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Around 60% of individuals with neurodevelopmental disorders (NDD) remain undiagnosed after comprehensive genetic testing, primarily of protein-coding genes1. Large genome-sequenced cohorts are improving our ability to discover new diagnoses in the non-coding genome. Here we identify the non-coding RNA RNU4-2 as a syndromic NDD gene. RNU4-2 encodes the U4 small nuclear RNA (snRNA), which is a critical component of the U4/U6.U5 tri-snRNP complex of the major spliceosome2. We identify an 18 base pair region of RNU4-2 mapping to two structural elements in the U4/U6 snRNA duplex (the T-loop and stem III) that is severely depleted of variation in the general population, but in which we identify heterozygous variants in 115 individuals with NDD. Most individuals (77.4%) have the same highly recurrent single base insertion (n.64_65insT). In 54 individuals in whom it could be determined, the de novo variants were all on the maternal allele. We demonstrate that RNU4-2 is highly expressed in the developing human brain, in contrast to RNU4-1 and other U4 homologues. Using RNA sequencing, we show how 5 splice-site use is systematically disrupted in individuals with RNU4-2 variants, consistent with the known role of this region during spliceosome activation. Finally, we estimate that variants in this 18 base pair region explain 0.4% of individuals with NDD. This work underscores the importance of non-coding genes in rare disorders and will provide a diagnosis to thousands of individuals with NDD worldwide.

The literature on play and learning attests many developmental benefits for children. The Australian curriculum endorses play-based learning (PBL) as an age-appropriate teaching pedagogy. However, what enables or prevents PBL in the classroom is not well documented. The present study examined the responses of 334 teachers currently employed in Queensland Primary schools (Prep-6) in order to investigate knowledge, practices, beliefs, confidence and perspectives on matters pertaining to PBL. Findings highlighted organisational issues (space, time, resources), lack of support from leadership and curriculum issues such as assessment and reporting as barriers to PBL. Qualifications and/or experience in Early Childhood Education (ECE) resulted in greater confidence in PBL and therefore enabled PBL. Overall teachers recognised the importance of PBL, that it benefited children right across the primary school grades (Prep-6) and that there should be more PBL than what there is currently. Recommendations based on these findings have been suggested.

Internationally and in Australia, there is growing evidence that graduate teachers feel under prepared to teach diverse groups of children. This study, using a social lab and drawing on theories from Archer and Foucault examined Australian teacher educators' views on knowledge about diversity and the enabling and constraining factors that influenced their teaching around diversity in their universities. Eleven discourses emerged, revealing knowledge associated with teaching "about" and "to" diversity, rather than teaching "for" diversity. The authors argue that all three facets are necessary for thorough preparation of preservice teachers for today's diverse classrooms.

We report the labor market effects of the Jamaica Early Childhood Stimulation intervention at age 31. The study is a small-sample randomized early childhood education stimulation intervention targeting stunted children living in the poor neighborhoods of Kingston, Jamaica. Implemented in 1987-1989, treatment consisted of a two-year home-based intervention designed to improve nutrition and the quality of mother-child interactions to foster cognitive, language and psycho-social skills. The original sample is 127 stunted children between 9 and 24 months old. Our study is able to track and interview 75% of the original sample 30 years after the intervention, both still living in Jamaica and migrated abroad. We find large and statistically significant effects on income and schooling; the treatment group had 43% higher hourly wages and 37% higher earnings than the control group. This is a substantial increase over the treatment effect estimated for age 22 where we observed a 25% increase in earnings.

Using data from a national sample of parent and family educators in the US (n = 697), this comparative study examines professionals' practices and technology-related attitudes, skill and workplace conditions. Overall, professionals report positive attitudes about the value of using technology in practice and view themselves as proficient. They most frequently use technologies like the email and document preparation software, and less frequently social media and even virtual reality. Workplace resources vary significantly, educators are not motivated by employer expectations and most report self-training as more valuable than formal sources. Mean comparisons by family educator type validate differences by context. Parenting educators, occasional family educators (e.g., teachers, counselors) and Family Life Educators vary from those in Higher Education/Administration. Those in Higher Education/Administration have more technology resources, report more positive attitudes, are more confident about their skills, and view formal technology training as useful. Conclusions suggest the need for the field of parent and family education to join other educational professions (e.g., licensed classroom teachers) to embrace technology use as a critical competency and advocate for the necessary resources in the preparation and ongoing service training of professionals.

