin et al ., 2018 ; The Midwives Council of Hong Kong, 2010 ; Midwifery Council of New Zealand, 2016 ). The process of developing competency standards for Vietnamese midwives in 2014 is also based on these definitions of competence, to describe the professional standards set by the profession for members and society. The National Midwifery Competency Standards has been reviewed and supplemented for a variety of purposes including informing to clients, professions and others about the midwifery competency standards. At the same time, competency standards also serve to inform the approval or recognition process of midwifery education programs; Determining the conditions for midwifery practice for people who have graduated from midwifery in Vietnam; Evaluation of qualified midwives who need to demonstrate their continuing qualifications for their current position; Allowing midwives to define their continuing professional development plan; creating conditions for Vietnam and the world to recognize each other in the midwifery discipline ( Vietnam Ministry of Health, 2015 ). Midwifery national competency standards include the core competencies required to fulfill the role of a midwife. Therefore, it is important to clearly define midwifery professional competence in order to develop education programs for midwifery qualifications and ultimately to improve midwifery quality. While National Competency Standard for Midwives in Vietnam has been standardized and legally recognized. There are still challenges in implementing the basic competency standards of midwives in 2014, as well as difficulties in developing training programs based on the competency standards. Therefore, the Vietnamese national competency standard for midwives were not universally adopted in educational institutes. Previously, Vietnam’s midwifery education had three levels including university bachelor (4 years), college bachelor (3 years), and secondary-level programs (2 years) (UNFPA; 2017). Currently, Vietnam’s midwifery education has two main levels of university and college bachelor. However, there was some universities/colleages adopted the Vietnamese national competency standards for midwive education whereas others developed their own standards because unapplicable standards. In addition, the national exam for certification of midwifery practice has been included in the law draft on Medical Examination and Treatment. Accordingly, all midwife graduates must pass a national exam to be granted a practicing certificate. In order to be able to have an accurate assessment tool for midwifery practice competency, the midwifery professional competencies need to be standardized and legally recognized as well as applicable criteria for competency-based education to support assessment of midwifery competencies ( UNFPA, 2014 ). Therefore, it is very important to review and supplement Vietnam’s midwifery national competency standards. Firstly, midwifery competency standards were reviewed and supplemented after nearly a decade of application to higher education institutions to develop education competencies for midwifery in Vietnam. The institutions develop appropriate graduate outcomes, curriculum, methods and teaching contents. Second, this is the basis for managers to develop competencies for certification, recruitment, appointment, promotion of midwives, planning and creating opportunities for midwives to be trained continuously while working in medical facilities. Consequently, the quality of health care for women and children in Vietnam will be improved. Third, midwifery national competency standards are the basis for midwives at each level to develop their competency in the working process. This study aimed to develop the national competency standards for midwifery in Vietnam. Methods Study design The study used a multi-stage modified Delphi process ( de Loë et al. , 2016 ) to reach a national agreement on competency standards for midwives in Vietnam. The study was managed by Vietnam Ministry of Health and the Nam Dinh University of Nursing and in constant consultation with the Steering Committee and the Professional Committee. The research was conducted at Nam Dinh University of Nursing, which is the first institution providing the bachelor of midwifery program in Vietnam. The Ministry of Health convened Nam Dinh University of Nursing and representatives from regulatory agencies, the healthcare universities/colleges, obstetrics and gynecology hospitals, departments, Midwifery Association and the other professional associations related to midwifery in Vietnam such as WHO and JICA through the dispatches. These organisations were selected sine they represent different regions of Vietnam and have midwifery experts either at the workplace or at educational institutes. The research was conducted from October 2020 to December 2021. Procedure Phase 1: phase 1 consisted of a systematic review to synthesize the initial set of competency standards. A literature review was conducted to identify the Vietnamese and international literature on midwifery competency standards. The review included material from established databases such as the Ministry of Health, ICM, CINAHL, Sciencedirect and Medline as well as conference presentations, national and international publications and reports from regulatory and professional bodies. Keywords included in the literature were “midwifery competency standards”; “bachelor of midwifery”; “professional competency standards”. The literature resources were identified according to the following inclusion criteria: (1) involved midwifery population; (2) addressed the issues of the competency standards, no restriction on publication date and study methodology. The PRISMA Flow Diagram was used to guide the search ( Thanh Le et al. , 2023 ). Initial searches captured 275 records across all databases. Duplicated references were removed, and 105 citations remained for screening. Finally, 15 documents that met the inclusion criteria were included, in which there were 7 research studies and 8 midwifery competency standards. The most relevant literature found are listed as Basic competency standards of Vietnamese midwives (2014); Vietnam Nursing Basic Competency Standard (2012); Basic midwifery competency standards ( ICM, 2019 ); Singapore Midwifery Core