Objective: To evaluate the effectiveness of a work-based module and in-service educational programme in perineal repair for midwives on their perceived level of competency undertaking this skill in clinical practice. Design: a quasi-experimental pre-post intervention case study combining a non-equivalent comparison group and evaluation action research. Setting: six NHS consultant/midwifery led Trusts in South East England between December 2002 and 2006. Participants: 145 midwives from six NHS Trusts. Interventions: a post-registration work-based module in perineal repair for midwives and alternative two hour in-service perineal repair workshops across five intervention Trusts. Main outcome measures: midwives' perceived level of competency and confidence undertaking perineal repair. Main findings: significantly greater numbers of midwives were able to practice perineal repair at higher levels of competency following an educational intervention in five intervention Trusts (P<.006). There was a non-significant difference in the comparison Trust (P<.535). In addition, an educational programme for midwives increased the numbers of senior student midwives who were able to participate in perineal repair confidently under the direct supervision of their mentor when they perceived that their mentor was confident and competent undertaking the procedure. Key conclusions: an educational programme in perineal repair can make a significant difference to the midwives' perceived level of competency and confidence when assessing and managing perineal trauma and repair. Implications for practice: competency and expertise are complex phenomena and the data has provided greater insight into the complex nature of workplace learning alongside the multiple factors influencing clinical decision-making such as staff shortage, time constraints and inadequate numbers of midwives who are able to instruct, supervise and assess competency in perineal repair. Funding for training is fundamental for the sustainability of future practice development. © 2011 Elsevier Ltd.
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