Truncating variants in exons 33 and 34 of the SNF2-related CREBBP activator protein (SRCAP) gene cause the neurodevelopmental disorder (NDD) Floating-Harbor syndrome (FLHS), characterized by short stature, speech delay, and facial dysmorphism. Here, we present a cohort of 33 individuals with clinical features distinct from FLHS and truncating (mostly de novo) SRCAP variants either proximal (n = 28) or distal (n = 5) to the FLHS locus. Detailed clinical characterization of the proximal SRCAP individuals identified shared characteristics: developmental delay with or without intellectual disability, behavioral and psychiatric problems, non-specific facial features, musculoskeletal issues, and hypotonia. Because FLHS is known to be associated with a unique set of DNA methylation (DNAm) changes in blood, a DNAm signature, we investigated whether there was a distinct signature associated with our affected individuals. A machine-learning model, based on the FLHS DNAm signature, negatively classified all our tested subjects. Comparing proximal variants with typically developing controls, we identified a DNAm signature distinct from the FLHS signature. Based on the DNAm and clinical data, we refer to the condition as "non-FLHS SRCAP-related NDD." All five distal variants classified negatively using the FLHS DNAm model while two classified positively using the proximal model. This suggests divergent pathogenicity of these variants, though clinically the distal group presented with NDD, similar to the proximal SRCAP group. In summary, for SRCAP, there is a clear relationship between variant location, DNAm profile, and clinical phenotype. These results highlight the power of combined epigenetic, molecular, and clinical studies to identify and characterize genotype-epigenotype-phenotype correlations.

IntroductionEarly childhood development can be described by an underlying latent construct. Global comparisons of children's development are hindered by the lack of a validated metric that is comparable across cultures and contexts, especially for children under age 3 years. We constructed and validated a new metric, the Developmental Score (D-score), using existing data from 16 longitudinal studies.MethodsStudies had item-level developmental assessment data for children 0-48 months and longitudinal outcomes at ages >4-18 years, including measures of IQ and receptive vocabulary. Existing data from 11 low-income, middle-income and high-income countries were merged for >36 000 children. Item mapping produced 95 'equate groups' of same-skill items across 12 different assessment instruments. A statistical model was built using the Rasch model with item difficulties constrained to be equal in a subset of equate groups, linking instruments to a common scale, the D-score, a continuous metric with interval-scale properties. D-score-for-age z-scores (DAZ) were evaluated for discriminant, concurrent and predictive validity to outcomes in middle childhood to adolescence.ResultsConcurrent validity of DAZ with original instruments was strong (average r=0.71), with few exceptions. In approximately 70% of data rounds collected across studies, DAZ discriminated between children above/below cut-points for low birth weight (

The underpinnings of mild to moderate neurodevelopmental delay remain elusive, often leading to late diagnosis and interventions. Here, we present data on exome and genome sequencing as well as array analysis of 13 individuals that point to pathogenic, heterozygous, mostly de novo variants in WDFY3 (significant de novo enrichment P = 0.003) as a monogenic cause of mild and non-specific neurodevelopmental delay. Nine variants were protein-truncating and four missense. Overlapping symptoms included neurodevelopmental delay, intellectual disability, macrocephaly, and psychiatric disorders (autism spectrum disorders/attention deficit hyperactivity disorder). One proband presented with an opposing phenotype of microcephaly and the only missense-variant located in the PH-domain of WDFY3. Findings of this case are supported by previously published data, demonstrating that pathogenic PH-domain variants can lead to microcephaly via canonical Wnt-pathway upregulation. In a separate study, we reported that the autophagy scaffolding protein WDFY3 is required for cerebral cortical size regulation in mice, by controlling proper division of neural progenitors. Here, we show that proliferating cortical neural progenitors of human embryonic brains highly express WDFY3, further supporting a role for this molecule in the regulation of prenatal neurogenesis. We present data on Wnt-pathway dysregulation in Wdfy3-haploinsufficient mice, which display macrocephaly and deficits in motor coordination and associative learning, recapitulating the human phenotype. Consequently, we propose that in humans WDFY3 loss-of-function variants lead to macrocephaly via downregulation of the Wnt pathway. In summary, we present WDFY3 as a novel gene linked to mild to moderate neurodevelopmental delay and intellectual disability and conclude that variants putatively causing haploinsufficiency lead to macrocephaly, while an opposing pathomechanism due to variants in the PH-domain of WDFY3 leads to microcephaly.

