Midwifery participatory curriculum development: Transformation through active partnership

Accepted Manuscript Midwifery participatory curriculum development: Transformation through active partnership Mary Sidebotham, RM PhD, Associate Professor and Director Primary Maternity Care Programs, Caroline Walters, RN MHlthPrac, Senior Research Assistant, Janine Chipperfield, BA (Hons), Griffith Health Curriculum Consultant: Curriculum, Assessment & Technology (CATT), Jenny Gamble, RM PhD, Professor of Midwifery, Discipline Head for Midwifery@Griffith PII:

S1471-5953(17)30239-1

DOI:

10.1016/j.nepr.2017.04.010

Reference:

YNEPR 2217

To appear in:

Nurse Education in Practice

Received Date: 29 April 2016 Revised Date:

10 April 2017

Accepted Date: 14 April 2017

Please cite this article as: Sidebotham, M., Walters, C., Chipperfield, J., Gamble, J., Midwifery participatory curriculum development: Transformation through active partnership, Nurse Education in Practice (2017), doi: 10.1016/j.nepr.2017.04.010. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT TITLE PAGE MIDWIFERY PARTICIPATORY CURRICULUM DEVELOPMENT: TRANSFORMATION THROUGH ACTIVE PARTNERSHIP (5085 words)

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Authors Mary Sidebotham RM PhDa (First Author) Associate Professor and Director Primary Maternity Care Programs [email protected] Ph +61 7 338 21378 M 0434932303

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Caroline Walters RN MHlthPraca (Corresponding Author) Senior Research Assistant [email protected] Ph +61 7 338 21378 M 0434932303

Janine Chipperfield BA (Hons)a Griffith Health Curriculum Consultant: Curriculum, Assessment & Technology (CATT) [email protected]

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Professor Jenny Gamble RM PhDa Professor of Midwifery, Discipline Head for Midwifery@Griffith [email protected]

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School of Nursing and Midwifery / Menzies Health Institute Queensland/ Griffith University, University Drive, Meadowbrook, Queensland, Australia, 4131

ACCEPTED MANUSCRIPT MIDWIFERY PARTICIPATORY CURRICULUM DEVELOPMENT: TRANSFORMATION THROUGH ACTIVE PARTNERSHIP ABSTRACT

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Evolving knowledge and professional practice combined with advances in pedagogy and learning technology create challenges for accredited professional programs. Internationally a sparsity of literature exists around curriculum development for professional programs

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responsive to regulatory and societal drivers. This paper evaluates a participatory curriculum development framework, adapted from the community development sector, to determine its

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applicability to promote engagement and ownership during the development of a Bachelor of Midwifery curriculum at an Australian University. The structures, processes and resulting curriculum development framework are described. A representative sample of key curriculum development team members were interviewed in relation to their participation. Qualitative

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analysis of transcribed interviews occurred through inductive, essentialist thematic analysis. Two main themes emerged: (1) ‘it is a transformative journey’ and (2) focused ‘partnership in action’. Results confirmed the participatory curriculum development process provides

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symbiotic benefits to participants leading to individual and organisational growth and the perception of a shared curriculum. A final operational model using a participatory

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curriculum development process to guide the development of accredited health programs emerged. The model provides an appropriate structure to create meaningful collaboration with multiple stakeholders to produce a curriculum that is contemporary, underpinned by evidence and reflective of ‘real world’ practice. (199 words)

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ACCEPTED MANUSCRIPT Highlights •

Participatory curriculum development framework promotes engagement of interested parties (stakeholders) Professional programs benefit from stakeholder involvement in maintaining the fit

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between theory and practice •

Involving representatives from all drivers of the curriculum, creates a curriculum that

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is responsive to changes within knowledge and societal expectations

A participatory curriculum development process results in a curriculum that is owned

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by all involved parties. Keywords

Participatory Curriculum Development, Transformative, Industry Partnership

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INTRODUCTION

To respond to rapid societal changes, expansion of knowledge and growth in technology, professional programs in higher education need to adopt innovative approaches to curriculum

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development. The curriculum for any program of study, foregrounds the knowledge, learning opportunities and expected outcomes for learners and is grounded in value judgements of

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what kind of knowledge is important (Walker 2012). Whilst there is a wealth of information directing generic curriculum development, little research exists exploring curriculum development models for programs that require professional accreditation. Added complexity arises in developing curricula that lead to professional qualifications. Graduates must attain requisite foundational knowledge and essential skills but also develop professional attitudes and behaviours that will enable them to practise, in a safe and ethical manner (Stan 2014). These standards for professional practice are monitored through national regulatory bodies

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ACCEPTED MANUSCRIPT which set the criteria for accreditation of professional programs (Hurlimann, March, & Robins, 2013). Professional accreditation assures the community that graduates of an accredited program meet the standard required of the profession; an example of this being the Bachelor of Midwifery (BMid) program within Australia (Australian Nursing and Midwifery

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Accreditation Council, 2014).

