a bit difficult to bring up’ (FG1). ‘Scenarios would be good. Then you start thinking about how you would actually deal with a situation’ (FG1). ‘Being given communication skills to raise the subject” (would increase confidence) (QR2-26). ‘The ‘how to’ is kind of left up to your mentors, isn’t it, when you’re looking at…going out on your placements[...] you’re doing as she does and if you’re not getting it from there, then you’re not getting it from anywhere’ (FG3). ‘Whereas with other topics we’re taught how to sensitively discuss it with the parents, I don’t think with sexual health and contraception, it’s kind of like ‘Here’s the facts, off you go’ (FG1). WALKER & DAVIS: LEARNING AT WORK AND UNIVERSITY: MIDWIFERY STUDENTS AND SEXUAL HEALTH ADVICE 71 ‘As a nineteen year old asking a thirty eight year old about their sexual health, talking to them about contraception. It’s a bit weird really’ (FG1). While some role play and case based work is incorporated into the undergraduate curriculum, the participants in this study wanted much more. This reinforces the need for the university based element of the programme to be based in ‘real life’ examples, and to make the student consider practical and theoretical elements together, and for these ‘real life’ examples to be broadened so that they take account of the fact that participants did not consider that they were receiving sufficient experience in practice. Within the theme of ‘practical learning’, participants identified that those who had experienced a placement in a CaSH clinic had been able to observe professionals raising and addressing CaSH topics in their everyday practice. The participants considered that all midwifery students should experience such a placement, as it would provide practical experience of how to raise issues and discuss them: ‘I couldn’t feel comfortable just going up to someone and going let’s talk about your sexual health. So seeing it in context how other people talk about it’ (FG1). ‘I think a placement in a family planning clinic would be really valuable […] (to learn) how to address it, and how to discuss each method and seeing it in practice from someone who is a professional in that field’ (FG3). Placements are a significant challenge for many health professional courses, but the value which could be gained from even a short (two week) placement where the midwifery student could observe CaSH advice being given would appear to be very valuable for enabling learning in the student midwives. Finally, within the general theme of ‘practical learning’ the participants stated that CaSH was not assessed through their practice portfolios, and hence did not have the status of some of the other elements of midwifery practice. The need to ensure practice to follow up theoretical learning was reduced: ‘A lot of our skills and a lot of our midwifery outcomes are validated and signed off but we don’t have one for sexual health or contraception’ (FG1). The importance of mentors The second theme arising from the data regarding factors which would increase the student midwife’s confidence to give CaSH advice was in relation to the mentorship the student received in placements. Participants stated that many mentors did not routinely give advice in this field. Although it is a requirement on discharge that contraception is addressed, participants identified that in many cases mentors saw this as a ‘tick box ‘ exercise or limited to the giving of very general facts on fertility and advising women to see the GP: WALKER & DAVIS: LEARNING AT WORK AND UNIVERSITY: MIDWIFERY STUDENTS AND SEXUAL HEALTH ADVICE 72 ‘A lot of the midwives don’t feel confident in their knowledge of contraception. And therefore feel like their duty of care it’s better to say: here’s a leaflet, go and see your GP’ (FG1). ‘There is a note in the…discharge note and it says ‘contraception discussed’ and you just tick it, and then it says ‘form of method chosen’ and then a lot of people just write ‘discuss with GP at 6 week check’ (FG3). ‘Do the midwives we work with know that much? I don’t know that they do so they don’t offer information. They’re not confident in it themselves […] I think it’s always glazed over and they’re told to see their GP in 6 weeks’ (FG3). Students felt that the mentors themselves needed updating in CaSH in order to feel confident, and that continuing professional development or further training in the topic of contraception and sexual health would be appropriate for qualified midwives: ‘You do hear mentors saying ‘well you’re more up to date than me’ and ‘we learn stuff off you all the time’ (FG3). ‘ would do an extra course (in CaSH methods including implant insertion) once I was a qualified midwife, and I think a lot of midwives would be happy to do something like that’ (FG2). ‘For qualified midwives, they do annual updates, even just half an hour, you know ‘this is what’s new (in contraception). It just keeps you updated’ (FG2). There was huge variability in the students’ experience of CaSH due to the variability of their practice placements and mentors’ attitudes. It is important to note here that the participants were not criticising the mentors per se, they were identifying the pressures under which the mentors were working, and clearly identifying the lack of information available to the qualified midwife to support this aspect of their role. Lack of time in the curriculum and in