Teachers consistently identify working with "diverse learners" as challenging. This raises questions about how teacher educators conceptualize and enact preparation of teachers for heterogeneous populations. This article provides a systematic review of literature relating to both "teacher education" and "diverse learners," to identify knowledge claims regarding the way this "problem" and possible "solutions" should be framed. Analyzing 209 peer-reviewed journal articles (2009-2019), the article identifies groups most frequently described as diverse, three qualitatively different clusters of claims regarding how teachers can be prepared for diversity, and factors identified as constraining preparation. Analysis reveals a literature broad in focus--referencing many groups--but shallow in depth. The majority describe strategies for teaching about or catering to diversity with only few considering teaching for diversity. There is also limited engagement with specialist literature relating to concepts such as gender or race and little attention to teacher educators' own knowledge. The article concludes with implications for teacher educators, arguing for enhanced critical epistemic reflexivity.

Objective: To compare specific perinatal outcomes in nulliparas with a singleton infant in cephalic presentation at term, with and without exposure to the COVID-19 pandemic during pregnancy. We hypothesised that the pandemic conditions in Melbourne may have been an independent contributor to trends in maternal Body Mass Index ≥ 25 kg/m2, macrosomia and caesarean section. Design: Multi-centre retrospective cohort study and interrupted time-series analysis. Setting: Metropolitan Melbourne, Victoria. Population: Singleton infants ≥ 20 weeks gestational age born between 1 January 2019 and 31 March 2022. Main outcome measures: Rates of maternal Body Mass Index ≥ 25 kg/m2, macrosomia (birthweight ≥ 4000 g) and caesarean section. Results: 25 897 individuals gave birth for the first time to a singleton infant in cephalic presentation at term in the pre-pandemic cohort, and 25 298 in the pandemic-exposed cohort. Interrupted time-series analysis demonstrated no significant additional effect of the pandemic on pre-existing upward trends in maternal Body Mass Index ≥ 25 kg/m2, caesarean section or macrosomia. The rate of maternal Body Mass Index ≥ 25 kg/m2 was higher in the pandemic-exposed cohort compared with the pre-pandemic cohort, (45.82% vs. 44.58% respectively, p = 0.041) as was the overall rate of caesarean section (33.09% vs. 30.80%, p < 0.001). However, this increase in caesarean section was confined to individuals who had either an induction of labour or no labour. There was also a nonsignificant trend to higher rates of macrosomia in the pandemic-exposed cohort compared with the pre-pandemic cohort (8.55% vs. 7.99% respectively, p = 0.124). Conclusions: While rates of Body Mass Index ≥ 25 kg/m2, pre-labour caesarean section, and caesarean section following induction of labour were higher among pandemic-exposed nulliparas, these findings represented a continuation of pre-existing upward trends, with no significant independent contribution from the pandemic. These trends are forecast to continue, with long term implications for population health. [ABSTRACT FROM AUTHOR]