Competency Standards (2018); Australian Midwifery Competency Standards (Australia, 2007). Based on the systematic review results, one author listed out all the statements from included papers, the other author linked these statements to specific competencies and both authors discussed this list. Overlapping statements were removed from the list. As a result, the research team proposed the first draft of Vietnamese midwifery competency. This draft of competency with 110 statements were included in the survey of phase 2. The process was presented in Figure 1 . Figure 1. Results of the article selection and flow diagram of the data search process. Phase 2: A modified Delphi survey with 2 rounds was conducted to reach a consensus on proposed Vietnam Midwifery Competencies. The purposive sampling method was widely used to collect data through official correspondence to hospitals, universities/college training midwives, and Vietnamese midwifery associations. The university coordinated with the Ministry of Health to send dispatches to hospitals, universities, colleges and associations related to midwifery. The dispatches asked each institution to appoint a leader to participate in the survey. There were 75 managers, policy makers, presidents of midwifery associations, head midwives and midwives in obstetric departments and hospitals. This data collection process was carried out in different settings representing different regions of Vietnam. Using this approach, midwives from urban, regional and rural settings, as well as from public and private institutions, were included in the survey. This shows the diversity of the participants. Participants rated importance of each competency statement using a four-point Likert scale (1 = not relevant at all; 4 = relevant) and gave feedback/suggestions in text. The participants were asked to rate the questionnaires and send back to Nam Dinh University of Nursing by the dispatches. The round 1 survey was conducted from October to December, 2020. At the end of the first round of the surveys, the research team met to review the data and revise the statements. The round 1 results provided the competency set with 75 statements, which were included in round 2. The round 2 survey was from February to April 2021 providing the set of competencies with 72 statements. For each round, the team retained the midwifery competencies that reached a consensus level of 80% or more of the participants. Step 3: the phase to finalize the consensus on the competency standards. The Ministry of Health sent an invitation to attend the workshop on assessment of midwifery competency standards, attached with the expected midwifery competency standards to relevant institutions. The “Developing Midwifery Competency Standards in Vietnam” workshop was conducted within four hours at Nam Dinh University of Nursing under the chairmanship of MOH in June 2021. Participants were representatives from associations related to midwives such as Vietnam Midwifery Association; managers of midwifery training units, hospitals and policy makers. Each institution appointed a representative to attend the workshop and give feedback on the expected midwifery competency standards. The workshop was organized with different representatives from different regions of Vietnam. In particular, the input of regulatory agencies was essential for the common goal of ensuring the consistency of national midwifery competency standards. At the workshop, the Ministry of Health and the manager boards of Nam Dinh University of Nursing presented on importance of midwifery competency standards, the results of Delphi phase and proposed midwifery competency standards. Representatives of the institutions gave feedback and discussed on each criteria in the proposed midwifery competency standards. The Steering Committee and the Professional Committee followed the minutes of the workshop on comments and suggestions of the participants to propose the final version of the national midwifery competency standards. The workshop was a strategy for consultation and feedback on the draft text and for informing the various authorities of the process and results. Ethical considerations The research proposal was approved by the Ethical Board of Nam Dinh University of Nursing (#2539/GCN-HĐĐĐ). All study participants were clearly informed about the purpose of the study, the data collection procedure, possible inconveniences, and the right to participate in the study. The research team respects the participants’ decisions, ensuring anonymity and confidentiality of information. This study was conducted without physical assessment or intervention; therefore it did not pose risks to the participants. Data analysis Qualitative and quantitative data analysis methods were used to analyze the data obtained from the survey and workshop consultation. Quantitative data were analyzed using a statistical software program. Statistical significance level was set at p < 0.05. Descriptive statistics will include frequencies, percentages, mean for categorical variables, and standard deviation for continuous variables. The comments/suggestions about the competency statements were converted into a single report by the research assistant for the study team members to review and discuss. Results The study participants in Rounds I and II had similar characteristics in terms of their years of work, education, current position, and workplace. The majority of participants in both rounds had worked for 10-19 years, followed by those who had worked for 1-9 years and those who had worked for 20-29 years. In terms of education, most participants had an undergraduate degree, followed by those with a master’s degree and then those with a diploma/certificate or doctorate. Most of the participants in both rounds worked as midwives, followed by doctors and managers. The most common workplace was an obstetrics and gynecology hospital, followed by an obstetrics and gynecology department and a midwifery education institution. The participants’ characteristics were presented in Table 1 . The full dataset can be found under Underlying data ( Thanh Le et al. , 2023 ). Table 1. Characteristics of study participants. Characteristics Round I 75 Round II 72 Number % Number % Worked years 1-9 12 16.00 12 16.67 10-19 35 46.67 33 