Overview

BCCNM’s Quality Assurance (QA) program is designed to assure and improve the quality of clinical and professional midwifery practice. Its underpinning philosophy is that midwives are ultimately accountable and responsible for sustaining and enhancing their own knowledge, skills, judgement and competencies over a lifetime of practice. BCCNM supports midwives in achieving this through the following QA requirements:

Clinical Experience

Hands-on, clinical experience is integral to a midwife’s knowledge, skills and ability to continue to provide ongoing safe clinical care. Midwives are required to stay clinically active in the provision of prenatal, intrapartum and postpartum care over a rolling period of three years in order to maintain status as practising registrants. At the time of annual renewal, midwives are required to report on clinical activities over the preceding three year period. Please note that midwives in their first two years of practice have additional active practice requirements.

Policy on Active Practice Requirements (PDF)

Continuing Competencies

As per the Policy on Continuing Competencies (PDF), midwives are required to recertify in mandatory CPD for continuing competency in the following:

Neonatal Resuscitation (NRP)
Cardiopulmonary Resuscitation (CPR)
Fetal Health Surveillance (FHS)
Emergency Skills (ES)

Self-assessment

Midwives are required to participate in ongoing self assessment in order to promote reflective practice and accountability in maintenance and enhancement of knowledge, skills, and ability.

Questions? Email qualitymidwives@bccnm.ca

Midwives registered with BCCNM complete an annual self-assessment questionnaire (PDF) as part of registration renewal. The questionnaire is based on the Standards of Practice and Code of Ethics and is an opportunity for midwives to complete a thorough assessment of their practice.

Professional Development (PD)

A professional development (PD) plan is a confidential document midwives create that guides and records the activities they undertake to meet the BCCNM standards of practice and their quality assurance requirements. In February 2024, BCCNM rescinded the traditional CPD framework that midwives had been using, and moved to a more principle-based, goal setting approach.

Midwives must develop a PD plan each year as part of meeting their QA requirements. Midwives are expected to set a minimum of two goals annually, and then evaluate the impact of this professional development on their practice

Each PD plan is different. It reflects the creativity and uniqueness of each midwife's learning journey and their commitment to continuing competence in their midwifery practice. A PD plan may be electronic, handwritten, or both. It may be organized by date, skill, theme, or event, and employ a variety of resources to reflect the various ways the midwife integrates knowledge into their practice.

Recordkeeping

Some midwives prefer to use their computer to store their information, scan documents, and “blog" their ongoing activities. Others prefer to use a binder or folder to collect evidence and to store certificates, letters, and other items that demonstrate their learning. BCCNM has a basic template (PDF) that midwives may use.

Creating a professional development plan is one way midwives indicate to the public they are maintaining their competence to practise and take their professional development obligation seriously. This commitment is an important part of being a self-regulating professional.

Midwives are expected to keep supporting records to document their compliance with BCCNM's annual quality assurance (QA) program requirements for at least three years after the end of each calendar year, in accordance with section 155 of BCCNM's bylaws.

These records may be subject to audit by BCCNM under section 156 of the BCCNM bylaws, and the QA Committee may require a registrant to submit information to verify their compliance with requirements of BCCNM's QA program.

Getting started

The foundation of a professional development plan is self-assessment and peer feedback: this is how midwives will identify the areas they want to focus on.

Creating a professional development plan

Midwives should reflect on their self-assessment and peer feedback, and ask themselves:

What do I need to learn?
What do I want to learn?
What goals do I have for my professional development?
What are my strengths?
What areas require improvement?
How does my practice reflect the BCCNM standards and guidelines?

Then, midwives should set SMART goals to plan how they will achieve their learning needs and how they will measure their success.

SMART goals are Specific, Measurable, Achievable, Realistic, and Timely. Midwives should include all these criteria in their PD goals to help focus their PD activities.

What should PD plans include?

SMART goals

Specific: What will you do?
Measurable: How will you know you've succeeded?
Attainable: Can you achieve this?
Realistic: Is this appropriate for your practice or career stage?
Time bound: When will you achieve this by?