Leukocyte-associated immunoglobulin-like receptor 1 (LAIR1) is an inhibitory receptor expressed on immune cells. We evaluated LAIR1 in placentas from preeclamptic or small for gestational age (SGA) pregnancies, and placental explant model (1 % O 2 , IL6 and TNFα, or control). LAIR1 mRNA was reduced in placentas from preeclamptic (p < 0.0001, n = 78) and SGA (p < 0.0001, n = 32) pregnancies. LAIR1 protein expression was reduced in placentas from preeclampsia (p < 0.0001, n = 43) and SGA (p = 0.009, n = 10) pregnancies. Hypoxia (1 % O 2) reduced LAIR1 mRNA expression in placental explants (p = 0.008). These findings suggest hypoxia modulates LAIR1 expression in the placenta. • LAIR1 is reduced in placenta from preeclamptic and small for gestational age pregnancies. • Hypoxia reduced LAIR1 expression in placental explants. • IL6 and TNF-α did not change LAIR1 expression in placental explants. [ABSTRACT FROM AUTHOR]

Background: Sleep Disordered Breathing (SDB) in pregnant patients ranges from 3 to 27% and varies depending on gestational age and method used to diagnose. SDB increases the risk of advanced pregnancy complications such as gestational diabetes mellitus, pregnancy-induced hypertension, and preeclampsia. Screening and diagnosis of SDB during pregnancy remains a challenge, with existing screening tools underperforming during pregnancy. This study aimed to validate a previously developed model for predicting SDB during late pregnancy and compare the predictive value of bedpartner responses. Methods: Ninety-six women in the third trimester of pregnancy underwent polysomnography and completed the Berlin Questionnaire (BQ), with 81 bedpartners completing the BQ about their pregnant partner. A subset of BQ items (snoring volume and tiredness upon awakening) along with BMI > 32 kg/m2was utilised to calculate the Wilson Optimized Model (WOM), which demonstrated strong predictive properties in development. Results: SDB (RDI/hr ≥ 5) was detected in 43.8% of women. BQ identified 72% of pregnant mothers as high risk for SDB (Sensitivity = 83%, Specificity = 37%), compared to 29% of mothers identified by the WOM (Sensitivity = 45%, Specificity = 83%). At RDI of ≥ 15, the WOM correctly classified more women according to SDB risk than the BQ (76.0% vs. 41.7% cases correct,X2(1) = 23.42,p <.001), with no difference at RDI ≥ 5. Bedpartners were more likely to report high risk for SDB on the WOM than pregnant women themselves (38.3% vs. 28.4%), however predictive ability was not improved by bedpartner input (RDI ≥ 5 bedpartner AUC = 0.69 v mother AUC = 0.73). Conclusion: BQ largely overestimates the prevalence of SDB in pregnancy compared to the WOM which underestimates. Utilising bedpartner responses didn't improve screening for SDB in late pregnancy. More work is needed to develop a pregnancy-specific tool for quick and accurate screening for SDB. [ABSTRACT FROM AUTHOR]

In post-registration, professional healthcare education, learning outcomes should reflect the needs of several stakeholders, including the professionals studying the programme, workplace managers aiming to develop their workforce, and the educators teaching the programme. This study aimed to gain a multifaceted view of how these different stakeholder groups understand the learning outcomes associated with four English, postgraduate healthcare modules designed to develop advanced healthcare practice. A concurrent mixed methodology research design was used. Online questionnaires were used to collect data from purposive samples of students and workplace managers, and semi-structured interviews were used with educators teaching on the four advanced practice modules in two English universities. The findings indicated that learning outcomes crystallise a variety of academic, regulatory and professional imperatives into a set of curriculum objectives. However, these learning outcomes-as-intended appear distinct from learning outcomes-as-enacted and as experienced. Furthermore educators, students and workplace managers have distinct perspectives on the module learning outcomes. Students and workplace managers prioritised clinical and work-specific skills, while the educators also focused on a broader range of underpinning academic outcomes. The challenges associated with shared understanding are discussed, including the inherent tension of meeting the demands and expectations of both higher education and clinical practice.

ObjectiveTo evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship.Study designWe assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis.ResultsOf 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively.ConclusionsAmong former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences.Trial registrationClinicalTrials.gov: NCT01022580.