Comprehensive support material on the structure content and development of entry to

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practice midwifery programs is provided by the International Confederation of Midwives (ICM) to strengthen midwifery education, regulation and practice globally, thereby

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improving care and outcomes for childbearing women and their babies (International Confederation of Midwives 2011, 2013a, 2013b). The global aim is to develop a profession with a core skill set able to work to full scope of practice and meet the requirements set by the ICM definition of the midwife. Individual countries then determine regulatory structures

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that guide professional practice, including clear educational standards that mandate the design and structure of entry to practice curricula to ensure graduates meet the competence and practice standards for professional practice and registration. In Australia, the Australian

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Nursing and Midwifery Board of Australia determine the required competence and practice

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standards for the midwifery profession which are published as national mandatory education standards (Australian Nursing and Midwifery Accreditation Council 2014). Guidance is provided to education providers and all program applications are required to complete a robust accreditation process demonstrating adherence to the published standards (Australian Nursing and Midwifery Accreditation Council 2013). To maintain practice standards and ensure responsiveness to contemporary practice, accreditation of entry to practice program is provided for five years after which time a new program submission must be completed. This is similar to the process initiated in other countries for example those directed by the Nursing

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ACCEPTED MANUSCRIPT and Midwifery Council in the United Kingdom. Despite the requirement to meet regulatory standards within midwifery curricula – there is little published evidence on the processes undertaken by the education provider to create and review curricula that meet those

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standards.

Information on the individual fields of pedagogy, content and assessment in relation to curriculum development is abundant, however, Tight et al (2012) emphasises a lack of

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research around how they combine to form a whole curriculum approach. Literature is also scant on the process of curriculum development within national jurisdictions where

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regulatory standards must be met for professions in general (Hurlimann et al. 2013). Within higher education, the curriculum frames knowledge, its purpose and the pedagogy surrounding knowledge acquisition by learners (Walker 2012). However, a curriculum leading to a professional qualification is also grounded within the society it is to serve and the

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values of the profession it is to enter. Consequently, any curriculum developed to meet both the regulatory standards of the profession and also the expectations of society must account for and encapsulate the expected values and attitudes the student emerges with in relation to

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the acquired knowledge and skills (Walker 2012).

Contextual background

Programs that award a professional qualification with a health delivery focus must ensure that graduates are able to practice safely and respond to challenges of contemporary practice within their specific field. There is now irrefutable evidence supporting the benefits of providing all women regardless of risk with continuity of care from a known midwife (Sandall et al.2016). Implementation of midwifery caseload models requires a reorientation of maternity services and an educational framework to prepare graduates to work in this way.

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ACCEPTED MANUSCRIPT As a result, the midwifery profession within Australia is in transition (Sidebotham 2012). The midwifery education standards have been designed to support graduates acquiring the skills required to work in these models, including the mandatory completion of ten continuity of care experiences. Accounting for current and future workforce needs, the midwifery

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curriculum development process and final product should provide an aligned evidence based framework, designed to prepare a future orientated midwifery workforce able to work to full

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capacity within the rapidly changing maternity care environment.

Historically curriculum development is a detached process that happens away from those who

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deliver and receive the curriculum (Faison and Montague 2013; Hills et al. 1994). The risk of this, especially in a professional program, is a sense of isolation and lack of connectivity with the real world of practice. There is a growing awareness of the generic external factors driving curricula design including an increasing focus on the need to prepare graduates in the

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skills of employability, entrepreneurship and digital awareness (Bridgstock 2016), but there is acknowledgment that some curriculum drivers specifically influence the unique properties of programs leading to professional accreditation. When considering the development of a BMid

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curriculum it is essential that all factors are taken into consideration. The external drivers

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governing curriculum development are country and program specific with regard to professional and educational standards; however, the community of professional practice also exerts a major influence on the curriculum within accredited programs. These drivers co-exist with the generic quality and governance drivers influencing all higher education.

INSERT FIGURE 1 HERE Figure 1 Model representative of the internal and external drivers influencing a Midwifery curriculum

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The multifactorial demands presented by these complex curriculum drivers require a systematic process to guide curriculum development and implementation. Using a BMid program as a case study, this paper reports on the structures and processes that

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evolved during the development of an entry to practice midwifery curriculum, using the

participatory curriculum development (PCD) framework (Taylor 2003). The goal was to test the applicability of the PCD framework within this context and assess whether it was

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effective in engaging key stakeholders, in developing a curriculum that reflected the

knowledge, skills and pedagogy required within a professional program, thereby preparing

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graduates to work within the rapidly evolving world of midwifery practice.

Participatory Curriculum Development process

A senior midwifery academic, with extensive experience of the current midwifery program,

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was appointed as the project lead and had overall responsibility for developing the curriculum and managing the accreditation submission. The Participatory Curriculum Development (PCD) framework was chosen as the underlying model to govern the development process,

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reflecting the transformative paradigm of the BMid program. A transformative paradigm is

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governed by underlying assumptions of active participation, openness, reflection and the student’s ability to become agents of change within their own lives and society (Clifford and Montgomery 2015). A participatory approach to curriculum development evolved within the community development sector in the 1980s, recognising that consultation with the involved parties needed to occur for effective implementation of educational strategies (Taylor 2003). Whilst PCD emerged largely within organisations working in developing countries and Teachers of English as a Secondary Language there exist many advantages to its adoption

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ACCEPTED MANUSCRIPT within higher education sectors (Auerbach 1992; Price 2004; Taylor 2003; Taylor 2008; Xiaowei et al 2008).

