Midwifery Core Competency Assessment Tool: A Systematic Review Protocol

Background: In recent years, the capacity building of midwives has attracted the attention of all countries in the world, especially in countries with a lack of midwifery human resources. Improving the capacity of midwives is an important strategy to ensure the health of mothers and infants.Professional associations in many countries have issued standards for midwife competency, which are basically similar to the core competency module proposed by ICM, but some countries have made localization adjustments according to their own characteristics. In August 2019 a further update was made to correct an error in competency of the English version,the French and Spanish versions by ICM.In order to further standardize the evaluation tools of midwives' core competence, it is urgent to evaluate them. Methods/Design: We will conduct a systematic review and utility critique of instruments used to measure effectiveness of core competence assessment tools for midwives at different levels. The databases Medical Literature Analysis and Retrieval System Online(MEDLINE), Cumulative Index to midwife competency and Web of Knowledge will be searched from inception until end November 2020. Search strategies will include the key words; midwife, core competency ,questionnaires, instruments, delphi technique, index system, reliability, validity. We will contact experts in the eld of measuring core competency and scrutinise all secondary references. A reviewer will apply an inclusion criteria scale to all titles and abstracts. A second reviewer will apply the inclusion criteria scale to a random 10% selection. Two reviewers will independently evaluate the methodological rigour of the testing of the instruments using the Consensus-based Standards for the selection of core competency checklist. We will present a narrative synthesis on the utility of all instruments and make recommendations for instrument selection in practice. Discussion: This systematic review of the utility of instruments to measure the core competence assessment tools for midwives at different levels. It will aid managers ,educator and policy makers to select an instrument t for purpose. Importantly, appropriate instrument selection will provide a mechanism for effective training of midwives' core competency ability in different levels.


Abstract
Background: In recent years, the capacity building of midwives has attracted the attention of all countries in the world, especially in countries with a lack of midwifery human resources. Improving the capacity of midwives is an important strategy to ensure the health of mothers and infants.Professional associations in many countries have issued standards for midwife competency, which are basically similar to the core competency module proposed by ICM, but some countries have made localization adjustments according to their own characteristics. In August 2019 a further update was made to correct an error in competency of the English version,the French and Spanish versions by ICM.In order to further standardize the evaluation tools of midwives' core competence, it is urgent to evaluate them.
Methods/Design: We will conduct a systematic review and utility critique of instruments used to measure effectiveness of core competence assessment tools for midwives at different levels. The databases Medical Literature Analysis and Retrieval System Online(MEDLINE), Cumulative Index to midwife competency and Web of Knowledge will be searched from inception until end November 2020. Search strategies will include the key words; midwife, core competency ,questionnaires, instruments, delphi technique, index system, reliability, validity. We will contact experts in the eld of measuring core competency and scrutinise all secondary references. A reviewer will apply an inclusion criteria scale to all titles and abstracts. A second reviewer will apply the inclusion criteria scale to a random 10% selection.
Two reviewers will independently evaluate the methodological rigour of the testing of the instruments using the Consensus-based Standards for the selection of core competency checklist. We will present a narrative synthesis on the utility of all instruments and make recommendations for instrument selection in practice.
Discussion: This systematic review of the utility of instruments to measure the core competence assessment tools for midwives at different levels. It will aid managers ,educator and policy makers to select an instrument t for purpose. Importantly, appropriate instrument selection will provide a mechanism for effective training of midwives' core competency ability in different levels.

Background
The core competence of midwives is de ned as "in midwifery practice and education, midwives can be competent for the combination of skilled and accurate knowledge, professional behavior and speci c Council NMC issued the "core competency standard for registered midwives" in September 2010 [7,8]. In 2011, Wang Dehui developed China's "midwife core competency table" [9].
As one of the three pillars of developing midwifery specialty and providing high-quality maternal and infant health services, midwifery education plays an extremely important role. According to the state of midwifery report 2014, investment in midwifery education can receive up to 16 times of investment return [10]. in recent years, the capacity building of midwives has attracted the attention of all countries in the world, especially in countries with a lack of midwifery human resources. Improving the capacity of midwives is an important strategy to ensure the health of mothers and infants.Professional associations in many countries have issued standards for midwife competency, which are basically similar to the core competency module proposed by ICM, but some countries have made localization adjustments according to their own characteristics. In August 2019 a further update was made to correct an error in competency of the English version,the French and Spanish versions by ICM [11].In order to further standardize the evaluation tools of midwives' core competence, it is urgent to evaluate them.
Therefore, on the one hand,this study attempts to explore the main content of the midwife core competency evaluation tool from the perspective of system evaluation, in order to provide reference for the revision of the midwife core competency standard. on the other hand,the purpose of this study is to nd the best recommended guidance for the evaluation tools of midwife core competence, and to provide a scienti c method for the evaluation of the results of clinical midwife educators and midwives core competence.

