The impact of competency-based education on cognitive improvement and clinical skills in midwifery students
DOI:
https://doi.org/10.17509/curricula.v5i3.742Keywords:
clinical skills, cognitive development, competency-based education, midwifery studentsAbstract
Midwifery education is increasingly shifting toward the implementation of Competency-Based Education (CBE), a transformative approach aimed at producing graduates with robust clinical and cognitive competencies by emphasizing measurable outcomes across cognitive, psychomotor, and affective domains. Understanding how the CBE model is implemented and the outcomes it yields is crucial for informing curriculum design, faculty development, and institutional readiness. This article aims to evaluate the impact of CBE on enhancing the clinical skills and cognitive development of midwifery students. A literature search was conducted across PubMed, Google Scholar, Scopus, and ScienceDirect databases using Boolean operators for keywords related to CBE and midwifery education. Studies were selected using the PRISMA method based on specific inclusion criteria, resulting in the identification of 13 relevant studies published between 2021 and 2026. The analysis indicates that CBE significantly improves students' clinical procedural skills, critical thinking abilities, and decision-making capabilities. Simulation-based approaches, problem-based learning, and structured assessments proved effective in supporting competency attainment. However, implementation barriers—such as resource limitations, a lack of faculty training, and institutional resistance—remain prevalent, particularly in resource-limited settings. CBE contributes positively to the development of clinical and cognitive competencies among midwifery students.
References
Açıkgöz, T., & Babadoğan, M. C. (2021). Competency-based education: Theory and practice. Psycho-Educational Research Reviews, 3(3), 67-95.
Aker, S., & Kartal, Y. A. (2026). Effect of simulation-based postpartum hemorrhage management on midwifery students’ skill levels: A randomized controlled trial. Clinical Simulation in Nursing, 114(1), 1-10.
Alemu, F. M., Yimer, N. B., Kasegn, B. B., Kassie, B. A., Ibrahim, I. Y., Abdo, A. A., & Worke, M. D. (2023). Effectiveness of simulation-based cesarean section education on improving non-physician clinician midwife’s competency in performing cesarean section in Ethiopia: A quasi-experimental study. BMC Medical Education, 23(1), 1-12.
Alharbi, A., Nurfianti, A., Mullen, R. F., McClure, J. D., & Miller, W. H. (2024). The effectiveness of Simulation-Based Learning (SBL) on students’ knowledge and skills in nursing programs: A systematic review. BMC Medical Education, 24(1), 1-21.
Arundell, F., Sheehan, A., & Peters, K. (2024). Strategies used by midwives to enhance knowledge and skill development in midwifery students: An appreciative inquiry study. BMC Nursing, 23(1), 1-10.
Balding, K., Geraghty, S., Pezaro, S., McChlery, S., & Timler, A. (2026). “Learning to sip tea intelligently”: A phenomenographic exploration of midwifery students’ perceptions of emotional intelligence and its relationship to midwifery. Women and Birth, 39(2), 1-11.
Chakraborty, S., Saggurti, N., Adanu, R., Bandoh, D. A., Berrueta, M., Gausman, J., ... & Rima Jolivet, R. (2023). Validating midwifery professionals’ scope of practice and competency: A multi-country study comparing national data to international standards. Plos One, 18(5), 1-27.
Cornell, P., Godwin, H., Thomson, B., Vacarro, M., Costins, P., Simms, G., & Kuliukas, L. J. (2026). A qualitative descriptive study exploring student experiences of video-recorded clinical skills assessments. Next Research, 8(1), 1-6.
Davitadze, M., Ooi, E., Ng, C. Y., Zhou, D., Thomas, L., Hanania, T., ... & Kempegowda, P. (2022). SIMBA: Using Kolb’s learning theory in simulation-based learning to improve participants’ confidence. BMC Medical Education, 22(1), 1-11.
Davoodi, A., Zamanzadeh, V., Ghahramanian, A., Onyeka, T. C., & Jabbarzadeh, F. (2022). Impact of integrated teaching-learning method on oncology clinical decision-making ability and cognitive learning of nursing students. BMC Medical Education, 22(1), 1-8.
Firoozehchian, F., Zareiyan, A., Geranmayeh, M., & Behboodi Moghadam, Z. (2022). Domains of competence in midwifery students: A basis for developing a competence assessment tool for Iranian undergraduate midwifery students. BMC Medical Education, 22(1), 1-15.
Gebrekidan, F. C., Aweke, A. M., Gella, G. B., & Bekele, Y. A. (2024). Midwifery students’ satisfaction with simulation-based education and associated factors among governmental universities in Amhara Region, Ethiopia 2022. BMC Medical Education, 24(1), 1-10.
Ghodsi Astan, P., Goli, R., Hemmati Maslakpak, M., Rasouli, J., & Alilu, L. (2022). The effect of evidence‐based nursing education on nurses' clinical decision making: A randomized controlled trial. Health Science Reports, 5(5), 1-8.
Gholamian, S., Alidousti, K., Zolala, S., & Sabzevari, S. (2022). The effect of implementing the competency-based education model on the clinical skills among midwifery students. Strides in Development of Medical Education, 19(1), 91-100.
Hakimi, M., Kheirkhah, M., Abolghasemi, J., & Hakimi, R. (2021a). Investigating the effect of neonatal resuscitation simulation using a competency‑based approach on knowledge, skill, and self-confidence of midwifery students using Objective Structured Clinical Examination (OSCE). Journal of Family Medicine and Primary Care, 10(4), 1766–1772.
Hakimi, M., Kheirkhah, M., Abolghasemi, J., & Hakimi, R. (2021b). The effects of competency-based education on midwifery students’ knowledge, skills, and self-confidence for postpartum hemorrhage management. Nursing and Midwifery Studies, 10(3), 137–144.