45.83 20-29 21 28.00 20 27.78 30+ 7 9.33 7 9.72 Education Diploma/certificate 18 24.00 17 23.61 Undergraduate degree 28 37.33 28 38.89 Masters 21 28.00 20 27.78 Doctorate 8 10.67 7 9.72 Current position Manager 17 22.67 13 18.06 Doctor 22 29.33 21 29.17 Midwife 24 32.00 24 33.33 Midwife educator 11 14.67 11 15.28 Other 1 1.33 1 1.39 Work place Obstetrics and gynecology hospital 31 41.33 29 40.28 Obstetrics and gynecology department 23 30.67 22 30.56 Midwifery education institution 17 22.67 17 23.61 Other 4 5.33 4 5.56 The research results indicated that midwifery competency was mostly rated as quite relevant or higher (over 80%). The statements in competency standards on effective communication competency, comprehensive, consistent and continuous quality of care and maintaining a safe environment through the use of quality assurance and risk management strategies were the highest rating (97.8%). Some participants rated “not relevant at al” and “somewhat not relevant”, in which the criterion related to the midwife’s communication competency was rated at only 70.5%. Participants provided comments on the text that it is necessary to adjust some criteria of the competency for future feasibility of evaluating these competencies for the midwife. At the same time, the criteria should connect to each other and to specific competency. Some participants said that the criteria should only be given as a guideline framework to ensure feasibility and relevance in case there are changes to other related guiding documents. The final set of competency standards for Vietnamese midwifery was structured into 4 areas, 11 standards and 43 criteria; along with the general skills of midwifery. Each area represents a basic role of the midwifery. The competency standards was divided into 4 areas of (1) Midwifery Professional Practice; (2) Care management; (3) Midwifery management; (4) Professional development. Each standard represents a section of the field and covers a task for the midwifery. Furthermore, the midwifery competency benchmark provides a set of general skills that midwives should be able to perform. Based on the results shown in Table 2 , the fist area of competecy stadards for Vietnamese midwifery is professional practice in compliance with ethical and legal regulations. The graduate midwives are expected to have a thorough understanding of their positions, roles, functions, and duties. They were able to perform midwifery interventions according to standards and guidelines while practicing within laws, policies, and regulations. Midwives maintained complete and clear care documentation and records. They ensured their physical, cognitive, psychological, and emotional well-being in order to provide safety services for clients. Table 2. Final version of Vietnamese midwifery competency standards. Domain Statement Mean (S.D.) Professional Practice 1.1 Understand the position, role, function and duties of midwives 3.27 1.2 Perform midwifery interventions according to standards/guidelines 3.79 1.3 Practice midwifery in accordance with the laws, policies and regulations 3.93 1.4 Maintain complete and clear care documentation and records 3.45 1.5 Ensure one's own physical, cognitive, psychological and emotional well-being 3.77 1.6 Demonstrate obligation and responsibility for care within the scope of practice and level of competence 3.85 1.7 Practice in accordance with the required competency of midwives 3.51 1.8 Respecting the values, customs, beliefs and spiritual practices of individuals, families, and community of customers 3.75 1.9 Recognize the beliefs and values of midwives and their influence on practice 3.91 Care Management 2.1 Communicate clearly through verbal/non-verbal means, in writing, and use other means of communication 3.72 2.2 Develop a midwifery care plan in collaboration with the healthcare team, client and family 3.83 2.3 Carry out a comprehensive, systematic assessment 3.89 2.4 Implement and document planned midwifery care 3.56 2.5 Evaluate and adjust the plan of care 3.97 2.6 Demonstrate critical thinking, problem solving and clinical reasoning in decision making 3.52 2.7 Use research findings and apply evidence-based practice 3.66 2.8 Participation in care decision-making and coordination 3.71 2.9 Collaborate with clients, families, and colleagues in providing a continuum of health care services 3.84 2.10 Create a safe care environment 3.77 2.11 Engage in continuous quality assurance and improvement activities 3.47 2.12 Assign, monitor and supervise the work of other supportive care workers 3.72 2.13 Overcoming limitations in midwifery practice 3.56 2.14 Implement continuous quality improvement in care delivery 3.53 2.15 Provide feedback, exchange of practice results 3.42 2.16 Carry out a health care education needs assessment 3.79 2.17 Apply principles of learning and teaching in education and health promotion 3.48 2.18 Implement health education 3.55 Midwifery Management 3.1 Demonstrate the ability to make appropriate management decisions 3.76 3.2 Apply positive thinking skills to problem solving 3.58 3.3 Implement and critique new initiatives and changing processes 3.49 3.4 Seek help and advice to manage tasks effectively 3.52 3.5 Collect, analyze and use incident data and trends to improve care and service strategies 3.48 3.6 Effective use and management of resources 3.52 3.7 Apply measures and guidelines in safe midwifery practice 3.71 3.8 Participate in projects and initiatives to improve quality and ensure safety 3.92 3.9 Analyze possible risks in the working environment 3.56 3.10 Support and cooperate with care team members on risk management 3.75 Professional Development 4.1 Maintain and enhance the professional role of midwives 3.89 4.2 Participate in projects/research, applying evidence-based midwifery practice 3.59 4.3 Correct deficiencies in knowledge, skills and continuous learning 3.61 4.4 Contribute to policy development 3.67 4.5 Demonstrate understanding of basic knowledge of scientific research processes 3.56 4.6 Participate in research and innovative technical improvement 3.91 Midwives also demonstrated obligation and responsibility for care within the scope of practice and level of competence, following the required competency of midwives while respecting the values, customs, beliefs, and spiritual