The usefulness of the Participatory Curriculum Development framework is that it: creates partnerships between stakeholders and providers of education

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promotes shared ownership of the curriculum and the process of education

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improves the potential of effective and real world learning through participation

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and tends to go beyond developing the curriculum into creating an ongoing cyclical

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•

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process of development and feedback (Taylor, 2003).

The decision to conduct the project within a participatory framework was made to capture the voices of all associated with maternity care – especially those who are often not heard: the consumer, women and families. Subsequently a staged participatory curriculum development

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process was used based on the five-step process developed by Taylor (2003); situational analysis, program outline development, plan and develop detailed program framework, develop and deliver program and develop PCD evaluation system. Due to accreditation

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processes the five steps were expanded into 10 steps. A clear connection between

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stakeholders and learners developed through a participatory approach to curriculum, results in more effective and ‘real-world’ learning (Taylor, 2003). Recognising the proposed benefits of PCD it was hoped that, through inviting and valuing the contribution of a wide range of participants, the curriculum development process would bring together like-minded stakeholders with shared values, and result in a sense of shared ownership, and ongoing connection with the program.

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ACCEPTED MANUSCRIPT INSERT FIGURE 2 HERE Figure 2 Participatory Curriculum Development Structural Framework

Representatives of each curriculum driver established a steering group to oversee the whole

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project and advise on development of the curriculum through its transitionary stages. A

project group was formed to include wide representation and active involvement from each of the sub-groups of stakeholders. Members of both groups were sought from existing bodies

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that the University had prior relationships with. This included the long established Midwifery Advisory Committee which has full stakeholder representation and meets, six monthly to

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provide guidance and advice to the programs on an ongoing basis, the midwifery academic group, the student body, alumni and established university community. A notification of the curriculum development process was made to all stakeholders, and an opportunity provided for interested people to self-nominate. All parties interested in participating in developing the

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curriculum were represented within the process. This included two consumer representatives including The Queensland President of peak maternity consumer group “Maternity Choices Australia” and the three elected BMid student representatives who sit on the Griffith

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University Midwifery Advisory Committee – where they regularly provide feedback on

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program issues and the student experience following consultation and discussion with their peer group .

The structures governing the project enabled full participation with the project group working closely within defined areas and the steering group providing advice and direction to keep the project on track. The project lead facilitated the flow of information and ensured all contributions were acknowledged within the final draft working through a series of phases. The process model is described in Table 1.

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Table 1 A phased model of Participatory Curriculum Development

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INSERT TABLE 1 HERE

The first steering group meeting highlighted the need to demonstrate a robust educational model underpinning the curriculum and incorporating the established program values. This

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foundational work was undertaken by the project group and is to be published separately. An iterative process was established where small stakeholder groups within the project group

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worked on specific aspects of the curriculum, that were brought back to the main group and debated, integrated and then aligned. The steering group provided input and direction at the macro and micro levels. This iterative process was used between the three levels until the proposed final product was presented to the steering group for consideration and

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confirmation. A curriculum that was fully aligned and strengthened through the acknowledgement of all the stakeholders within the process evolved.

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Evaluation of project

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Evaluation of the participatory curriculum development framework required an approach that sought and valued the views of all, to maintain the underpinning philosophy of a participation. Not only would gathering the personal experiences/views of the stakeholders enhance the truth, credibility validity and rigor of the evaluation (Mertens 1999), but elucidating the qualities and inadequacies of the process would produce a broader evaluation of PCD. A transformative paradigm, which recognises ontological assumptions that there exists a diversity of viewpoints and that these need to be placed within political, cultural and social contexts (Mertens 1999), is the lens through which the evaluation was conducted to

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ACCEPTED MANUSCRIPT help understand the basis for difference and to consequently reveal an objectivity based on a complete and balanced view of the PCD processes and effects.

Aim

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The aim of evaluation was to determine whether a Participatory Curriculum Development approach to developing a professional curriculum was effective in meeting the broad aims described by Taylor (2003) that it:

creates partnerships between industry partners (midwives), students, consumers and other stakeholders and the education provider;

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promotes shared ownership of the curriculum and the process of education;

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improves the potential of effective and real world learning through participation;

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goes beyond developing the curriculum into creating an ongoing cyclical process of

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development and feedback (Taylor, 2003).

