Developing an implementation guide for quality assurance of midwifery education - A Delphi study

OBJECTIVE: This study addresses the need for a validated, consensus-based Implementation Guide for internal quality assurance to strengthen midwifery education in Bangladesh. BACKGROUND: Quality in midwifery education is central to safe and effective maternal and newborn care, yet discipline-specific guidelines for internal quality assurance are lacking. To address this, Bangladesh developed a PLAN-DO-STUDY-ACT (PDSA) cycle-based internal quality assurance process with a validated self-assessment tool. AIM: To develop an Implementation Guide for the internal quality assurance process in midwifery education. METHOD: Using the Delphi technique, a Bangladeshi expert panel (n = 28) developed a PDSA-based Implementation Guide for internal quality assurance. Four consultation rounds were conducted: (i) workshops, (ii) iterative design, (iii) structured validation review and (iv) consensus building. FINDINGS: In the first round, an expert panel (n = 20) defined the steps, activities and actions in the PDSA-cycle. In the second round, the panel (n = 22) revised the initial draft by refining the language, strengthening the focus on follow-up, and clarifying accountability and institutional ownership. During third round, a panel of midwifery educators and government officials (n = 6) confirmed that guide demonstrated strong face and content validity and was considered acceptable and applicable for use in midwifery education in Bangladesh. Finally, in the fourth round, the complete Implementation Guide was consolidated through consensus among 22 experts, with consensus ≥85% agreement on all statements among the total 28 participants. KEY CONCLUSIONS: This study produced a validated, consensus-based Implementation Guide offering a practical, context-sensitive approach to strengthening internal quality assurance in midwifery education in Bangladesh, with potential applicability in similar contexts.