Early Career Midwives’ Recommendations to Improve Clinical Education: “Honestly, We Just Need to Do Better”

Abstract

Introduction

The Accreditation Commission for Midwifery Education determines the accreditation criteria and ongoing evaluation for midwifery education programs, which ensures program quality, including clinical education experiences. Increasing evidence about the deficits and strengths in clinical education experience can improve the evaluation process. Little is known about which elements of clinical education are most valued by early career midwives. The purpose of this research was to identify early career midwives’ recommendations to improve clinical education.

Methods

We surveyed early career certified nurse‐midwives (CNMs) and certified midwives (CMs) who were certified between 2019 to 2024 (n = 640) using an electronic mailing list with the American Midwifery Certification Board. We conducted a thematic analysis on 371 (58%) responses to the open‐ended question, “What recommendations do you have to improve the clinical education experience?”

Results

Recommendations were grouped into 3 themes: (1) programs should protect students from short and long‐term harm by securing vetted, trained preceptors and ensuring clinical education promotes balance and prevents burnout; (2) programs should take a more active role in securing and overseeing clinical education; and (3) national accrediting and professional organizations as well as midwifery education programs should lead systemic reform to strengthen midwifery clinical education, including revisions to current clinical requirements and rethinking its funding and structure.

Discussion

Study findings highlight multiple actionable steps for improving US midwifery clinical education. Investing time, resources, and oversight into preceptor preparation is critical to ensure midwifery students learn in safe, welcoming environments. Ensuring that high quality clinical education is available and accessible to all midwifery students is necessary to sustain and grow the workforce.

INTRODUCTION

High quality clinical education is a critical component of the professional education of certified nurse‐midwives (CNMs) and certified midwives (CMs), collectively called midwives. In the United States, the Accreditation Commission for Midwifery Education (ACME) provides accreditation to midwifery education programs. ¹ The goal of ACME is to provide learning experiences in midwifery education programs that lead to optimal student outcomes and ensure that programs perform at the highest level of quality. ¹ Notably, ACME necessitates that the didactic and clinical components are implemented by numerous evidence‐based methods to realize both the program objectives and ensure students are prepared to work as new midwives. ¹ To date, the majority of research about midwifery education has focused on the didactic components. ² , ³ , ⁴ Less evidence is available about the value of patient‐facing, hands‐on clinical education to effectively prepare midwifery graduates.

1. QUICK POINTS

• ✦Early career midwives described their clinical education as foundational not only for developing clinical competence, but also for shaping long‐term professional well‐being, confidence, and workforce retention.
• ✦Supportive, well‐prepared preceptors and active program oversight are important in creating safe learning environments that protect students from burnout, mistreatment, and inequitable training experiences.
• ✦Early career midwives called for structural changes to midwifery education, including more reliable clinical placement systems, stronger support for preceptors, and expanded opportunities for immersive clinical learning and transition‐to‐practice support.
• ✦Strengthening clinical education requires coordinated action from education programs, accrediting organizations, and professional bodies to ensure equitable, high quality training experiences across settings.

Historically, clinical placements for US midwifery students have been actualized based on personal relationships rather than a formal system to secure and assess sites. ⁵ , ⁶ ACME permits variation in clinical education. Students may stay at a single site or rotate, and students may be precepted by physicians and advanced practice providers, although the majority of their training must take place with midwives. ⁷ ACME accreditation criteria specify that programs must secure clinical sites. Further, criterion VI states that the program's assessment process should capture evaluation of clinical site effectiveness in meeting student learning needs and ensuring they achieve clinical competence. ¹ Overall, programs have autonomy to evaluate the overall effectiveness of clinical placements, but there is flexibility with the process and limited evidence on the criteria.

Research conducted outside of the United States provides some insight into critical aspects of successful clinical education, although differences in midwifery education and midwifery within health systems may limit the applicability of findings. A systematic review of European and Australian midwifery students identified the importance of a supportive preceptor, a supportive environment, and predictability of learning. ⁸ A mixed‐method study from Malawi similarly emphasized that successful training required a positive relationship between the student and the preceptor. ⁹

Strengthening the evidence base about effective clinical education experiences in the United States would enhance the ability of midwifery education programs to assess how well the clinical sites provide competencies and skills, thus fulfilling the requirements set forth by ACME. This is especially critical given the high rates of health care provider turnover and burnout in the US health care system, ¹⁰ , ¹¹ including midwives. ¹² The need to replace those leaving the health care workforce and promote longevity and job satisfaction has never been more important. ¹³