METHOD

Study design

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In keeping with a transformative paradigm, a qualitative process evaluation was undertaken

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through a descriptive explanatory approach (Hesse-Biber and Leavy 2011) to describe the experiences of a representative group of participants involved in the development of the BMid curriculum. This approach gleans both the how and why of the process, gains the perspectives of the stakeholders and addresses the research question (Hesse-Biber and Leavy 2011). Semi-structured interviews, with stakeholders who took part in the PCD process, either as part of the steering group, project group or both, were used to provide both guidance and allow the participants to explore areas they felt important (Schneider et al. 2013). Ethical approval was obtained from the Human Research Ethics Committee of XXXX University.

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ACCEPTED MANUSCRIPT Anonymity and confidentiality were ensured through no identifying material being collected during the interviews and the transcription process removing any names mentioned resulting in only the research assistant knowing who participated. Informed consent was provided either in writing (for face to face interviews) or verbally (for telephone interviews). Only

related data has been used in written reports or presentations.

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Participants

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interviewees are aware of which stakeholder group they were representing and no name

To represent the views of each group involved in the curriculum development team, a

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purposeful sample (Creswell 2013) from each of the stakeholder groups (Table 2) was invited to be interviewed. All participants approached agreed to take part in the study.

Table 2 Participant group representation

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INSERT TABLE 2 HERE

Data Collection

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The interviews were conducted by a research assistant not associated with the BMid program

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to assist with anonymity and encourage the participants to speak freely. An interview guide was used to prompt the conversations around the experiences of the process, feelings about ownership of the curriculum and ongoing connection with the BMid program as well as any strengths or challenges they found in relation to the PCD approach. The average interview length was 25 minutes.

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ACCEPTED MANUSCRIPT Data analysis An inductive, experiential, essentialist form of thematic analysis (Braun and Clarke 2006) was used to analyse the data to allow the experiences and feelings of the participants to guide the evaluation of the PCD approach. The transcribed interviews were uploaded to QSR

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International’s NVivo 10 data management tool for assistance with the retrieval of data and collation of themes to conduct a six-step thematic analysis as outlined by Braun and Clarke (2012). The six steps included becoming familiar with the data through reading each of the

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transcripts, generating initial codes by working in a systematic manner throughout the data set and undertaking discussions between two authors (MS and CW), searching for themes

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which involved grouping initial codes into meaningful themes relevant to the research question, reviewing the themes which occurred through assessing themes in relation to codes and the overall data set, defining and naming themes and producing the report (Braun and

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Clarke 2006).

FINDINGS

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Two themes emerged from the data reflecting the perspectives of the participants in relation

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to Participatory Curriculum Development: (1) ‘it is a transformative journey’ and (2) focused ‘partnership in action’. This led to shared ownership, which resulted in personal and organisational growth.

INSERT FIGURE 3 HERE Figure 3 Participatory Curriculum Development Model

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ACCEPTED MANUSCRIPT It is a transformative journey The participants experienced the process as a transformative journey for themselves, the students and organisations. The journey began with a clear vision which was flexible and encouraged engagement from all stakeholders, ‘we had a vision but it was a very flexible

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framework for people to then bring into’ (MAc1). The University leadership team,

particularly the midwifery discipline head and the program director, were key to the success of the project and were described by participants as ‘transformative’. Creation of an

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atmosphere that truly acknowledged the value of individual contributions was interpreted as being genuine and non-tokenistic. ‘The other thing, in terms of enjoying it, was the

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leadership. I really liked the consultative and enthusiastic visionary style’ (MAc2). Throughout the data, the leadership team’s actions of being encouraging, positive, mindful and enthusiastic, respecting and acknowledging other people’s opinions, working in a cohesive manner, listening, providing verbal feedback and demonstrating a genuine desire for

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consultation were described as promoting the transformative journey. ‘The team were very welcoming and I didn’t feel that... there may be some hidden agendas and they want to push that…I felt there was a genuine feeling amongst the team, to seek our own input’ (CAT2).

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This ability to have input into the early stages of the process built participant commitment to

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the process and consequently the curriculum. The journey began with shared values and philosophy; shared vision and goals and was further assisted by the style of the leadership team creating a transformative process that resulted in positive experiences for the individual, group and consequently added value in the curriculum. ‘The curriculum development… was participatory, that it is a transformative journey and that we are as much a part of that as the students, doing it together in partnership’ (MAc2).

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ACCEPTED MANUSCRIPT The PCD was a collaborative and enjoyable process which was affirming for the individual, especially those not usually involved in curriculum development: I really enjoyed the fact that the students were consulted in the process and that the feedback that we provided was always accepted openly by the project team

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and that at the end of the day we saw a lot of changes as a result of our feedback and recommendations (MS).

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Individuals found the process developmental and enriching, allowing them to ‘see the bigger picture’, affecting their perspective: ‘I don't know that I would have had the same perspective

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as I do now about where we're going, had I not been involved in the inception’ (MAc2).

The formation of the coalition and embedding of people created feelings of being better able to contribute and participants gained a ‘good overview’ (MAc1), ‘learnt from each other and

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saw previous work built upon’ (MAc2). Consequently, quality feedback was received from a range of sources that was more objective and had an agreed outcome. ’You might not always have agreed with the outcome, but that's the outcome that the discussion led to, and that's

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what we all went out of the room believing that's the way forward’ (MIP2).