practices of the individual, family, and community of customers. Care management is the essential aspect of midwifery competency standards. Midwives could communicate clearly through verbal/nonverbal means in writing and other means of communication. They developed a midwifery care plan in collaboration with the healthcare team, client, and family while conducting a comprehensive, systematic assessment to provide a continuum of healthcare services, and creating a safe care environment. Midwives also implemented, evaluated and adjusted the plan of care, and demonstrated critical thinking, problem-solving, and clinical reasoning in decision-making. The results demonstrated that they also engaged in continuous quality assurance and improvement activities; assigned, monitored, and supervised the work of other supportive care workers; and implemented continuous quality improvement in care delivery. The third important area of the midwifery competency standards is midwifery management. Midwives demonstrated the ability to make appropriate management decisions; applied positive thinking skills to problem-solving; implemented and critized new initiatives and changing processes; sought help and advice to manage tasks effectively; collect, analyze, and use incident data and trends to improve care and service strategies; and effectively use and manage resources. They also applied measures and guidelines in safe midwifery practice, participated in projects and initiatives to improve quality and ensure safety, analyzed possible risks in the working environment, and supported and cooperated with care team members in risk management. They maintained and enhanced their professional roles; participated in projects and research; applied evidence-based midwifery practice; corrected deficiencies in knowledge, skills, and continuous learning; contributed to policy development; demonstrated an understanding of the basic knowledge of scientific research processes; and participated in research and innovative technical improvement. Discussion This study develops a set of midwifery competency standards in Vietnam. The basic midwifery competency standards issued by MOH in 2014 were developed based on the ICM’s midwifery competency standards updated in 2013 while this competency benchmark is constantly updated and verified by practice. Moreover, the Vietnamese midwifery competency standards are structured according to the common template of the Singapore midwifery core competency standards and the International Basic Midwifery Competency Standard (ICM) to meet the requirements of regional and international integration ( ICM, 2018a , b ; Singapore Nursing Board, 2018 ). Research results showed that the midwifery competency standards, after being developed through the Delphi process changed significantly. Most of the participants found this competency standard to be relevant and important for Vietnamese midwives. Research results indicated that the set of midwifery national competency standards was built to reflect the up-to-date criteria and competency standards, which presented the characteristics of midwifery care according to the reproductive process of a person’s life cycle. That is, midwives in midwifery care serve individuals of all ages and form long-term, ongoing relationships with clients. This element of continuity of midwifery care is reflected throughout the competency statements and helps define the scope of midwifery practice in this particular role. In addition, the areas of competence and statements identified in this study may serve as a framework to guide midwifery roles and responsibilities. Bäck et al. (2017) developed a Swedish midwifery competency standards that described the competence and role of midwives, not limited to, care for the reproductive periods of the clients, vaccinations and immunizations, care for prenatal women, during labor and postpartum, infant development, breastfeeding, medications, reproductive health education and, follow-up on admission, PAP smear, maintainance of health policies and procedures ( Bäck, Hildingsson, Sjöqvist, Karlström, 2017 ). The competency standards covers four key areas of care including midwifery practice in compliance with regulations and professional ethics, care management, midwifery management and career development in which there are 11 standards and 43 criteria. Moreover, the competency standards also reflect general skills, which is a set of skills that midwives perform in their career. Along with midwifery professional competencies, general skills define the requirements for applying for a midwifery license in Vietnam. Included in this document are 112 skills common to midwives covering seven key skill groups in the care of women through the reproductive and neonatal periods. The competency standards identified may serve as a guiding framework for assessing midwifery performance and contributions and assist researchers and other stakeholders (e.g. employers) to generate evidence on the effectiveness of midwives’ contribution to the prevention and reduction of maternal and child mortality and the broader reproductive health care system. To date, there is still limited research to support the assessment of midwives’ contributions to the reproductive health care system, particularly regarding the impact of midwives on clients, providers system-level results. Nove et al. (2021) performed a study on low- and middle-income populations estimating the potential impact of midwives in reducing maternal and neonatal mortality. Due to the growing number of midwives in the reproductive health care workforce, recent research in this area suggested a need for undergraduate programs that specifically target this role ( Gavine et al. , 2019 ). The role of competency standards is to establish minimum requirements for training and to assess midwifery skills during midwifery training. These competency-based training institutions are the basis for developing specific curricula to enhance the readiness of midwifery students before entering the clinical practice environment. This set of competency standards also supports policy makers; provides a list of essential skills that a bachelor of midwifery needs to perform when practicing midwifery; provides guidelines for developing an assessment plan for