To most effectively prepare midwives for practice, a greater understanding of optimal clinical education is essential to help midwifery programs assess clinical sites and improve the student experience. Further, an evidence base for midwifery clinical education should include the perspectives of early career midwives, who are more racially and ethnically diverse and more likely to be sexual or gender minorities than prior generations. ¹⁴ , ¹⁵ Supporting newer generations to grow, strengthen, and diversify the workforce is tantamount to the future of the profession. ¹⁶ To address these gaps, this study is an analysis of the responses of early career midwives who were asked for recommendations to improve clinical education within a larger survey about midwifery education. ¹⁷

METHODS

Using a national cross‐sectional study design, 4117 CNMs/CMs certified within the past 5 years (2019‐2024) were invited to complete an online survey. This group of early career midwives was the population of CNMs/CMs at the time of the study. The study protocol was approved by the Rutgers University Institutional Review Board and the American Midwifery Certification Board (AMCB) Research Committee. The Standards for Reporting Qualitative Research guides the information presented about this study (Appendix S1). All US CNMs/CMs are required to be certified by AMCB, and of these, approximately 80% opt in to receive research requests. The date of certification was confirmed by participants in the survey.

Recruitment and Data Collection

Through an AMCB electronic mailing list, eligible participants were solicited to complete the online survey and received up to 4 email invitations between August and November of 2024. Participants were offered a $10 electronic gift card for participation, which was increased to $30 in the fourth recruitment email to encourage responses. Additionally, participants could choose to be entered in a raffle for 1 of 3 $100 gift cards or an iPad. Study data and consents were collected and managed using Qualtrics. Participation was voluntary and participants were informed they could not answer specific questions or exit the study as desired. No identifying information, aside from demographic characteristics, was collected. Participant emails to facilitate gift card transmission was collected in a subsequent Qualtrics link that could not be connected to the initial survey.

Measures

The survey ¹⁷ consisted of 13 open and 33 closed‐ended questions (46 total) about clinical and precepting experiences, current work environment, and demographics, and it took about 15 minutes to complete. Question items were drawn from existing validated scales as well as prior related studies. Some items were developed based on content expertise and the lived experiences of the authors as midwifery educators. Participants were able to review and change their answers through a back button in Qualtrics. To explore the research question, we analyzed responses to one open‐ended question: What recommendations do you have to improve the experience of clinical education?

Analysis

We used thematic analysis, which is useful when data need to be minimally organized but understood deeply. ¹⁸ , ¹⁹ Anonymized responses to the recommendation question were coded by a team of 4 coders in Atlas.ti. The first author coded the first 20 responses to inductively create a preliminary codebook, which was subsequently expanded upon throughout the coding process. Each response was individually coded by either the first author or one of 3 trained student coders, who were public health, nursing, or midwifery students. Then each code was reviewed by another member of the coding team. Discrepancies were reviewed in team meetings until the team came to a consensus. The final thematic organization of recommendations was achieved by grouping similar codes into code groups. The organization of themes and subthemes was agreed upon by the research team (Figure 1).

Figure 1.

Recommendations to Improve Midwifery Clinical Education

Positionality

The first and fourth authors are CNMs. Both our experiences in midwifery clinical education as students and as midwifery preceptors influenced our understanding of this topic and engagement with this study. The fourth author is also a midwifery education program director who has deep knowledge of the clinical education process from an administrative perspective. The second author is a nurse scientist, and the third author is a quantitative sociologist studying women's health care with extensive survey design and analysis experience. Throughout the study, we each reflected on how our subjective experiences, social identities, and positionalities might influence coding, interpretations, and the underlying assumptions that informed them.

RESULTS

We received 640 completed surveys and had a response rate of 93.6%. Of the 640 completed surveys, 371 (58%) participants answered the open‐ended question. Demographic characteristics are presented in Table 1. The majority (72.5%) of participants identified as White or non‐Hispanic, and 97% identified as cisgender female. Eight were CMs; the remainder were CNMs. Three main themes were identified: (1) education programs should protect students from short‐term and long‐term harm; (2) education programs should take a more active role in securing and overseeing clinical education; and (3) national accrediting bodies and professional organizations, as well as midwifery education programs, should lead systemic reform to strengthen midwifery clinical education.