The adoption of a transformative participatory approach to curriculum development with a guiding coalition generated a sense of synergy that led to enthusiasm and commitment with all participants involved in the journey: So I think you get a broader range of opinion. As well as I said, making everyone feel that they're part of a group of people who are really enthusiastic about improvement and getting the best possible outcome for students (CAT2).

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ACCEPTED MANUSCRIPT It was partnership in action Partnership was seen as; central to the success of participatory curriculum development, a major contributor to the final curriculum and an ongoing activity melding the knowledge and expertise of the members. Participants identified a number of factors that promoted the

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partnership and the process. A sense of inclusion through recognition and feeling valued was a major influencer. Each participant reported feeling actively involved and encouraged to share their common knowledge and values - this in turn created a sense of inclusion as

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demonstrated by one participant, ‘the more we're involved and we're working collaboratively and we're embedded in the team, the better we're able to contribute’ (CAT 1). The ‘expert’

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roles of members were valued and opinions actively sourced leading to agreed outcomes and goals that were aligned with the values established during the initial phases of the process. The partnership was described by another participant as ‘open and transparent, providing support when needed, being helpful, being symbiotic, it was a ‘mutual and team effort’

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(CAT1).

Factors that promoted partnership through the perspectives of the participants were: feeling

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included and listened to, being participatory, the culture of the people in the curriculum

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development team, and being actively involved from both sides with two way communications. This was articulated by the consumer representative, ‘What we feel, a partnership it’s not necessarily born out of the University itself but it’s, it’s the culture of the people in the team’ (MSCA). Consequently, it was the pre-existing and ongoing relationships that were emphasised as being important to the feeling of inclusion and willingness to contribute time to the process. The investment in the relationships promoted open exchanges of ideas, feeling valued and listened to; ‘I think what I enjoyed most, was the partnership and

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ACCEPTED MANUSCRIPT the open and frank discussions that we had as a curriculum development committee…I think that was valued, and we were listened to’ (MIP1).

Participants expressed willingness to undertake ongoing actions to maintain and strengthen

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the partnerships. The melding of health providers, consumers, students and university staff through collaboration breaking down any sense of ‘us and them’ emerged from the data and resulted in further strengthened partnerships and improved two-way systems; ‘…we come

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together a lot more and we talk about any issues. So, talking about any problems that might arise is a lot easier because it helps to build relationships as well. We know each other’

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(MIP2).

Coming together in a focussed partnership resulted in a program identified as relevant to the participants needs and they expressed a vested interest in the outcome as ’their [University]

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students become our students (MIP1)’. Participants recognised the power of the partnership in influencing change across maternity services. Adopting a participatory approach was seen as enabling ‘a much more objective look at what's going on, and sometimes that can raise

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issues or highlight issues that perhaps it's not possible to see yourself, because you're so

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closely involved in the program’ (MAc2).

Emphasis was placed on the importance of building on existing strong relationships across and within the partnership to achieve the shared goals and vision. Time and space was made to ensure every stakeholder group driving the curriculum was heard and respected. The consumer voice, which is often overlooked within committees, was clearly respected and valued within the active partnership process that emerged;

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ACCEPTED MANUSCRIPT I think the relationship was the main thing that encouraged me to contribute… It’s very satisfying as a consumer representative in maternity care to be approached by a university to get consumer input… to have the education

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provider value the perspectives of consumer (MSCA).

The participants felt they had actively contributed to the development of the curriculum and consequently expressed feelings of shared ownership and responsibility for the creation of a

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transformative curriculum with embedded values, melded theory and practice and an

environment that supports the students through the program resulting in an end product that

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all are proud to be associated with and committed to investing in.

We own it. We own the course. We've developed it. We've suggested changes, and they've been taken on board. …I think we have a shared ownership. We share the curriculum. We share the midwives and we share the students' learning

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experience (MIP1).

The factors that created this sense of shared ownership included ’taking on board any suggestions’ (CAT1) and ‘seeing a lot of changes as a result of our feedback’ (MS) so there

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was a blending of practice and theory, with discussions around how clinical areas can better

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facilitate the students’ learning but also how preparation within the University allows the students to possess the necessary knowledge, skills and values to take advantage of the realworld experiences. This was particularly important to the Maternity Industry Partners who value the symbiotic relationship between the University and clinical areas recognising that ‘it's about preparing the students and then making sure that we in the industry can provide them with the clinical practice experience that they need’ (MIP1) but also about ensuring that staff who are working with the midwifery student feel supported ‘so making sure the clinical

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ACCEPTED MANUSCRIPT lecturers are visible and available, not only to the student, but to our staff as well on site in the clinical area’ (MIP2).

Having a truly collaborative process facilitated the sharing of knowledge and challenges

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which resulted in shared responsibility for the solutions to those challenges. Having a

participatory process, guided by a transformative team led to collaboration, connection, the sharing of values, responsibility and ownership. This sense of ownership was particularly

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apparent during the accreditation process when it was identified that ‘it wasn’t the BMid team that owned it [BMid Program], it was the students, the amount of input that we had I think

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that was not just obvious to us in the project team but to the outside that were assessing us as well’ (MS).

