discharge talk is limited on ward’QR3-04 Mentor (14%) (12/86) Confidence is affected by students’ experiences with mentors, both the attitude and the practice of mentors affects confidence ‘Mixed advice from mentors’ QR3- 12 ‘Mentor’s attitude’ QR2-17 What are the factors which would improve confidence in ability to give advice? The midwifery students who were participants in this study had firm views on factors which could increase their confidence to give CaSH advice to women. Both questionnaire respondents (67%) (59/86) and focus group participants identified the need for increased knowledge and more education on the topic of CaSH. Questionnaire respondents (19/86) (22%) and focus group participants expressed a desire for patient friendly resources, such as advice leaflets to be available in wards, so that these could be given to women post-natally, supplying advice on contraception and sexual health. Three themes arose strongly from the focus groups. Firstly, they identified the nature of midwifery as a practical activity and the need therefore for their learning to be practical and practice based, in order to increase their confidence in this role. Secondly, they identified the important role of the mentor in allowing confidence to be developed by observing good practice. Finally, they were very aware of the many constraints within which they would be working as a registered midwife, and that time was a major constraint. Despite this there was strong agreement that giving CaSH advice was part of the midwife’s role. WALKER & DAVIS: LEARNING AT WORK AND UNIVERSITY: MIDWIFERY STUDENTS AND SEXUAL HEALTH ADVICE 69 Table 2. Factors reported in questionnaire which would improve confidence in giving sexual health advice (Q7). Theme (Percentage of questionnaire respondents reporting this theme) Elements of the theme Examples from free text in questionnaires Greater knowledge or more training (67%) (59/86) More in depth training More revision and updating Education in CaSH to be spread throughout 3 year curriculum ‘Regular lessons in small chunks. Perhaps a workbook in Year 1 so we do individual work on it’ (QR1-01) ‘Further advice and training in our 3rd year to keep us up to date’ (QR2-07) ‘Further, repeated up to date training. Regular updates and info. on new products and changes to existing products AND to be able to see the contraceptive devices’ QR3-05 ‘A more detailed module incorporating contraception and sexual health. It is a major public health need that is briefly taught within midwifery’ QR2-24 Time constraints (47%) (40/86) Time in practice to give CaSH advice is limited. Time learning about CaSH is limited. ‘Having more time to fully discuss this in practice’ QR2-04 Midwifery is practical, learning needs to be practical and practice based. (12%) (10/86) Include practical elements of CaSH in all stages of the programme of study. Seeing CaSH advice given in practice. ‘Being involved in this kind of discussion with women regularly, encouraging updating knowledge and observing others' practice’ QR2-41 ‘Education from a sexual health expert. Being given communication skills to raise the subject’ QR2-26 The mentor plays an important role in developing confidence (7%) (6/86) More experience needed of mentors providing CaSH. . ‘Updates providing mentors and students with the right up to date knowledge’ QR1-10 ‘Midwives discussing it in practice’ (QR2- 01) ‘Good mentors’ QR1-11 More detail of these findings, derived from the focus group data, is provided below. Practical learning The value midwifery students placed on ‘practical learning’ was expressed with regard to a number of issues. Students wanted a practical element to be included in WALKER & DAVIS: LEARNING AT WORK AND UNIVERSITY: MIDWIFERY STUDENTS AND SEXUAL HEALTH ADVICE 70 their CaSH education at all stages, and felt that the emphasis on theoretical knowledge delivered by a lecture was not helpful. ‘midwifery is a practical role and I would say the majority of us learn by doing or practising so I don’t think the way the content is delivered (for whole curriculum) necessarily matches the course’ (FG1). Practice placements were valued for their ability to reinforce theoretical learning and allow the application of knowledge. Participants remarked that mentors did not always place much emphasis on CaSH and so they missed an opportunity to see advice being given in the community: ‘The way you can learn from it is by continuous going out in practice and because if you’re working alongside a midwife and they’re not really practicing that way you lose it’ (FG1). ‘Some midwives go into quite a lot of detail about contraception but then others just sort of skim over it’ (FG2). Due to the difficulties the participants experienced in raising the topic of CaSH within their own practice, they wanted role play and practice based scenarios to be included in their undergraduate learning, to allow them first to observe and then to practice the communication skills necessary for such a sensitive topic and to think about different scenarios. The students had especial difficulty in raising the subject of sexually transmitted infections. ‘I think it’s just really difficult to bring up the subject of sexual health with someone who’s pregnant, because obviously you know they’ve had unprotected sex to get pregnant, and I think that’s, you know,