Table 1.

Sociodemographic Characteristics of Subsample (n = 371)

Characteristics	Value
Age, n (%), y
24‐34	153 (41.2)
35‐44	136 (36.7)
45‐54	65 (17.5)
55‐65	17 (4.6)
Gender Identity, n (%)
Female (cisgender; sex assigned at birth aligns with gender identity)	360 (97.0)
Male (cisgender; sex assigned at birth aligns with gender identity)	2 (0.5)
Non‐binary/transgender/non‐conforming	8 (2.2)
Missing	1 (0.3)
Race/Ethnicity, n (%)
Hispanic	31 (8.4)
Non‐Hispanic Black	46 (12.4)
Non‐Hispanic White	269 (72.5)
Other Non‐Hispanic or multiple	24 (6.5)
Missing	1 (0.3)
Religion, n (%)
Christian	193 (52.0)
Jewish	21 (5.7)
Muslim	2 (0.5)
Other	34 (9.2)
None	120 (32.3)
Missing	1 (0.3)
Year Certified, n (%)
2019	44 (11.9)
2020	55 (14.8)
2021	62 (16.7)
2022	68 (18.3)
2023	54 (14.6)
2024	88 (23.7)

Education Programs Should Protect Students From Short and Long‐term Harm

Participants desired protection and support during their clinical education. They identified negative interactions with preceptors and other providers during their clinical education, as well as a cultural milieu of burnout, as especially harmful to their education and transition to practice. The desire for protections could be manifested in many ways, including vetting and training preceptors to better equip them to educate students and placing emphasis on supporting students to cultivate work and life balance with tools for burnout prevention.

Vetted, Trained Preceptors

Many of the recommendations centered around ensuring preceptors are engaged and prepared to take on this pivotal role in the clinical education experience. Many participants recommended that more effort should be invested in vetting potential preceptors, and that midwifery programs should not assume every practicing midwife is suitable for preceptorship. One participant shared:

I think that it should NOT be an expectation that all midwives precept students, since some midwives do NOT enjoy teaching or are not great at it. It's a disservice to students when their preceptor doesn't have the skill or willingness to teach. (#337, emphasis theirs)

Another suggested that the preceptor be interviewed before taking on a student, writing that this would “set expectations and make sure the preceptor was appropriate for training a student” (#549). For some participants, vetting preceptors was an important missing component of ensuring quality clinical education experiences. Many participants saw vetting preceptors as essential to protect students. One participant wrote, “Don't place students with harmful preceptors out of desperation, create quality experiences. Believe students and protect them as valuable assets rather than continue a chain of abusive educational experiences” (#664).

Another recommendation was to improve the training of preceptors to better prepare them to train students. One participant wrote, “REQUIRE basic preceptor training!” Being a good midwife does not make one an able educator‘’ (#664, emphasis theirs). Others felt that the preceptors needed more direction on what skills to emphasize, writing, “Provide more guidance for preceptors about the skills midwives need to develop so it is more standardized—everyone has such different experiences!” (#450). Another felt that training needed to encompass the psychosocial aspects of learning, recommending “more training for preceptors on what students need both practically for clinical requirements but also emotionally” (#251). Taken together, these recommendations suggest the need to better identify midwives interested and willing to precept and then train and support them appropriately in their educational role.

Clinical Education That Promotes Balance and Prevents Burnout

Participants also recommended incorporating education and training on professional and personal balance in their clinical education. Many described their time in clinical education as stressful and sought more emphasis on their own mental health during their midwifery clinical education. One participant recommended “talking about how to integrate self‐care and process the mental load that comes with midwifery” (#121). Many described wanting to see their program prioritize teaching professional and personal balance, whereas others felt that balance was something to learn from a preceptor.

Participants also highlighted long‐term implications of establishing a strong foundation in balance as they navigate the competing demands of life and potential burnout as practicing midwives. For example, one suggested to “prioritize self‐care even during training because these habits will last a lifetime” (#342). One participant reflected on the harm done to the entire workforce when care is not given to the newest members of the profession. They wrote, “I think that there has to be a culture shift in nursing and midwifery to care for the babies in the field. Otherwise, we just run them through and burn them out” (#484).

Programs Should Take a More Active Role in Securing and Overseeing Clinical Education

Participants frequently described a request for their program to take a more active role in securing and overseeing their clinical education. For many, especially those who struggled to find their own placements, that meant increased responsibility in the placement process. Once students were in the sites, they desired improved oversight and mechanisms for addressing challenging situations.