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DISCUSSION

The aim of this study was to determine whether a participatory curriculum development approach was effective in developing curricula for professional accredited programs meeting

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the broad aims described by Taylor (2003). The findings demonstrated that using this model

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strengthened the feeling of partnership amongst the participants, created a sense of shared ownership, improved opportunities for effective and real world learning and developed an ongoing cyclical process of development and feedback. Strong connections were found between the data and transformational change theory (Henderson 2002). As in transformative learning, where a person engages in activities that allow them to focus on and examine assumptions that lie beneath their beliefs, feelings and actions resulting in changed views (Kitchenham 2008); participants experienced a journey of transformation. Transformation occurs through psychological, cognitive and social processes of learning and is a result of a

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ACCEPTED MANUSCRIPT variety of reflexive and maturing experiences (McWhinney and Markos 2003). The journey included encouraging the examination of personal perspectives through reviewing the metavalues and philosophy that the program is based on, critical reflection through a SWOT analysis looking at the past curriculum and looking forward to the future and problem-solving

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around challenges identified. For this journey to occur, leaders fostered an environment

where participants were able to learn from each other through coming together in problem-

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solving groups.

A transformative leadership style, which is an ethically based leadership model that

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encompasses a commitment to the values and philosophy of stakeholders ensuring optimal long term outcomes (Caldwell et al. 2012), was reflected in the views of the participants. Features of transformative leadership include a compelling vision, congruent values with followers, shared vision, the creation of commitment through personal connection, being

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supportive, sharing information and providing opportunities for learning (Caldwell et al., 2012). The participants identified these traits within the leadership team expressing that they felt acknowledged, encouraged, listened to, valued, respected and the environment was

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positive, enthusiastic and cohesive.

The creation of a guiding coalition, with a clear vision and strategy aligned to the drivers of the curriculum, the building of commitment, critical reflection and development of synergy that supported the Participatory Curriculum Development approach are all identifiers of a transformative process (Henderson, 2002). The process was shown to be developmental for the individual, affirming for relationships amongst the groups and produced a curriculum that had broader input, real world connections, greater support and better learning opportunities, thereby supporting findings in previous studies (Price 2004; Taylor 2000; Xiaowei 2008).

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ACCEPTED MANUSCRIPT These changes have already been noted in the positive end product as the newly accredited program has completed the first year of implementation.

Further development of strong partnerships built on previous relationships facilitated the

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process. Effective partnerships are synergies that produce better results than can be attained in isolation (Dietrich et al. 2010; Franklin 2009). The PCD was found to be a positive

process largely due to the ability to work with others and gain both personally and see the

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benefits for others through the partnership. Franklin (2009) identifies that before joining a partnership; individuals must take a ‘leap of faith’ and trust that participation will add value

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to the work, process or the individual. As the invited participants were already known to each other and many had built relationships prior to the PCD process, the trust largely existed. However, the strength of the relationships grew within the partnership during the PCD process, with benefits seen not only in the development of the curriculum but beyond to

manner.

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its implementation where challenges could be addressed in a cooperative and facilitative

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Another factor that promoted success was the early establishment of a clear vision, identified

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as important to the process of collaboration by Gardner (2011), that was flexible to allow input from all participants. This encouraged buy-in early to the process and led to ongoing commitment through being encouraged and feeling heard and aligned to the process. Effective partnerships share power, help and depend on one another and work towards a shared understanding, where decisions can be negotiated and not imposed (Franklin, 2009). This agreed understanding was seen as important to many of the participants, who acknowledged at times the outcome was not their individual choice but it was agreed and would be tried and could be reviewed in the future. This willingness to ‘give it a go’ was

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ACCEPTED MANUSCRIPT backed by the mutual respect within the groups and the early establishment of core values and philosophy which helped focus and align the curriculum. The partnership also commences the cyclical process of development, feedback and review.

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Participatory Curriculum Development strengthened the sense of ownership for all

stakeholders. Reflecting on what is already known and determining whether this is justified under the present circumstances with the inclusion of the maternity industry partners,

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maternity consumer advocates and student midwives allowed for past experiences to be considered and suggestions for improvement acted on. Personal involvement has been

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identified as increasing a sense of ownership (Wood 2003) and this was shown in the responses of the participants. Closely aligned with ownership is the sense of commitment which arose as a subtheme across each participant group, culminating in the desire to be involved in the Accreditation process. The shared ownership and commitment was

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acknowledged by the Accreditors who commended the program for the ‘strong, mutually

CONCLUSION

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beneficial relationships between health industry partners and the university’.

