October 2018 Research Rounds

Negotiating Learner Participation in Care: An Exploration of what Enables and Disables Practice

Courtney Broten

Courtney Broten

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Date: Wednesday, October 17, 2018

Time: 12:00pm to 1:30pm (feel free to bring a bagged lunch)


  • JPPN 141 – Taylor Fidler Auditorium* (host venue)
    *Please note the room change for this session of Research Rounds
  • IRC 305
  • RJH CA 120
  • NHSC 9-370



Learner participation in clinical care is essential for preparation for independent practice. Previous research findings describe factors that influence learner participation, however there is little understanding of effective negotiations for participation. In midwifery, clients are integral to entrustment decisions about learner’s participation, yet their contributions to negotiations for participation are not understood. In this session I will describe a multi-case study to explore how learner participation in labour and birth is negotiated between clients, midwives and learners.

Results suggested that negotiations learner participation at the time of birth often started much earlier in the relationship, with the midwife stepping back during prenatal care to enable the development of trust between student and client. At the time of the birth, the midwife actively coordinated the negotiation of student participation. Although there was a three way negotiation between the clients, midwife and student, clients tended to act as ‘silent negotiators’ by setting the tone and pace of labour. Moment by moment negotiations between the midwife and student commonly used nonverbal communication to not disrupt the client in labour. Thus, in a model of co-participation in care, learners often attended to care of the client, with the midwife choosing when to step forward to manage care, at which time students stepped back temporarily to observe and learn through role modeling rather than active participation. The planning and moment by moment decision making around student participation was not discussed or debriefed, potentially impeding the development of clinical competence.


Courtney Broten completed her degree in Midwifery at Laurentian University in 2006, and has cared for a diverse group of women through their pregnancies and births in both rural and urban settings in British Columbia. She helped found Birth & Beyond the Midwifery Faculty Practice at UBC along with a group of experienced and kindhearted midwives. Since 2010, she has served as Course Lead and Clinical Instructor with the Division of Midwifery at UBC. She has taught many dynamic and inspiring midwifery students, in addition to being a clinical preceptor to nursing, midwifery and medical students. She pursued a Master’s degree in Health Professional Education to develop a passion for education and research. She has strong ties to the Kootenays, spending time learning about maternity care in rural communities of BC. In all of these roles, she has been privileged to serve women in the creation of their families and beyond and have seen time and again how a peaceful, satisfying pregnancy, labour and birth has the potential to create a life-long foundation of loving, healthy families and communities.


The University of British Columbia Division of Continuing Professional Development (UBC CPD) is fully accredited by the Committee on Accreditation of Continuing Medical Education (CACME) to provide study credits for continuing medical education for physicians. This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by UBC CPD. You may claim a maximum of 1.5 (x 10 sessions) hours (credits are automatically calculated). This Group Learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by UBC CPD for up to 1.5 (x 10 sessions) Mainpro+ credits. Each physician should claim only those credits he/she actually spent in the activity.

Accredited by UBC CPD