Research Question
What are the best assessment tools for core competencies of midwives at different levels?
What are the reliability and validity of these assessment tools?
Whether these assessment tools are also suitable for the core competency guide for midwives revised by ICM in 2019?

Aims
To nd out the best evaluation tool for different levels of midwives' core competence.
To evaluate the reliability and validity of these evaluation tools.
To assess the consistency of these assessment tools with the revised midwife core competency guidelines of the International Federation of midwives 2019.

Methods/design
Types of outcomes This review will consider studies that investigated the core competency index and content of midwives (junior and senior) and midwives students were involved, and the best assessment tool for core competence of midwives at different levels was found, rather than involving midwives training program or midwife nursing education literature analysis.

Inclusion criteria
Used a qualitative method, quantitative method, or mixed method of data collection and analysis.
Study must be the primary research studies.
Studies must be published in English or Chinese (because we have access to Chinese investigators but not other languages, and we do not have funds to access interpreter services).
It involves the core competency indicators and contents of midwives (junior, senior) and midwives.
These documents were published from January 2002 to December 2020. These documents were published from January 2002 to December 2020.

Exclusion criteria
Studies are systematic reviews, opinion pieces, editorials, commends or letters should be excluded.
Study does not include the core competency indicators which should be excluded. non midwives and non midwives students Study should be excluded.
other contents related to midwife training program or midwife nursing education literature analysis.
Use one-dimensional assessment tools.
Lack of reliability and validity of evaluation tools.

Search strategy
A three-step search strategy will be utilized in this review. An initial limited search of Medline was undertaken including the terms derived from the "PICO" in Table 1 with the aim of identifying indexed terms from relevant titles and abstracts to re ne the search strategy. A comprehensive search using all identi ed keywords and indexed terms will then be undertaken across all included databases (Medline, EMBASE, PsycINFO, CINAHL, Chinese CNKI) from 2002 to today. Thirdly, a hand-search of the reference lists of all relevant articles will be conducted to identify additional studies that may not have been identi ed through the databases searches. The search for grey literature will include: ProQuest Dissertations and Theses, relevant organizations' websites. Search results will be exported from each databases into an Endnote Library where duplicates will be identi ed and removed. From Endnote, references will be exported to the systematic review management software program Covidence. Title and abstract screening, full text screening and quality appraisal will be managed in Coindence. An MS Excel worksheet will be used to store and manage extracted data.
Assessment of methodological quality Paper selected for retrieval will be assessed by two independent reviews for methodological validity prior to inclusion in the review. Standardized critical appraisal instruments appropriate to the study design from the JBI Reviewer's Manual will be used and the procedures for critical appraisal outline in the manual will be followed. The JBI Reviewer's Manual includes tools to assess various quantitative and qualitative study designs. Any disagreement that arise between the reviewers will be resolved with a third reviewer.
Data extraction Data will be extracted from papers selected for inclusion using customized versions of the data extraction tools for qualitative, quantitative studies from the JBI Reviewers Manual. Data extraction will be completed independently by two reviewers. A third reviewer will independently perform data extraction in the event that there are discrepancies in the data extracted by the initial two reviewers.

Data synthesis
We will use a mixed methods approach to synthesize qualitative and quantitative data. In the rst phase, we will extract qualitative data from qualitative, quantitative, and mixed methods studies. We will use thematic analysis to identify relevant themes related to assessment tools for core competence of midwives at different levels.

Conclusions
This systematic review of the utility of instruments to measure the core competence assessment tools for midwives at different levels. It will aid managers, educator and policy makers to select an instrument t for purpose. Importantly, appropriate instrument selection will provide a mechanism for effective training of midwives' core competency ability in different levels.

Consent for publication
Not applicable.
Availability of data and materials Not applicable.