Whilst Participatory Curriculum Development emerged within the community development sector, this study has shown it is highly effective for developing curricula for programs leading to professional accreditation within higher education, especially with increasing societal awareness and demands for professional performance. Adopting a respectful effective participatory approach brings interested parties together for discussion and reflection on the evolving profession and the best process for advancement through a curriculum that is contemporary and relevant to the real world. Learning becomes highly

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ACCEPTED MANUSCRIPT embedded in the local context and there is increased dynamics of the curriculum development process through more open feedback loops. Stakeholders experienced greater responsibility for all stages of the curriculum development process leading to increased motivation and commitment. Combining all these factors leads to a curriculum that is more sustainable,

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reflective of national and international standards and with real world outcomes.

Limitations

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Whilst the evaluation of the project was reported to be positive by those selected for

interview – we acknowledge that only a limited sample of participants were interviewed. We

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also acknowledge that this process is a lengthy one and requires commitment and sign up from all involved for the process to be effective. Another factor that may have affected the success of using the model was its use within a wider existing partnership relationship. This negated the need to spend large amounts of time on team building and awareness sessions as

Recommendations

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the majority of team members had prior experience of working together.

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The adoption of a representative participatory approach produces a curriculum that is

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responsive to changing societal and professional requirements. This approach is particularly beneficial to professional programs to promote the active engagement of stakeholders, thereby fostering partnerships that will benefit the students attaining real world experience. Engaging with partners from industry, consumers and students facilitates the university being proactive to generate knowledge within the local, national and global context. The curriculum development framework model produced within this study can be used to guide other program development teams to use a participatory process to actively hear the voice of those

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REFERENCES

Auerbach, E., 1992. Making meaning, making change: participatory curriculum development for adult ESL literacy, United States.

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Australian Nursing and Midwifery Accreditation Council, 2013. National guidelines for the accreditation of nursing and midwifery programs leading to registration and

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endorsement in Australia. Australian Nursing and Midwifery Accreditation Council, Canberra.

Australian Nursing and Midwifery Accreditation Council, 2014. Midwife Accreditation standards 2014. Australian Nursing and Midwifery Accreditation Council, Canberra.

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Braun, V., Clarke, V., 2006. Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77-101.

Braun, V., Clarke, V., 2012. Thematic analysis. American Psychological Association, DC;

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US; Washington, 57-71.

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Bridgstock, R., 2016. Educating for digital futures: what the learning strategies of digital media professionals can teach higher education. Innovations in Education and

Teaching International, 53(3): 306-315.

Caldwell, C., Dixon, R.D., Floyd, L.A., Chaudoin, J., Post, J., Cheokas, G., 2012. Transformative leadership: achieving unparalleled excellence. Journal of Business Ethics 109, 175-187.

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ACCEPTED MANUSCRIPT Clifford, V., Montgomery, C., 2015. Transformative Learning Through Internationalization of the Curriculum in Higher Education. Journal of Transformative Education 13, 4664.

approaches. SAGE Publications, Los Angeles.

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Creswell, J.W., 2013. Qualitative inquiry & research design: choosing among five

Dietrich, S.L., Kornet, T.M., Lawson, D.R., Major, K., May, L., Rich, V.L., Riley-

Wasserman, E., 2010. Collaboration to partnerships. Nursing administration quarterly

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34, 49.

Faison, K., Montague, F., 2013. Paradigm shift: curriculum change. The ABNF journal :

24, 21-22.

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official journal of the Association of Black Nursing Faculty in Higher Education, Inc

Franklin, T., 2009. How partnership works. Development in Practice 19, 789-792. Gardner, D.C., 2011. Characteristic collaborative processes in school-university partnerships.

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Planning and Changing 42, 63.

Henderson, G.M., 2002. Transformative Learning as a Condition for Transformational Change in Organizations. Human Resource Development Review 1, 186-214.

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Hesse-Biber, S.N., Leavy, P., 2011. The practice of qualitative research. SAGE, Los Angeles.

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Hills, M.D., Lindsey, A.E., Chisamore, M., Bassett-Smith, J., Abbott, K., Fournier-Chalmers, J., 1994. University-college collaboration: rethinking curriculum development in nursing education. The Journal of nursing education 33, 220-225.

Hurlimann, A., March, A., Robins, J., 2013. University Curriculum Development - Stuck in a Process and How to Break Free. Journal of Higher Education Policy and Management 35, 639-651. International Confederation of Midwives, 2011. Global Standards for Midwifery Education, in: Bulletin, A. (Ed.). ICM, The Hague.

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ACCEPTED MANUSCRIPT International Confederation of Midwives, 2013a. Essential competencies for basic midwifery practice. . International Confederation of Midwives, The Hague. International Confederation of Midwives, 2013b. ICM Global Standards for Midwifery Education. International Confederation of Midwives, The Hague.

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Kitchenham, A., 2008. The Evolution of John Mezirow's Transformative Learning Theory. Journal of Transformative Education 6, 104-123.

McWhinney, W., Markos, L., 2003. Transformative Education: Across the Threshold. Journal

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of Transformative Education 1, 16-37.

Mertens, D.M., 1999. Inclusive Evaluation: Implications of Transformative Theory for

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Evaluation. American Journal of Evaluation 20, 1-14.