the midwifery practice certification exam. Well-defined national competencies may also aid in this role integration by assisting with staff recruitment through the development of job descriptions, interview guides, and the use of identification tools, guidelines as well as other relevant literature ( Mharapara et al. , 2022 ). A standardized set of competencies may serve as a framework for developing a well-defined scope of practice ( Hastings-Tolsma et al. , 2018 ). This may enable midwives to practice to the best of their abilities in a reproductive healthcare environment, optimize the performance of their interdisciplinary team, and deliver high-quality midwifery care services to their clients throughout their life ( Chakraborty et al. , 2023 ). This study has several limitations. The views of all midwives and those involved in midwives in Vietnam cannot be fully expressed during the review and supplementation process, only designated units will be selected to participate. Recognizing this limitation, the research team made every effort to ensure that the most representative midwifery units were selected to participate. The consultation team will also select those that will make an important contribution related to midwifery such as midwifery unit leaders in educational and practice roles nationally and in policy and expertise. The time frame of the study is limited so the stage of confirming the competency standards by observation of midwifery practice will not be carried out which also means that the competency standards cannot be verified in practice settings. However, the participants in the survey and consultation process are those who work in a range of units closely related to midwives such as the midwifery association, the ministry of health, midwifery training schools and state and private maternity hospitals. The additional review also resulted in participant reports on the applicability of the competency benchmarks that helped policymakers recognize the importance of next steps to further strengthen the applicability of competency standards and to ensure that they are relevant to midwives working in different settings across the country. For example, some participants responded that it was not possible to use or meet all competency standards due to organizational and systemic barriers. Incorporation of competency standards into employment contracts, position description and evaluating the results of the job performance will support the acquisition of more competency standards, and at the same time provide a toolkit to assess midwifery clinical practice. Developing a framework of midwifery training program based on competency standards is urgent after the promulgation of this competency standard. Data availability Underlying data Figshare: Vietnam National Competency Standards for Midwifery: A Delphi Study. https://doi.org/10.6084/m9.figshare.23502300.v2 ( Thanh Le et al. , 2023 ). This project contains the following underlying data: - Underlying Data.xlsx Extended data - PRISMA Checklist.docx Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgements The authors would like to express their gratitude to QUVAE Research and Publications for their invaluable assistance in depositing the underlying and extended data into the Figshare repository. References ACNM: Core competencies for basic midwifery practice 2012.2014. Bäck L, Hildingsson I, Sjöqvist C, et al. : Developing competence and confidence in midwifery-focus groups with Swedish midwives. Women Birth. 2017 Feb; 30 (1): e32–e38. Epub 2016 Aug 22. PubMed Abstract | Publisher Full Text Chakraborty S, Saggurti N, Adanu R, et al. : Validating midwifery professionals’ scope of practice and competency: A multi-country study comparing national data to international standards. PLoS One. 2023 May 25; 18 (5): e0286310. Publisher Full Text de Loë RC , Melnychuk N, Murray D, et al. : Advancing the state of policy Delphi practice: A systematic review evaluating methodological evolution, innovation, and opportunities. Technol. Forecast. Soc. Change. 2016; 104 : 78–88. Publisher Full Text Gavine A, MacGillivray S, McConville F, et al. : Pre-service and in-service education and training for maternal and newborn care providers in low- and middle-income countries: an evidence review and gap analysis. Midwifery. 2019; 78 : 104–113. Publisher Full Text Hastings-Tolsma M, Foster SW, Brucker MC, et al. : Nature and scope of certified nurse-midwifery practice: A workforce study. J. Clin. Nurs. 2018 Nov; 27 (21-22): 4000–4017. PubMed Abstract | Publisher Full Text | Free Full Text ICM: Essential competencies for basic midwifery practice 2010 revised 2013.2013. The Midwives Council of Hong Kong: Core competencies for registered midwives. Hong Kong.2010. International Confederation of Midwives: ICM Position Statements. [accessed 24 March 2023]. Reference Source International Confederation of Midwives: ICM International Definition of the Midwife.2017. [accessed 24 March 2023]. Reference Source International Confederation of Midwives: ICM Definitions. [accessed 20 December 2018a]. Reference Source International Confederation of Midwives: ICM Policy and Practice. [accessed 20 December 2018b]. Reference Source International Confederation of Midwives: Essential Competencies for Midwifery Practice.2019. Reference Source Mharapara TL, Staniland N, Stadler M, et al. : Drivers of job satisfaction in midwifery-A work design approach. Women Birth. 2022 Jul; 35 (4): e348–e355. Epub 2021 Jul 24. PubMed Abstract | Publisher Full Text Midwifery Council of New Zealand: The Association; Wellington.2016. [cited 2018 Jan 15]. Maintaining Competence. Reference Source Nove A, Friberg IK, de Bernis L , et al. : Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. Lancet Glob. Health. 2021 Jan; 9 (1): e24–e32. Epub 2020 Dec 1. PubMed Abstract | Publisher Full Text | Free Full Text Singapore Nursing Board: Core competencies of registered midwife.2018. [accessed from December 2021]. Reference Source Thanh Le T, Tuan Truong A, Van Vu T, et al. : Vietnam National Competency Standards for Midwifery: A Delphi Study. Dataset. figshare. 