ObjectiveWe aimed to generate a review and description of the phenotypic and genotypic spectra of ARHGEF9 mutations.MethodsPatients with mutations or chromosomal disruptions affecting ARHGEF9 were identified through our clinics and review of the literature. Detailed medical history and examination findings were obtained via a standardized questionnaire, or if this was not possible by reviewing the published phenotypic features.ResultsA total of 18 patients (including 5 females) were identified. Six had de novo, 5 had maternally inherited mutations, and 7 had chromosomal disruptions. All females had strongly skewed X-inactivation in favor of the abnormal X-chromosome. Symptoms presented in early childhood with delayed motor development alone or in combination with seizures. Intellectual disability was severe in most and moderate in patients with milder mutations. Males with severe intellectual disability had severe, often intractable, epilepsy and exhibited a particular facial dysmorphism. Patients with mutations in exon 9 affecting the protein's PH domain did not develop epilepsy.ConclusionsARHGEF9 encodes a crucial neuronal synaptic protein; loss of function of which results in severe intellectual disability, epilepsy, and a particular facial dysmorphism. Loss of only the protein's PH domain function is associated with the absence of epilepsy.

ObjectiveWe aimed to generate a review and description of the phenotypic and genotypic spectra of ARHGEF9 mutations.MethodsPatients with mutations or chromosomal disruptions affecting ARHGEF9 were identified through our clinics and review of the literature. Detailed medical history and examination findings were obtained via a standardized questionnaire, or if this was not possible by reviewing the published phenotypic features.ResultsA total of 18 patients (including 5 females) were identified. Six had de novo, 5 had maternally inherited mutations, and 7 had chromosomal disruptions. All females had strongly skewed X-inactivation in favor of the abnormal X-chromosome. Symptoms presented in early childhood with delayed motor development alone or in combination with seizures. Intellectual disability was severe in most and moderate in patients with milder mutations. Males with severe intellectual disability had severe, often intractable, epilepsy and exhibited a particular facial dysmorphism. Patients with mutations in exon 9 affecting the protein's PH domain did not develop epilepsy.ConclusionsARHGEF9 encodes a crucial neuronal synaptic protein; loss of function of which results in severe intellectual disability, epilepsy, and a particular facial dysmorphism. Loss of only the protein's PH domain function is associated with the absence of epilepsy.

Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.

Doing the right thing at school involves moral reasoning about right and wrong that interplays with a sense of responsibility as children move towards being active citizens. In the current study, we investigated how 124 Australian children's understanding and reasoning about doing the right thing changed over the early years of primary school (age 5-6 years through to age 7-8 years). This study included children's ideas about how they knew what was right and wrong and how they worked out for themselves what was right and wrong at school. The main finding suggests that children did not believe they were engaged in personal decision-making or reflections about what was right and wrong at school as they progressed through Year 1 to Year 3. Instead of developing autonomy and personal decision-making, children came to rely more on external authorities for knowledge. The implications from these findings point to the need to support children to become active citizens through participatory pedagogies and a focus on democracy.

Background In vitro fertilisation (IVF) is a common mode of conception. Understanding the long-term implications for these children is important. The aim of this study was to determine the causal effect of IVF conception on primary school-age childhood developmental and educational outcomes, compared with outcomes following spontaneous conception. Methods and findings Causal inference methods were used to analyse observational data in a way that emulates a target randomised clinical trial. The study cohort comprised statewide linked maternal and childhood administrative data. Participants included singleton infants conceived spontaneously or via IVF, born in Victoria, Australia between 2005 and 2014 and who had school-age developmental and educational outcomes assessed. The exposure examined was conception via IVF, with spontaneous conception the control condition. Two outcome measures were assessed. The first, childhood developmental vulnerability at school entry (age 4 to 6), was assessed using the Australian Early Developmental Census (AEDC) (n = 173,200) and defined as scoring The study included 412,713 children across the 2 outcome cohorts. Linked records were available for 4,697 IVF-conceived cases and 168,503 controls for AEDC, and 8,976 cases and 333,335 controls for NAPLAN. There was no causal effect of IVF-conception on the risk of developmental vulnerability at school-entry compared with spontaneously conceived children (AEDC metrics), with an adjusted risk difference of -0.3% (95% CI -3.7% to 3.1%) and an adjusted risk ratio of 0.97 (95% CI 0.77 to 1.25). At age 7 to 9 years, there was no causal effect of IVF-conception on the NAPLAN overall z-score, with an adjusted mean difference of 0.030 (95% CI -0.018 to 0.077) between IVF- and spontaneously conceived children. The models were adjusted for sex at birth, age at assessment, language background other than English, socioeconomic status, maternal age, parity, and education. Study limitations included the use of observational data, the potential for unmeasured confounding, the presence of missing data, and the necessary restriction of the cohort to children attending school. Conclusions In this analysis, under the given causal assumptions, the school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived children. These findings provide important reassurance for current and prospective parents and for clinicians., Author(s): Amber L. Kennedy 1,2, Beverley J. Vollenhoven 3,4,5, Richard J. Hiscock 1,2, Catharyn J. Stern 1,6,7, Susan P. Walker 1,2, Jeanie L. Y. Cheong 1,8,9, Jon L. Quach 1,8, [...]

