10 Things You Should Know About PEP

[NARMinfo]

In response to both formal and informal requests to have authoritative information from NARM about the Portfolio Evaluation Process (PEP), the NARM Board of Directors has approved the following list of facts regarding this route of education. NARM looks forward to a day when the profession of midwifery unites under the common goal of providing women with access to the provider and setting of their choice for birth. In the meantime, NARM will continue to uphold the principles of evidenced-based standards for academic preparation and clinical practice.

1. Of the more than 5000 births included in the CPM 2000 study published by the British Medical Journal, 99% were attended by midwives who received the CPM credential through the NARM Portfolio Evaluation Process. The excellent results of this study attest to the safety of births attended by PEP prepared CPMs and the significant cost savings of reduced intervention in birth.

2. The majority of CPM candidates continue to become credentialed through NARM’s Portfolio Evaluation Process and all indications are that consumer demand will continue to drive aspiring midwives to seek the apprenticeship, community-based midwifery educational model that PEP validates.

3. The Certified Professional Midwife credential has been evaluated and accredited by the National Commission for Certifying Agencies (NCCA), the same organization that accredits the credentials for the Certified Nurse-Midwife and many other advanced practice nursing credentials. The NCCA is the accrediting arm of the National Organization for Competency Assurance (NOCA).

4. The core content of the education and the required clinical performance of skills has been set by NARM, and is followed by all MEAC-accredited midwifery programs. All educational routes to the CPM must follow the same curriculum, which may be verified through diplomas from accredited midwifery schools, licenses from states with equivalent requirements, or an extensive evaluation of alternative pathways through the Portfolio Evaluation Process. Students from all routes to certification must meet the same educational goals, follow the same curriculum, and pass the same nationally standardized examinations. These are equivalent routes to the same education.

5. The Portfolio Evaluation Process (PEP) is a mechanism for defining and evaluating apprenticeship training that follows a detailed and structured curriculum of 750 topics, and establishes criteria for preceptors who provide both the instruction for didactic education and supervision for the clinical training. The PEP requires documentation of the acquisition of the required knowledge and the supervised performance of the required skills. The PEP application verifies the competent performance, under the direct on-site supervision of the preceptor, of 20 births as an active participant, and, as primary midwife, 20 births, 75 prenatals, 20 newborn exams, and 40 postpartum exams. In addition to preceptor verification, the PEP measures the attainment of knowledge and skills through a hands-on skills assessment and an eight hour written exam.

6. The clinical training for CPM certification must fulfill a minimum of at least one year of preceptor supervised clinical practice, which is equivalent to 1350 hours. The average length of clinical training for PEP prepared CPMs is three to five years.

7. All states that license direct-entry midwives to provide home birth services accept the CPM credential as meeting all or part of their licensure requirements, and all of these states use the NARM exam as the state licensure examination. States with older programs that precede the establishment of the CPM credential may have some state-specific additional requirements, but all states with licensure programs established after 1993 have accepted the CPM credential, including the PEP, as the eligibility criteria for licensure. This saves the state the administrative expense of evaluating varied educational pathways, assures reciprocity with other licensed states, and follows national standards for midwifery education and training.

8. Twenty-five states license direct entry midwives to attend out-of-hospital births using the CPM credential or equivalent. Many programs have been in existence for over 20 years, and no state has sought to terminate the licensure program. This is testimony to the excellence of midwifery care by the Certified Professional Midwife.

9. Since 1993, fifteen states have passed midwifery legislation allowing legal practice. Only one of these states has required a MEAC accredited education. Of the ten states with older legislation, only three require institution-based education. While the issue of educational route is discussed in lobbying talking points at the state level, there is not a trend to limit the PEP route among states that have adopted licensure. Statements against the PEP route to CPM certification are primarily generated by groups who represent economic competition and not from state policy makers or legislators.

10. NARM takes seriously its responsibility to fulfill the demand for an evidence-based model of competency education. The evidence shows that the Portfolio Evaluation Process route to the CPM provides the student midwife with a rigorous clinical and didactic education that promotes the holistic development of essential midwifery skills through individualized instruction in community-based settings.

[Gretchen Spicer]

Thanks for this list. It is great. I wish I had had it when I spoke to a class last week. I will use it often.

[Leslie Payne]

[i]

5. The Portfolio Evaluation Process (PEP) is a mechanism for defining and evaluating apprenticeship training that follows a detailed and structured curriculum of 750 topics, and establishes criteria for preceptors who provide both the instruction for didactic education and supervision for the clinical training. The PEP requires documentation of the acquisition of the required knowledge and the supervised performance of the required skills.

I also appreciate this post. I am pretty nervous, though, about the quote above. Personally as a preceptor, I don't think I can, for many reasons, provide the didactic education piece for my apprentices. My present contract requires her to find that on her own. I can do my best to validate it, but I can't provide it. Is this really a required part of the preceptor job? Honestly, I cannot do it and still practice as well as document her acquisition of skills.

Thanks,

Leslie

[brynnepotter]

Hi Leslie-
When you sign on a PEP applicant's skills verification paperwork you are validating that you have ensured that the student has the knowledge basis necessary to not only perform the skill you have witnessed, but also understands the context for why that skill is being performed. For example, she may show you that she knows how to take an accurate blood pressure but she also needs to demonstrate that she knows what the values mean and appropriate actions to take if the values are abnormal. She may have learned some components of that skill from another preceptor or in another learning environment, but if you are signing off on her paperwork you are the one who is assuring us that she has enough mastery of that skill to be ready to sit for the skills exam and to become an entry-level CPM.

[Sora Colvin]

Kudos to those behind this document and the defense of the PEP process in the petition to ACNM. They are well-crafted and very timely.

[Leslie Payne]

Thanks, Brynne. I had not thought about it that way, but I guess I knew that was what I was doing--and that it is okay for me to make sure she has that competence in the way I see it working best. As such, every apprenticeship will be different, and still complete, which is part of the beauty of this model.

As a new preceptor, I'm looking forward to more documents like this one, which challenge me to be the best preceptor I can be and offer excellent training.

Leslie