Price, L., 2004. Participatory curriculum development: lessons drawn from teaching environmental education to industry in Zimbabwe. Environmental Education Research 10, 401-407.

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Sandall, J., Soltani, H., Gates, S., Shennan, A., Devane, D. (2016) Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016; 9.

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Schneider, Z., Whitehead, D., LoBiondo-Wood, G., Haber, J., 2013. Nursing and midwifery

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research: methods and appraisal for evidence-based practice. Elsevier Australia, Chatswood, N.S.W.

Sidebotham, M., 2012. Responding to the changing landscape: Australian midwifery. The practising midwife 15, 24-26.

Stan, L., 2014. Professional standards, competence and capability. Higher Education, Skills and Work-based Learning 4, 31-43.

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ACCEPTED MANUSCRIPT Taylor, P., 2000. Improving forestry education through participatory curriculum development: A case study from Vietnam. The Journal of Agricultural Education and Extension 7, 93-104. Taylor, P., 2003. How to design a training course: a guide to participatory curriculum

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development. VSO/Continuum., London.

Taylor, P., 2008. Higher education curricula for human and social development, in: Global University Network for Innovation (GUNI) (Ed.), Higher Education in the World 3, 3

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ed. Palgrave Macmillan, London.

Tight, M., Vidovich, L., O'Donoghue, T., 2012. Transforming university curriculum policies

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in a global knowledge era: mapping a "global case study" research agenda. Educational Studies 38, 283-295.

Walker, M., 2012. Universities and a Human Development Ethics: a capabilities approach to curriculum. European Journal of Education 47, 448-461.

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Wood, C.M., 2003. The Effects of Creating Psychological Ownership among Students in Group Projects. Journal of Marketing Education 25, 240-249. Xiaowei, G., Min, L., Juanwen, Y., Vernooy, R., Gubo, Q., Keke, C., Jingsong, L., Lin, L.,

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Yiching, S., Xiuli, X., Xiaoyun, L., Miankui, M., Zhipu, L., Ting, Z., Miao, J., 2008.

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Introducing Participatory Curriculum Development in China's Higher Education: The Case of Community-Based Natural Resource Management. The Journal of Agricultural Education and Extension 14, 7-20.

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ACCEPTED MANUSCRIPT Phase 1 Identify project lead and commence information gathering

ACTIONS

Identify the, strengths and challenges of the current curriculum and the drivers influencing the development of a new curriculum with the academic team involved in the current curriculum

Gather all data sources containing evaluative material on current program e.g.; Program Mapping, internal program review, student experience data, course quality improvement reports; to perform SWOT analysis in accordance with a review of the current curriculum

Create commitment, ownership, and be representative and inclusive of the real world of practice

Using an inclusive transparent process establish Steering Group; Project Group; and where required sub-committees and additional expert contribution.

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Phase 2 Identify and invite appropriate stakeholder involvement representative of all curriculum drivers

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Phase 3 Develop macro curriculum outline

Agree framework within which the micro detail of curriculum will be developed. Create framework model to which all courses will be aligned.

Establish first draft micro curriculum document guided by framework model and meeting accreditation standards

Iterative consultation between SubCommittees, Project Group and Steering Committee including SubCommittees detail mapping of Learning Outcomes, Aligned Assessment, Graduate outcomes, Pedagogy

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Phase 6 Widespread consultation on full draft

Ensure the pedagogical and philosophical drivers, and program values are visibly prominent and remain central to the process of micro development

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Phase 5 Micro curriculum development

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Provide overview of macro curriculum Project Group develop macro to steering group to provide feedback framework based on SWOT analysis and guidance to project group and sub and data for review by Steering Group committees

Phase 4 Program alignment to professional values, pedagogical and educational philosophy

To produce an Aligned Mapped Curriculum that all stakeholders feel connected and committed to, that is representative and inclusive of the real world of practice and meets accreditation standards

Feedback sought via project group and steering group members from their peer networks on final draft. Feedback collated by project lead and presented to steering group.

Agreement from all stakeholders that curriculum ready for submission for accreditation

Steering group review feedback. Consensus agreement reached. Recommendations for changes based on feedback to final submission document made. Final document produced

Submit curriculum for external review against national standards and respond to regulator requests made up to the point of final accreditation

Retain Stakeholder and Project Group engagement through regular updates. Respond to initial regulator queries. Prepare for accreditation visit involving full curriculum development team

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Phase 7 Final Curriculum agreed

Phase 8 Program accreditation process

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Develop an evaluation framework of the PCD process to determine the effectiveness of the model in achieving the stated aims.

Invite participants representative of each stakeholder group attend for interview to discuss their experience. Analyse interview data and identify common themes

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Phase 10 Evaluation of Participatory Curriculum Development Process

Ensure newly accredited program delivered by a well prepared faculty teaching team and student feedback is sought

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Phase 9 Accreditation approval Program implementation

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Participant Group Midwifery Industry (Clinical) Partner (MIP) Midwifery Student (MS) University Curriculum Advisory Team member (CAT) Midwifery Academics (MAc) Maternity Services Consumer Advocate (MSCA)

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