Programs Should Find or Help More to Find Clinical Placement Sites

Participants repeatedly expressed that their programs needed to do more to assist in clinical placements. Many thought that their program should be responsible for finding sites for all their students. One participant shared their own story of difficulty finding a placement and what they went through to ensure they could complete their education:

Finding preceptors for students in ALL programs. It was like a full‐time job finding placement. I moved my family 2,000 miles to accommodate my training, and then my placements fell through, and I had to scramble to start over. I found a new placement, and she decided we weren't a good fit before I even started working with her. I had to scramble again. The stress from that affected not only me but my family, and we still sometimes process this struggle. (#330, emphasis theirs)

Those who did not have to find their own placement saw this as a strength, sharing, “I think it is very important for…programs to facilitate the clinical placement of students. I never had to worry about my clinical placement and am very thankful for that” (#441). Another felt the process of finding placements should be more formalized in their institution and recommended that “CNM programs should function as MD and DO programs do. They should have dedicated clinical sites and…guarantee placement for students if and when necessary” (#504).

A smaller subset of participants wanted their program to be more involved and helpful in finding placements but stopped short of saying programs should be entirely responsible. One participant expressed the following call for improvement: “Honestly, we just need to do better. Schools should help students find preceptors more, and students shouldn't have to do all the heavy lifting to follow up with potential sites and credentialing” (#541).

Enhanced Oversight of the Student's Clinical Education to Protect Students

Many participants also recommended enhanced safeguards once students were in clinical placements to protect from harmful situations with their preceptor or other providers. Current safeguards from programs were, to many, not sufficiently protecting students. One participant wrote:

There is a clear gap between faculty oversight and precepting experiences that rendered me feeling helpless when things were not going well, or if I felt that it wasn't working for me in some way. Shaming and bullying are still a norm in some clinical experience climates… So I would say that accountability, attention to student quality of experience, and being able to have more autonomous experiences with proper feedback would all be an improvement. (#358)

Many described wanting more regular meetings with their faculty advisors and preceptors to communicate expectations for the placement and set the student up to succeed in their rotation. Others wanted a more protected route with “an easier and anonymous way of reporting interactions with preceptors that doesn't feel punitive to the student” (#306).

Some described clinical sites with known problems but saw that their program continued to use them. One explained:

During my student experience, many students voiced concerns about preceptors, and our program still sent students with the preceptors. The preceptors made homophobic, racist, and unprofessional comments to students that impacted their learning and confidence. It made students feel unwelcome and made them question their ability to become midwives. These allegations should be taken more seriously? to promote the wellbeing of these students and new midwives. (#633)

The cycle of continuing to send students to sites with prior complaints may, as some participants suggested, be the result of a severe lack of clinical sites. Others suggested that students were not taken seriously by programs when reporting which led to feelings of alienation. Whatever the cause, the ramification of these negative experiences was compounded by a lack of accountability and action on the part of programs, with many participants recommending changes in program accountability and reporting standards.

Systemic Reform to Strengthen Midwifery Clinical Education

The third theme highlights recommendations focused on systemic changes that participants felt were needed to better prepare them to become practicing midwives. Multiprong changes included increasing current clinical requirements, creating more postgraduate opportunities, and funding clinical education.

Clinical Requirements Are Insufficient

Many participants raised concerns that their clinical education was insufficient in preparing them to become independent new midwives. Specifically, some participants wanted more time with hands‐on learning to refine the specific clinical skills and decision‐making. One participant enrolled in a DNP midwifery education program wrote:

I wish the entire last year had just been my project and working full‐time as a midwife. The final integration that was a mere 8 weeks should be a year long. I would have felt way more prepared at graduation, and…been more desirable as a trained potential employee. (#558)

Although programs varied in required clinical education hours, participants consistently wanted more time. If they had one semester of integration, they wanted a year, and if they did rotations over one year, they recommended 2 years. The consistent theme was a recommendation for more clinical education.

Others specifically focused on increasing the minimum number of births they were required to manage during clinical education. Some provided specific numbers they felt should be the required minimum: “I feel like 50 hands‐on births would have better prepared me” (#424). Others felt strongly that meeting a birth minimum requirement insufficiently prepared them to be competent, noting, “How can we say that we've done enough? How can we say that we've experienced emergencies and all forms of normal variation in safe learning situations when we've only done 2 and a half dozen deliveries?” (#138). Instead of focusing on the number of births, others vocalized a desire to add requirements to ensure all students have experience with community birth, which includes care in a birth center or home.