Higgins, M., Madan, C. R., & Patel, R. (2021). Deliberate practice in simulation-based surgical skills training: A scoping review. Journal of Surgical Education, 78(4), 1328-1339.
Ige, W. B., Ngcobo, W. B., & Afolabi, O. (2023). Implementation of competency-based education for quality midwifery programs in Africa: Protocol for a scoping review. JMIR research protocols, 12(1), 1-6.
Imanipour, M., Ebadi, A., Monadi Ziarat, H., & Mohammadi, M. M. (2022). The effect of competency‐based education on clinical performance of health care providers: A systematic review and meta‐analysis. International Journal of Nursing Practice, 28(1), 1-18.
Jiang, G., & Hou, L. (2026). Enhancing professional outcome in nursing and midwifery: A systematic review of competency-based education’s impact on performance, self-confidence and anxiety reduction. Advances in Clinical and Experimental Medicine, 35(2), 333-342.
Kaya, İ. G., & Zengin, N. (2026). The effect of scenario-based high-fidelity simulation on midwifery students’ knowledge and self-efficacy in electronic fetal monitoring: A randomized controlled trial. Clinical Simulation in Nursing, 113(1), 1-10.
Lomis, K. D., Mejicano, G. C., Caverzagie, K. J., Monrad, S. U., Pusic, M., & Hauer, K. E. (2021). The critical role of infrastructure and organizational culture in implementing competency-based education and individualized pathways in undergraduate medical education. Medical Teacher, 43(sup2), 7-16.
Malya, R. M., Urstad, K. H., Bø, B., Mahande, M. J., & Rogathi, J. (2025). Simulation-based education on initial neonatal care knowledge among nursing and midwifery students in Tanzania: Quasi experimental study. International Journal of Africa Nursing Sciences, 22(1), 1-8.
Muraraneza, C., & Mtshali, G. N. (2021). Planning reform to competency based curricula in undergraduate nursing and midwifery education: A qualitative study. Nurse Education Today, 106(1), 1-6.
Nagai, M., Oikawa, M., Komagata, T., Basuana, J. D. B., Ulyabo, G. K., Minagawa, Y., ... & Tamura, T. (2024). Clinical competency of nurses trained in competency-based versus objective-based education in the Democratic Republic of the Congo: A qualitative study. Human Resources for Health, 22(1), 1-9.
Niu, Y., Yang, J., Wang, G., Zeng, T., Chen, C., Luo, L., & Wang, L. (2026). Resilience profiles and disaster preparedness in nursing and midwifery students: Linking educational preferences and behavioral intentions. Progress in Disaster Science, 30(1), 1-10.
Nove, A., Ten Hoope-Bender, P., Boyce, M., Bar-Zeev, S., de Bernis, L., Lal, G., ... & Homer, C. S. (2021). The state of the world’s midwifery 2021 report: Findings to drive global policy and practice. Human Resources for Health, 19(1), 1-7.
Pangerl, S., Ross-Adjie, G., Geraghty, S., & Monterosso, L. (2026). Is breastfeeding education in midwifery programs sufficient to equip future midwives? Phase 1: A curriculum mapping study. Midwifery, 154(1), 1-10.
Pfund, A., Abderhalden-Zellweger, A., Tawfik, A., & de Labrusse, C. (2026). Practice of midwifery competencies in Switzerland: Frequency and influencing factors from a national cross-sectional survey with qualitative analysis of open-ended questions. Nurse Education in Practice, 1(1), 1-10.
Podder, L., Bhardwaj, G., Saptarshi, A., Devi, S., Patel, S., & Dimple, K. (2025). Revitalizing midwifery education: Overcoming challenges and enhancing clinical learning experiences. Journal of Education and Health Promotion, 14(1), 1-14.
Ramanathan, R., Shanmugam, J., Gopalakrishnan, S. M., Palanisamy, K. T., Narayanan, S., Sridhar, M. G., & Palanisamy, K. (2022). Challenges in the implementation of competency-based medical curriculum: Perspectives of prospective academicians. Cureus, 14(12), 1-8.
Ruwayda, R., & Hastono, S. P. (2024). Midwifery leadership competenceto improving maternal and child healthservices: A scoping review. The International Conference on Public Health Proceeding, 9(1), 197-212.
Sirisomboon, R., Nuampa, S., Leetheeragul, J., Sudphet, M., Pimol, K., Sirithepmontree, S., & Silavong, L. (2024). Enhancing the competencies of obstetrical nurses and midwives in high-risk pregnancy management through simulation-based training in Lao people's democratic republic: A pilot study. Midwifery, 137(1), 1-7.
Son, H. K. (2023). Effects of simulation with problem-based learning (S-PBL) on nursing students’ clinical reasoning ability: Based on Tanner’s clinical judgment model. BMC Medical Education, 23(1), 1-10.
Tu, L., Wu, H., Xia, X., Zhu, X., Mei, B., Zhang, Y., ... & Yang, Y. (2026). Effects of standards of best practice in simulation-based training among midwifery students in China. BMC Medical Education, 26(1), 1-12.
Ulfa, Y., Igarashi, Y., Takahata, K., Shishido, E., & Horiuchi, S. (2021). A comparison of team-based learning and lecture-based learning on clinical reasoning and classroom engagement: a cluster randomized controlled trial. BMC Medical Education, 21(1), 1-11.
Wisesa, M., & Susanti, A. I. (2025). The future of midwifery education: Student-centered learning and digital technology. Curricula: Journal of Curriculum Development, 4(1), 581-594.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Annisa Karima Harda, Josi Noviani, Cindy Maharani Putri, Ari Indra Susanti

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.



