Theory Practice Gap: Myth or reality? 

I was chatting to a group of student midwives recently, and casually asked, have you ever experienced practice in the ‘clinical areas’ which just didn’t fit with the stuff you have been taught at university? 

The answer was quick in coming: ‘have we ever’!? One of the 3rd years almost shouted, ‘on a daily basis’! The group went on to recount episode after episode of encounters where mentors had behaved in a way that directly contradicted what they had been reading and learning from lecturers.

To be honest I was not surprised, when I qualified in 1994 we where having the same conversations, if it wasn’t ‘coaching pushing with breath holding’ it was using the ‘lithotomy position’ to speed up the birth.  
What is going on? 

When will this mad ‘theory practice gap’ be bridged? When will newly qualified midwives enter practice confident that they won’t have to ‘battle’ out dated practices that they know are, if not wrong, not the best we could be offering pregnant women and their families? 

Seems obvious to me, because of the way we are ‘wired’ to learn mentors in the clinical areas have more power to influence the practice and learning of student midwives than academics. 

It’s simple really if we reflect on our own experience of learning, I hate to say it but my children are walking in the footsteps I thought I covered up. 

All learning is a deeply unconscious process, we watch, we listen, we imitate, our behaviours are the outflow of what we have modelled from those around whose opinions are important for our survival.  

Hey, I know getting on with your mentor is not a ‘life or death’ issue, but when you’re a student it feels like it right? 
If you are going to survive the course and at some point fit into the workforce your behaviours have to become consistent with the spoken and unspoken rules of the institution. 

What is the answer to the ‘theory practice gap’? 
I’m guessing there isn’t one answer, but seeking to point midwifery education in the direction of the ‘old paths’ would be a good place to start; an apprentice model rather than a purely academic one. 

‘Wise woman, with wise woman’, the lecturer being in practice with a ‘caseload’ of pregnant women and small group of students that they work with day to day. 
The students are guided in their reading and reflection outside of the times when they are just being with their midwife/educator/mentor, no separation between what they are learning and what they are seeing, hearing, experiencing every day as they ‘become’ midwives. 

Imagine many, many, birth educator/practitioners each with a small group of students, little or no classroom work, yes, lots of study, writing and reflection but outside of the times that students are just with women as they birth, learning from their ‘wise woman midwife’. 

Mad? Maybe, unworkable? Probably, but something needs to be done, if the current situation is to be reversed. 

6 thoughts on “Theory Practice Gap: Myth or reality? 

  1. I am a Senior Lecturer in Midwifery who still practices regularly. It is difficult as I do this in my own time, however, I am a midwife first and foremost. I believe it is beneficial to both me and my students. I would love to have a small caseload and teach – what a fab combination. I initially tried part time teaching and part time practice but this was incredibly difficult to maintain- potential clashes with off duty and teaching sessions!

  2. 100% agree. I struggled so much with this concept. What I learnt at uni was how i wanted to practice. But my mentor in 2nd yr practiced without a care for evidence and bullied women into.doing a they were told . This got me down so much I ended up walking away. I’m going to return as women deserve better.

  3. Hi mark, I saved this blog post as I knew I would be looking into this issue as part of my studies. As a practitioner, this was my biggest source of infuriation. I kept myself updated, shared practice with other midwives and generally strived to be the best midwife I could for women, listening to them and implementing what I knew to be benificial. However, I constantly came up against institutional barriers that prevented me from practising using ‘best theory’ wether that be staffing implementation that prevented continuity, management strategies that prevented intervention, clashes of personalities that prevented collaborative working ( I could go on). I am not sure the solution to the theory practice gap would be to have midwifery teaches working on the shop floor alongside stunts, so to speak, but taking the shop floor away.
    If midwives had true autonomy and worked in a system which prioritised a social model of care, work models which treat birth as a manageable form of productivity, fulfilled midwives ( who don’t just comply because of despondency in the system) an ability to use best practice (theory) without organisational constraints ( the barriers to implementation) we may be able to close the gap! Aaaaaaaaah! Midwifery/birth utopia!!

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