Supporting materials

This list includes suggestions for items to include in a PDF plan, but it is not an exhaustive list. Midwives must make sure that personal or confidential information about clients or colleagues has identifying information removed/deleted to maintain their privacy.

Certificates, diplomas, or degrees
In‐services, workshops, or conferences attended
Transcripts from courses taken, re-certifications, etc.
Information about future events you want to attend
Letters from clients and families
Letters of reference or commendation
Performance evaluations
Mentor communication/peer feedback
Membership information
Minutes from meetings that reflect learning opportunities
Electronic resources
Notes about books or articles read
Participation in relevant focus or research groups
Samples of documents that you developed (policies, course outlines, service plan, etc.)
Volunteer work

Evaluation

Evaluation is a key component of the QA program that occurs throughout the year. It occurs during the self-assessment, peer feedback, and professional development stages as the midwife continually reflects and evaluates where they are at in their QA cycle and where they are heading.

When evaluating the impact of professional development on their practice, midwives should consider:

Did I meet my learning goals?
How did I meet my learning goals?
Was the outcome valuable to me? Why or why not?
Who (aside from me) benefited from my learning plan—clients, colleagues?
How have I shared or how will I share this learning experience with colleagues?
How have I been able to maintain and/or enhance my nursing practice?

Midwives may find it helpful to document and keep the answers to these questions as part of their QA records. Sometimes midwives are unable to meet their PD goals—this is not necessarily a bad thing. Priorities, workplaces, and personal circumstances change and can impact midwives'' goals.

Midwives who don't achieve a PD goal can ask themselves:

Were my learning goals SMART (specific, measurable, achievable, realistic, and time bound)?
Are there other ways that I can meet my learning goals?
Do I need to re-assess my learning needs and revise my goals?
How will I revise my professional development plan in the coming year?

The continuous cycle of QA (assessment, feedback, PD planning, and evaluation) ensures midwives reflect on their practice and strive for continuous professional improvement.

Provision of Clinical Information

This component of the QA program allows the BCCNM Quality Assurance Committee to request specific, de-identified information relating to the care given by midwives to clients, to assess for themes in practice or prescribing patterns. For an example of how this component of the QA program can be used, the QA Committee required midwives to seek peer review and maintain a log on their first three inpatient orders and first three outpatient prescriptions when midwives were first given the authority to prescribe controlled substances as per the Standards for Prescribing, Ordering and Administering Controlled Substances (PDF).

Peer Case Review

Midwives are required to participate in a minimum of four peer case reviews per registration year. Peer case review consists of a review of clinical care and is intended to be educational, confidential and conducted in a supportive, non‑punitive environment. At least two midwives and two midwifery practices must be present at each peer case review, which must include the following:

A presentation of a case history to date including available information on medical, family, obstetrical and psychosocial history, family circumstance, relevant lab work, test results, ultrasound findings, and significant developments when applicable over the course of pregnancy, labour, birth and postpartum period.
An explanation of how the case was managed by one of the midwives participating in the review, including consultations and/or transfer of care to other health care providers.
A discussion of the application of BCCNM regulations, standards, clinical practice guidelines and policies to the case.
Client feedback on care provided if available.
Observations and feedback by peer case review participants.
An explanation of changes made or recommendations for potential changes in practice if applicable.

Evaluation of Midwifery Care

BCCNM is in process of developing an integrated, validated multisource feedback tool that integrates client feedback with self-assessment and peer feedback. Until the tool is ready for deployment, midwives are required to distribute a copy of the Client Evaluation of Midwifery Care (PDF) form to each client, within six months of that client being discharged from care, and request that the client complete and return the evaluation to the midwife’s practice. The evaluation form shall not identify the client.

Midwives review these evaluations at regular intervals throughout the year and keep a record of any action taken in response to client evaluations. Completed evaluation forms and the record of action taken in response to the client evaluations are kept by midwives for six years from the date the evaluation form is returned in case of audit by BCCNM.