Rethinking the Funding and Structure of Clinical Education

Many participants vocalized a desire to restructure the funding of midwifery clinical education. Most responses focused on paying or otherwise incentivizing preceptors to train students. Many felt this was a critical component of clinical education that had been overlooked for too long. Payment could encourage midwives to precept, with one participant writing, “There needs to be reimbursement from schools for midwifery preceptorship. It takes so much effort to have a student, and there is a daily cost associated with it. Reimbursement would help incentivize it!” (#281). Some also felt that payment would help ensure high quality preceptors continue to precept, with many recommending paying and evaluating preceptors in tandem. One participant wrote, “Preceptors should be paid for their work! Will ensure that better people are responsible for training the next generation of midwives” (#296). One participant summed up the sentiments of others by simply stating that “paying preceptors for their work should be the norm” (#106).

Others saw payment as one solution to other systemic issues within midwifery education and health care. Several participants described the problematic nature of some programs paying preceptors versus others that do not offer payment. One participant described how this imbalance made it harder for them to find clinical sites. “The school that I attended also did not offer preceptors monetary benefits, so I found that several potential preceptors declined to accept me as a student because if they precepted students from another school, they would receive compensation for it” (#222). Others saw preceptor compensation as an approach to address the larger issue of burnout across health care. “Preceptors should be incentivized in some way because a lot of them are experiencing burnout. Those feelings of burnout are often projected on students, resulting in negative experiences while in school” (#459).

In addition to compensating preceptors, participants expressed a desire for additional opportunities for new graduates, such as midwifery fellowships. As one participant explained:

I think there needs to be an apprentice‐type setup that goes along with clinical education and preceptorship. Very often, my time felt like just checking off hours for graduation. It is a very short amount of time in comparison to other medical provider careers. (#456)

An important aspect that many participants described was the need to ensure that postgraduate training was a paid opportunity to make it more affordable. The recommendation for these postgraduate opportunities was ultimately suggested to improve transition to practice and set early career midwives up for success. “Midwifery needs to have more residency opportunities to better support the transition from student to practitioner” (#338).

DISCUSSION

In response to an open‐ended question about recommendations to improve the experience of clinical education in midwifery, participants identified suggestions for improving the clinical education placement process and hands‐on experiences once students are placed. Recommendations included actionable steps for midwifery education programs, professional organizations, and national accrediting bodies. Participants overwhelmingly vocalized a desire for clinical education that prepared them professionally and personally, and they envisioned ways in which this system could work better for students and preceptors.

To improve the overall student experience, programs could develop systems to ensure that preceptors are both trained as educators and vetted before working with students. The New Jersey Midwifery Preceptor Learning Platform education project is an example of a state‐funded initiative focused on preceptor‐specific education that could be replicated in other states and expanded. ²⁰ The initiative gives preceptors access to content in Canvas, designed to educate on foundational strategies and teaching innovations in the clinical environment. Any preceptor may access the platform and earn continuing education for a nominal fee; the resource is free to New Jersey preceptors. The American College of Nurse‐Midwives (ACNM), the professional membership organization for CNMs/CMs, could offer no‐cost, preceptor‐specific educational opportunities, making them available both at every annual meeting and in online educational material to ensure preceptors have access to best practices in precepting and learning.

Currently, programs are required to assess and approve clinical sites, including clinical faculty, for accreditation purposes. ¹ Given both the recommendations noted in the survey results and national data regarding significant midwifery workforce burnout and attrition, programs may consider developing and implementing strategies that seek to promote student resiliency, teach professional and personal balance, and mitigate negative student experiences at clinical sites. Exemplars of this model exist, such as the Birthworker Equity in Education Collaborative funded by the Massachusetts Department of Public Health. ¹² , ²¹ , ²² , ²³ This collaborative supports the Massachusetts perinatal workforce, including practicing midwives through education and training, mentoring, tools for burnout prevention, networking, community building, and leadership coaching. This model could be modified and tailored specifically for midwifery students and replicated and funded by other states. Additionally, the participants’ desire for more balance during their clinical education shows a heightened need for student support. ACME requires that programs support student well‐being and resiliency through implicit bias training, referrals to student services, and support groups. ¹ This programmatic change seems imperative, given the increased rate of burnout in the midwifery profession. ¹² , ²⁴