2023. Publisher Full Text Vietnam Ministry of Health: Basic Competency Standards of Vietnamese Nurses.2015. [accessed 24 March 2023]. Reference Source Yin Y, Li J, Lu H, et al. : Essential competencies for three grades of midwives in China. Int. J. Nurs. Sci. 2018 Jan 11; 5 (1): 18–23. PubMed Abstract | Publisher Full Text | Free Full Text UNFPA: The state of the World’s midwifery 2014.2014; pp. 22–35. Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 15 Aug 2023 ADD YOUR COMMENT Comment Author details Author details 1 Nam Dinh University of Nursing, Nam Dinh city, 420000, Vietnam Tung Thanh Le Roles: Conceptualization Anh Tuan Truong Roles: Data Curation Thanh Van Vu Roles: Formal Analysis Ha Thi Viet Tran Roles: Investigation, Methodology Huong Thi Thanh Pham Roles: Project Administration, Resources Huong Thi Thanh Nguyen Roles: Validation, Writing – Original Draft Preparation Anh Thi Lan Mai Roles: Resources, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 21 Feb 2024, 12:981 https://doi.org/10.12688/f1000research.138350.2 version 1 Published: 15 Aug 2023, 12:981 https://doi.org/10.12688/f1000research.138350.1 Copyright © 2024 Thanh Le T et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Thanh Le T, Tuan Truong A, Van Vu T et al. Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] . F1000Research 2024, 12 :981 ( https://doi.org/10.12688/f1000research.138350.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 21 Feb 2024 Revised Views 0 Cite How to cite this report: Mkhize SW. Reviewer Report For: Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] . F1000Research 2024, 12 :981 ( https://doi.org/10.5256/f1000research.158242.r289495 ) The direct URL for this report is: https://f1000research.com/articles/12-981/v2#referee-response-289495 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Jun 2024 Sipho Wellington Mkhize , School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa Approved VIEWS 0 https://doi.org/10.5256/f1000research.158242.r289495 SUMMARY OF THE ARTICLE This article examined the national competency standards midwifery: a Delphi study, it focused on the quality of midwifery human resources to meet the requirements of integration of countries in the region and around the world. ... Continue reading READ ALL SUMMARY OF THE ARTICLE This article examined the national competency standards midwifery: a Delphi study, it focused on the quality of midwifery human resources to meet the requirements of integration of countries in the region and around the world. The authors used a multi-stage Delphi process to teach midwifery on national agreement on competing standards . OVERALL ASSESSMENT The article addressed a critical and timely issue, contributing valuable insights to the field of midwifery. The multi-stage Delphi process is comprehensive and methodology sound providing a clear synthesis of research STRENGTHS The topic is highly relevant and significant The methodology is robust, with a thorough Delphi process The discussion offers insightful interpretations and identifies areas of future research LIMITATIONS The literature was not sufficient to cover a broader spectrum INTRODUCTION The introduction provided a good overview LITERATURE REVIEW The literature covered key studies and identified research effectively METHODOLOGY The multi-stage approach was well justified and described in sufficient detail to be replicable RESULTS Results were presented but some statistical terms were described DISCUSSION The discussion is well-developed, interpreting results within the context of existing literature and highlighting trends CONCLUSION The conclusion summarizes the findings well but should further explore the policy implications TABLES The tables are well-designed and enhance understanding. REFERENCES References are up-to-date and relevant but very limited RECOMMENDATIONS Improve on literature FINAL DECISION Minor revisions required JUSTIFICATION FOR DECISION The article makes a significant contribution to the midwifery practice. The recommended revisions are minor and will enhance the clarity and impact of the article. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Qualitative research in curriculum development and policy reviews. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Mkhize SW. Reviewer Report For: Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] . F1000Research 2024, 12 :981 ( https://doi.org/10.5256/f1000research.158242.r289495 ) The direct URL for this report is: https://f1000research.com/articles/12-981/v2#referee-response-289495 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 15 Aug 2023 Views 0 Cite How to cite this report: Catling C. Reviewer Report For: Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] . F1000Research 2024, 12 :981 ( https://doi.org/10.5256/f1000research.151540.r199885 ) The direct URL for this report is: https://f1000research.com/articles/12-981/v1#referee-response-199885 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Sep 2023 Christine Catling , University of Technology Sydney, Broadway, New South Wales, Australia Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.151540.r199885 Thank you for the opportunity to review this paper. There are a few queries and suggestions for improvement – mostly to enhance clarity. Overall the paper could do with an English-language edit. p. 3, ... Continue reading READ ALL Thank you for the opportunity to review this paper. There are a few queries and suggestions for improvement – mostly to enhance clarity. Overall the paper could do with an English-language edit. p. 3, second paragraph – consider using ‘education’ instead of ‘training’ – as midwives are highly educated, and we have moved away from ‘training’. Its unclear as to why, if there were national standards released in 2014, why do there appear to be two levels of midwifery education in Vietnam? Could you add a paragraph to explain the current education pathways for midwives in Vietnam – to make this clearer for the reader? Third paragraph – the sentence ‘They support safe childbirth and improve the reproductive health of women, babies and families’ – this reads as though babies and families have ‘reproductive health’ so I suggest deleting ‘reproductive’. Fourth paragraph – its unclear why you allude to ‘moderate knowledge’ in the second sentence? Fifth paragraph – the first sentence is unclear – please rewrite. Sixth paragraph – typo for the word ‘university’. The last sentence states that midwifery professional