Background: There are no established guidelines for the follow up of infants born after a prenatal diagnosis of a genomic copy number variant (CNV), despite their increased risk of developmental issues. The aims of this study were (i) to determine the perinatal outcomes of fetuses diagnosed with and without a CNV, and (ii) to establish a population-based paediatric cohort for long term developmental follow up. Methods: An Australian state-wide research database was screened for pregnant individuals who had a prenatal chromosomal microarray (CMA) between 2013–2019 inclusive. Following linkage to laboratory records and clinical referrer details, hospital records were manually reviewed for study eligibility. Eligible participants were mother–child pairs where the pregnancy resulted in a livebirth, the mother was able to provide informed consent in English (did not require a translator) and the mother was the primary caregiver for the child at hospital discharge after birth. Research invitations were sent by registered post at an average of six years after the prenatal diagnostic test. Statistical analysis was performed in Stata17. Results: Of 1832 prenatal records examined, 1364 (74.5%) mother–child pairs were eligible for recruitment into the follow up cohort. Of the 468 ineligible, 282 (60.3%) had 'no live pregnancy outcome' (209 terminations of pregnancy (TOP) and 73 miscarriages, stillbirths, and infant deaths), 157 (33.5%) required a translator, and 29 (6.2%) were excluded for other reasons. TOP rates varied by the type of fetal CNV detected: 49.3% (109/221) for pathogenic CNVs, 18.2% (58/319) for variants of uncertain significance and 3.3% (42/1292) where no clinically significant CNV was reported on CMA. Almost 77% of invitation letters were successfully delivered (1047/1364), and the subsequent participation rate in the follow up cohort was 19.2% (201/1047). Conclusions: This study provides Australia's first population-based data on perinatal outcomes following prenatal diagnostic testing with CMA. The relatively high rates of pregnancy loss for those with a prenatal diagnosis of a CNV presented a challenge for establishing a paediatric cohort to examine long term outcomes. Recruiting a mother–child cohort via prenatal ascertainment is a complex and resource-intensive process, but an important step in understanding the impact of a CNV diagnosis in pregnancy and beyond. Trial registration: ACTRN12620000446965p; Registered on April 6, 2020. [ABSTRACT FROM AUTHOR]

Concerns about the theory-practice gap and discussion regarding the role of the preregistration programme in preparing registered health care practitioners, are two recurring themes in the literature. This study was carried out in a higher education institution in England and was conducted over a twelve month period. It examined how well the undergraduate programme in midwifery prepares student midwives to provide sexual health advice to women. Using focus groups and questionnaires the study sought the views of three consecutive cohorts of final year midwifery students. The research focused on the students' experiences of giving advice on contraception and sexual health to women in their care and on how they responded to proposed changes in the programme. Findings indicated that students wanted more practice-based educational methods. The study suggests that a model in which theoretical knowledge is reinforced practically, with practice based scenarios and mentor emulation as staging points, would help to develop confident practice.