Educational Evaluation of Curriculum–Assessment Alignment of Ethical Competencies in Midwifery Education: A Mixed-Methods Study

Abstract

Purpose

This study evaluated curriculum–assessment alignment of ethical competencies in a midwifery program and identified gaps among the intended, enacted, and assessed curriculum components.

Methods

A convergent parallel mixed-methods design was employed at an Indonesian health polytechnic. Quantitative data were collected from 72 diploma midwifery students using a 20-item Likert-scale questionnaire assessing integration of ethical competencies across learning materials, instructional processes, clinical case analysis, and professional competence domains. Descriptive statistics, including means and 95% confidence intervals (CIs), were calculated using IBM SPSS Statistics ver. 26.0 (IBM Corp., Armonk, NY, USA). Qualitative data were obtained through document review (syllabi, semester learning plans, modules), classroom observations (n=4), and semi-structured interviews with lecturers (n=6) and students (n=8). Thematic analysis was conducted, and findings were integrated using a joint alignment matrix. Institutional Review Board approval was obtained (No. 012/KEPK-Poltekkes/2024).

Results

Alignment was strongest at the instructional level (mean, 3.86; 95% CI, 3.72–4.00) and moderate in written curriculum documents (mean, 3.20; 95% CI, 3.05–3.35). The lowest alignment was observed in clinical case analysis and assessed competencies (mean, 3.08; 95% CI, 2.91–3.25), indicating limited structured integration of ethical reasoning within assessment practices. Document analysis revealed minimal explicit ethical indicators in learning outcomes and grading rubrics. Qualitative findings confirmed instructor-dependent implementation and inconsistent assessment alignment.

Conclusion

Ethical competencies were present in classroom instruction but insufficiently embedded within curriculum documents and assessment systems. Strengthening curriculum–assessment alignment through explicit competency indicators and structured evaluation models may enhance sustainable integration in midwifery education.