Preceptorship and critical thinking among undergraduate midwifery students: Mediating role of the clinical learning environment.
AIM To identify predictors of critical thinking among Chinese undergraduate midwifery students and examine the extent to which the clinical learning environment mediates the association between preceptorship and students' critical thinking. BACKGROUND Critical thinking is a core competency for safe, woman-centred midwifery practice and a key global educational goal. However, little is known about links between preceptorship, the clinical learning environment and critical thinking especially in non-Western contexts. DESIGN This multi-centre cross-sectional study recruited 654 undergraduate midwifery students from 10 universities in mainland China. METHODS The online self-report survey included translated versions of the Midwifery Student Evaluation of Practice (MidSTEP) and student version of the Carter Assessment of Critical Thinking in Midwifery (CACTiM). Statistical analyses included bivariate tests, stepwise linear regression and mediation analysis using SPSS PROCESS (Model 4). RESULTS Five significant predictors of critical thinking were identified: passion for the midwifery profession, opting for a midwifery major, facilitating > 5 births, smaller clinical group size and no exposure to disrespectful maternity care. Critical thinking was positively correlated with both the clinical learning environment and preceptorship, with the clinical learning environment fully mediating the association between preceptorship and critical thinking. CONCLUSIONS Our findings extend an existing conceptual model of midwifery critical thinking by establishing the effect of the clinical learning environment. This finding supports the development of quantifiable clinical placement benchmarks and provides an evidence base for targeted educational reform in undergraduate midwifery programs to foster critical thinking competencies for safe, woman-centred maternity care.