NARM Policy Statement on Preceptor/Apprentice Documentation

In validating the apprenticeship as a valuable form of education and training for midwifery, NARM appreciates the many variations in the preceptor/apprentice relationship. In upholding the professional demeanor of midwifery, it is important that each party in the relationship strive to maintain a sense of cooperation and respect for one another. While some preceptor/apprentice relationships develop into a professional partnership, others are brief and specifically limited to a defined role for each participant.
To help NARM candidates achieve exceptional training and a satisfactory relationship from their apprenticeship, NARM makes the following recommendations:

  1. A preceptor for a NARM applicant must be a nationally certified midwife (CPM, CNM, or CM); or legally recognized in a jurisdiction, province, or state as a practitioner who specializes in maternity care; or a midwife practicing as a primary attendant without supervision for a least 50 out-of-hospital births and a minimum of three years. The preceptor privileges of some midwives have been revoked. It is the student’s responsibility to verify their preceptor’s status by asking their preceptor or contacting NARM.
  2. The clinical components of apprenticeship should include didactic and clinical experience, and the clinical component should be at least one year in duration, which is equivalent to approximately 1350 clinical contact hours under supervision. In the PEP Application, the dates from the first prenatal to the final primary birth should span at least one year, or the applicant should enclose a statement explaining additional clinical experiences that complete the requirement but are not charted on these forms. Additional births may also be reflected on Form 100 under Birth Experience Background.
  3. It is acceptable, even preferable, for the apprentice to study under more than one preceptor. In the event that more than one preceptor is responsible for the training, each preceptor will sign off on those births and skills which were adequately performed under the supervision of that preceptor. Each preceptor must also sign the Preceptor Verification Form 114. The apprentice should make multiple copies of all blank forms so that each preceptor will have a copy to sign.
  4. The preceptor and apprentice should have a clear understanding of the responsibilities of each person to the other, including the time expected to be spent in one-on-one training, classroom or small group study, self-study, clinical observation, opportunities for demonstration of skills, time on call, and financial obligations.
  5. The apprentice, if at all possible, should have the NARM application at the beginning of the apprenticeship, and should have all relevant documentation signed at the time of the experience rather than waiting until the completion of the apprenticeship.
  6. Preceptors are expected to sign the application documentation for the apprentice at the time the skill is performed competently. Determination of “adequate performance” of the skill is at the discretion of the preceptor, and multiple demonstrations of each skill may be necessary. Documentation of attendance and performance at births, prenatals, postpartums, etc., should be signed only if mutually agreed that expectations have been met. Any misunderstanding regarding expectations for satisfactory completion of experience or skills should be discussed and resolved as soon as possible.
  7. The preceptor is expected to provide adequate opportunities for the apprentice to observe clinical skills, to discuss clinical situations away from the clients, to practice clinical skills, and to perform the clinical skills in the capacity of a primary midwife, all while under the direct supervision of the preceptor. This means that the preceptor must be physically present when the apprentice performs the primary midwife skills. The preceptor holds final responsibility for the safety of the client or baby, and should become involved, whenever warranted, in the spirit of positive education and role modeling.
  8. Preceptors who sign off on experiences they did not witness risk losing their ability to sign as a preceptor in the future and also risk losing their NARM certification.
  9. NARM’s definition of the Initial Prenatal Exam includes covering an intake interview, history (medical, gynecological, family) and a complete physical examination. These exams do not have to occur all on the first visit to the midwife, but the apprentice should perform at least 20 of these examinations on one or more early prenatal visits.
  10. Births as an Active Participant (Form 111) are births where the apprentice is being taught to perform the skills of a midwife. Just observing a birth is not considered being an Active Participant. Charting, other skills, providing labor support, and participating in management discussions may all be done in Active Participant births in increasing degrees of responsibility. Catching the baby should be a skill that is taught towards the end of the active participant period, but not counted as a supervised primary. The apprentice should perform some skills at every birth listed on this Form and should be present throughout labor, birth, and the immediate postpartum period. The apprentice must complete most of the active participant births before functioning as Primary Midwife under supervision at births.
  11. Births as Primary Midwife under supervision (Form 112) means that the apprentice demonstrates the ability to perform all aspects of midwifery care to the satisfaction of the preceptor, who is physically present and supervising the apprentice’s performance of skills and decision making.

Guidelines for Verifying Documentation of Clinical Experience

In response to multiple requests for clarification about the role of the Preceptor in the NARM application/certification process, NARM has developed the following step-by-step guidelines based on the instructions set forth in the Candidate Information Bulletin. These guidelines are suggestions for successful completion of the application documentation.

1. The preceptor and applicant together should—

a. review the three (3) separate practice documents required by NARM—Practice Guidelines, Informed Consent, and Emergency Care Plan.

b. review all client charts (or clinical verification forms from a MEAC accredited school) referenced on the NARM Application and confirm that the preceptor and applicant names appear on each chart/form that is being referenced.

c. confirm that the signatures/initials of the applicant are on every chart/form for: initial exam, history and physical exam, complete prenatal exams, labor, birth and immediate postpartum exam, newborn exam, and complete follow-up post partum exams listed on the NARM Application. Be sure the numbers written on the application forms are the same number of signatures/initials on the charts/forms.

d. check all birth dates and dates of all exams for accuracy.

e. check all codes to make sure there are no duplicate code numbers. Each client must have a unique code. If there is more than one birth with any given client, there must be a different code assigned for each subsequent birth.

2. If a preceptor has more than one student (applicant), each chart must have a code that all students will use. Students should not develop different codes for the same client.

3. Preceptors need to be sure their forms show that the student participated as primary under supervision and that the preceptor was present in the room for all items the preceptor signs. For example, the arrival and departure times at the birth should be documented on the chart for both the applicant and the preceptor. At the time of clinical experience, preceptors and students should initial each visit.

4. Applicants should have access to or copies of any charts listed in the application, Form 112a-f and Form 200 with Code # in case of audit.

The Informed Consent document used by the apprentice/student should not indicate that she is a CPM, even if she is in the application process. The CPM designation may not be used until it is earned.

Preceptors who sign off on experiences they did not witness risk losing their ability to sign as a preceptor in the future and also risk losing their NARM certification.