competencies need to be standardized and legally recognised – but it appears there were national competency standards released in 2014 – were these not legally recognised? If not – please make this clearer. Page 4, top of page – it is stated that midwives can be ‘self-trained’ – please elaborate – perhaps you mean that they are educated within the workplace (as opposed to a university/college)? Methods – first paragraph. Could it be made clearer that the organisations listed were selected to participate in the Delphi process? How/why were these organisations selected? What are the ‘other professional organisations’ that are alluded to here? Second paragraph – last sentence – could you check that you have the correct reference for the PRISMA diagram? This appears wrong. See here PRISMA (prisma-statement.org) Third paragraph – this explains the search process but the inclusion and exclusion criteria have not been stated clearly, please do this. The second half of this paragraph states the relevant literature that was found which informed the second survey to progress the Delphi process. There is a jump from identifying the literature to the creation of the survey – how were the 110 competency statements chosen from the literature by the research team? That process needs more depth of reporting here. Fourth paragraph. It is stated that round 1 resulted in 75 statements and round 2 resulted in 72 statements – which 3 statements were deleted and why? Did they not reach the 80% consensus? Also – in the abstract it is mentioned that there were 75 participants in round 1 and 72 in round 2 – are these similarity in numbers (to your numbers of statements) just a coincidence – or has there been a mis-reporting here? Fig 1 – there are two asterisks in one of the boxes but no legend included that explain them. Why are the ‘Reports assessed for eligibility recorded as ‘7+8’? Also the boxes to the right of the first column of boxes appears to report a higher number of articles than the box on the left – this is not the usual way of reporting included/excluded papers in a PRISMA. Similarly – there is repetition in the way the duplicates are reported in this figure (repeated three times), and usually the boxes just contain numbers and concise reasons why articles are excluded, but do not include the article in-text citations themselves. Please look at examples from other authors to gain clarity on the best way to use PRISMA diagrams and re-write. Ethical considerations paragraph. It is unclear why the last sentence is there – regarding physical assessment or intervention. Results – can it be made clearer that the participants had worked in midwifery/reproductive health? At the moment it reads that they had just ‘worked’ for a certain length of time – but unclear in what capacity. p. 7 first paragraph – there are many sentences in this paragraph that are unclear, eg ‘..ensure vertical and horizontal connectivity’ – this is unclear. The sentence about participants providing comments – can you give an example? Third paragraph – last sentence – did the midwives ensure their own physical etc. wellbeing or do you mean that of the women they care for? Please re-write for clarity. Page 7 needs to be clearer in general – as many small paragraphs could be amalgamated. p. 9 second from last paragraph – the second from last sentence here needs qualifying and a reference given. The last sentence mentions a study by Nove et al – more information about this study is necessary for clarity here. In the middle of the last paragraph on p. 9 – you mention a ‘bachelor of midwifery’ – do you mean a ‘bachelor of midwifery graduate’? P. 10 – the first paragraph needs to be changed to the past tense. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Midwifery I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Catling C. Reviewer Report For: Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] . F1000Research 2024, 12 :981 ( https://doi.org/10.5256/f1000research.151540.r199885 ) The direct URL for this report is: https://f1000research.com/articles/12-981/v1#referee-response-199885 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 15 Aug 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 21 Feb 24 read Version 1 15 Aug 23 read Christine Catling , University of Technology Sydney, Broadway, Australia Sipho Wellington Mkhize , University of KwaZulu-Natal, Durban, South Africa Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Mkhize S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Jun 2024 | for Version 2 Sipho Wellington Mkhize , School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa 0 Views copyright © 2024 Mkhize S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions SUMMARY OF THE ARTICLE This article examined the national competency standards midwifery: a Delphi study, it focused on the quality of midwifery human resources to meet the requirements of integration of countries in the region and around the world. The authors used a multi-stage Delphi process to teach midwifery on national agreement on competing standards . OVERALL ASSESSMENT The article addressed a critical and timely issue, contributing valuable insights to the field of midwifery. The multi-stage Delphi process is comprehensive and methodology sound providing a clear synthesis of research STRENGTHS The topic is highly relevant and significant The methodology is robust, with a thorough Delphi process The discussion offers insightful interpretations and identifies areas of future research LIMITATIONS The literature was not sufficient to cover a broader spectrum INTRODUCTION The introduction provided a good overview LITERATURE REVIEW The literature covered key studies and identified research effectively METHODOLOGY The multi-stage approach was well justified and described in sufficient detail to be replicable RESULTS Results were presented but some statistical terms were described DISCUSSION The discussion is well-developed, interpreting results within the context of existing literature and highlighting trends CONCLUSION The conclusion summarizes the findings well but should further explore the policy implications TABLES The tables are well-designed and enhance understanding. REFERENCES References are up-to-date and relevant but very limited RECOMMENDATIONS Improve on literature FINAL DECISION Minor revisions required JUSTIFICATION FOR DECISION The article makes a significant contribution to the midwifery practice. The recommended revisions are minor and will enhance the clarity and impact of the article. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Qualitative research in curriculum development and policy reviews. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Mkhize SW. Peer Review Report For: Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] . F1000Research 2024, 12 :981 ( https://doi.org/10.5256/f1000research.158242.r289495) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-981/v2#referee-response-289495 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Catling C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Sep 2023 | for Version 1 Christine Catling , University of Technology Sydney, Broadway, New South Wales, Australia 0 Views copyright © 2023 Catling C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review this paper. There are a few queries and suggestions for improvement – mostly to enhance clarity. Overall the paper could do with an English-language edit. p. 3, second paragraph – consider using ‘education’ instead of ‘training’ – as midwives are highly educated, and we have moved away from ‘training’. Its unclear as to why, if there were national standards released in 2014, why do there appear to be two levels of midwifery education in Vietnam? Could you add a paragraph to explain the current education pathways for midwives in Vietnam – to make this clearer for the reader? Third paragraph – the sentence ‘They support safe childbirth and improve the reproductive health of women, babies and families’ – this reads as though babies and families have ‘reproductive health’ so I suggest deleting ‘reproductive’. Fourth paragraph – its unclear why you allude to ‘moderate knowledge’ in the second sentence? Fifth paragraph – the first sentence is unclear – please rewrite. Sixth paragraph – typo for the word ‘university’. The last sentence states that midwifery professional competencies need to be standardized and legally recognised – but it appears there were national competency standards released in 2014 – were these not legally recognised? If not – please make this clearer. Page 4, top of page – it is stated that midwives can be ‘self-trained’ – please elaborate – perhaps you mean that they are educated within the workplace (as opposed to a university/college)? Methods – first paragraph. Could it be made clearer that the organisations listed were selected to participate in the Delphi process? How/why were these organisations selected? What are the ‘other professional organisations’ that are alluded to here? Second paragraph – last sentence – could you check that you have the correct reference for the PRISMA diagram? This appears wrong. See here PRISMA (prisma-statement.org) Third paragraph – this explains the search process but the inclusion and exclusion criteria have not been stated clearly, please do this. The second half of this paragraph states the relevant literature that was found which informed the second survey to progress the Delphi process. There is a jump from identifying the literature to the creation of the survey – how were the 110 competency statements chosen from the literature by the research team? That process needs more depth of reporting here. Fourth paragraph. It is stated that round 1 resulted in 75 statements and round 2 resulted in 72 statements – which 3 statements were deleted and why? Did they not reach the 80% consensus? Also – in the abstract it is mentioned that there were 75 participants in round 1 and 72 in round 2 – are these similarity in numbers (to your numbers of statements) just a coincidence – or has there been a mis-reporting here? Fig 1 – there are two asterisks in one of the boxes but no legend included that explain them. Why are the ‘Reports assessed for eligibility recorded as ‘7+8’? Also the boxes to the right of the first column of boxes appears to report a higher number of articles than the box on the left – this is not the usual way of reporting included/excluded papers in a PRISMA. Similarly – there is repetition in the way the duplicates are reported in this figure (repeated three times), and usually the boxes just contain numbers and concise reasons why articles are excluded, but do not include the article in-text citations themselves. Please look at examples from other authors to gain clarity on the best way to use PRISMA diagrams and re-write. Ethical considerations paragraph. It is unclear why the last sentence is there – regarding physical assessment or intervention. Results – can it be made clearer that the participants had worked in midwifery/reproductive health? At the moment it reads that they had just ‘worked’ for a certain length of time – but unclear in what capacity. p. 7 first paragraph – there are many sentences in this paragraph that are unclear, eg ‘..ensure vertical and horizontal connectivity’ – this is unclear. The sentence about participants providing comments – can you give an example? Third paragraph – last sentence – did the midwives ensure their own physical etc. wellbeing or do you mean that of the women they care for? Please re-write for clarity. Page 7 needs to be clearer in general – as many small paragraphs could be amalgamated. p. 9 second from last paragraph – the second from last sentence here needs qualifying and a reference given. The last sentence mentions a study by Nove et al – more information about this study is necessary for clarity here. In the middle of the last paragraph on p. 9 – you mention a ‘bachelor of midwifery’ – do you mean a ‘bachelor of midwifery graduate’? P. 10 – the first paragraph needs to be changed to the past tense. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Midwifery I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Catling C. Peer Review Report For: Vietnam national competency standards for midwifery: A Delphi study [version 2; peer review: 1 approved, 1 not approved] . F1000Research 2024, 12 :981 ( https://doi.org/10.5256/f1000research.151540.r199885) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-981/v1#referee-response-199885 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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