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Using sustainable innovation allowed time for data collection and evaluation throughout the implementation of CBME. Representing student achievement according to competencies, rather than as letter grades, is perceived as revolutionary by many stakeholders. Employing sustainable, incremental innovation facilitated stakeholder buy-in to the underlying principles of CBME. Fostering a new organizational culture will be the 'rate-limiting factor' for full implementation of CBME. Representing student achievement according to competencies,

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In contrast, research in support of the "in utero colonization hypothesis" is solely based on descriptive verifications that do not provide explanatory insight, which weakens the evidence for a prenatal intrauterine microbiome. We propose that a reflection on philosophical principles can inform not only the debate on the prenatal intrauterine microbiome but also other disciplines that attempt to study low-biomass microbial communities. Despite the advancement of scientific research in the field of maternity care, midwives face challenge