Implications for Education and Research

Our findings suggest ACNM, ACME, and midwifery programs take a more active role in securing and overseeing clinical education. Since 1953, the National Resident Matching Program (also known as The Match) has overseen the process of placing over 40,000 first‐year medical residents in US residency programs. ²⁵ Midwifery programs could consider the formation of a national, independent organization analogous to The Match to oversee the placement of midwifery students enrolled in ACME‐accredited midwifery programs. This would increase the efficiency of the placement process and ensure equitable access to quality clinical learning. Further, when the onus of securing placement falls to individuals instead of programs, this can actualize as professional gatekeeping. Individuals who do not see themselves reflected in the current midwifery workforce may have more challenges securing placements, which can serve as a barrier to diversification of the profession. ²⁶

Although participants in our study felt that preceptors should be paid for their work, prior research findings among New Jersey midwives noted that payment was not a motivating factor. ²⁷ Some preceptors reported that employers kept the money because preceptor payment was contractually disallowed. However, several did think that preceptor payments might incentivize employers to allow them to precept. ²⁷ Federal funding for midwifery education and enhanced support of midwifery preceptors, whether or not they are paid directly, is critical to supporting the growth and diversification of the workforce. ²⁸ Other federal, state, and institutional policies that support preceptors include independent practice, clinical resources, and workload reallocation. ²⁸ , ²⁹

Study participants felt that programs’ current clinical requirements should be revised to provide longer opportunities for clinical learning and more fellowship opportunities. Given that midwifery education is competency‐based and programs are not required to mandate a minimum number of clinical experiences such as births, ¹ transparent communication regarding attaining competency may mitigate student misunderstandings about these requirements. Competency‐based education relies on didactic and clinical skills that are assessed throughout the program—including the classroom setting, simulation, and in clinical settings—and is not based on a quantitative output of care provided. Some postgraduate fellowships are accessible for early career midwives. ³⁰ These opportunities may be a valuable learning opportunity, particularly for midwives interested in working in specialized settings (eg, community birth) or with specific populations. ³¹ However, US midwifery education programs prepare graduates to be safe, beginning practitioners and do not require fellowships. ³¹ Greater communication between educators, preceptors, and students may be needed to reassure students about their progress and address areas where they may need additional support.

Further research regarding opportunities to improve midwifery clinical education is needed. Since our findings focused on the student perspective, researchers must seek to better understand the complex system of midwifery clinical education. Previous study findings from a sample of experienced New Jersey midwives described strategies to improve clinical education, ²⁹ but recommendations from a national sample of preceptors is needed. Additionally, a cost‐benefit analysis for program leadership about the feasibility and value of paying midwifery preceptors is warranted.

Strengths and Limitations

These recommendations should be considered within the context of this study's strengths and limitations. This national sample represents a diverse group of early career midwives. Over a quarter of the participants identified as individuals other than non‐Hispanic White, as compared with a 2025 report indicating that 15% of all AMCB‐certified midwives identify as midwives of color. ²² Further, by surveying midwives who have completed their education and may already be practicing clinically, recommendations are informed by not only their experience in a program, but also their clinical practice and professional identity. However, the study had several limitations. Because data were collected in a survey, we could not ask probing or clarifying questions. Additionally, these recommendations capture only the perspective of early career midwives within a complex and broad health care system, involving midwife preceptors, other health care providers, midwifery education programs, and health care organizations. The perspectives of other stakeholders should be considered to promote meaningful policy change and improve midwifery students’ clinical experiences.

CONCLUSION

We explored the recommendations of early career midwives to better understand ways to improve the clinical education experience. Their suggestions should be strongly considered by midwifery education programs, professional organizations, and national accrediting bodies. Creating a strong, prepared workforce involves intentionally considering and rethinking both how students find clinical placements and ensuring students are protected from harm during their training. Further research should more deeply explore the recommendations of early career midwives and elicit perspectives of other individuals involved in the clinical education system, such as midwife preceptors, other providers, health care programs, and health care organization administrations. Improving midwifery clinical education is a core component of growing, strengthening, and diversifying the midwifery workforce.

CONFLICTS OF INTEREST

There are no conflicts of interest to report.

Supporting information

Appendix S1. Standards for Reporting Qualitative Research checklist.