Original article

Differences in learning objectives during the labour ward clinical attachment between medical students and their midwifery preceptors Julie A Quinlivan, Kirsten I Black, Rodney W Petersen & Louise H Kornman

Objectives Midwives have been actively involved in the clinical teaching of medical students for many years. However, this role has received little attention and limited research has been conducted into either its efficacy or the development of strategies to maximise the potential of such teaching opportunities. We examined medical student and midwifery preceptor attitudes towards students’ learning objectives during the labour ward placement. Methods A descriptive cross-sectional survey of midwifery preceptors and medical students was undertaken. The setting was an Australian teaching and tertiary referral hospital. The questionnaire contained questions about strategies to improve medical student involvement on the labour ward and opinions towards core competencies of the student curriculum.

Of 130 questionnaires issued to medical students, 93 were returned (response rate 72%). Major differences in the expectations of students and midwifery preceptors were identified. Only 17% of midwives felt medical students should be involved in helping mothers with breastfeeding, and some no longer saw a role for students in delivering babies or performing well baby checks. These differences in opinions led to student dissatisfaction with their obstetric learning experience. Conclusion Educators need to ensure that students and midwifery preceptors identify common learning objectives. Failure to address these differences may lead to poor interdisciplinary relationships. Keywords medical education, obstetrics, pregnancy, medical students, midwives, teaching.

Results Of 94 questionnaires issued to midwifery preceptors, 63 were returned (response rate 67%).

Medical Education 2003;37:913–920

Introduction

development of strategies to maximise the potential of such teaching opportunities.2 Teaching intrapartum management of labour raises particular challenges. High levels of acceptance of medical student involvement in patient care have been reported in accident and emergency centres, general practice, general medicine and specialty clinics. In these settings up to 98% of patients are willing to involve a medical student in their care.3–5 In contrast, acceptance rates for medical student involvement in intrapartum obstetric care are lower, at 62–75%.4,5 Acceptance of male medical students is even poorer, with only 43% of women prepared to accept a male medical student.5 Strategies to try and improve women’s acceptance of medical student involvement in their care are urgently required. However, if a woman agrees to medical student involvement, it is important that both students and their midwifery preceptors share common learning objectives and identify core competencies. Discordance

Midwives have been actively involved in the clinical teaching of medical students for many years. A recent survey of US medical schools reported that 54% were formally using midwives as educators, not only in obstetrics and gynaecology, but in family medicine residencies.1 The teaching role of midwives is even more common in UK and Australian medical schools, where they play an important part in teaching intrapartum management of normal labour. However, this role has received little attention and limited research has been conducted into either its efficacy or the University Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Carlton, Victoria, Australia Correspondence: Dr Julie A Quinlivan, Senior Lecturer in Obstetrics and Gynaecology, University Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia. Tel.: 00 61 3 9344 2130; Fax: 00 61 3 9347 1761; E-mail: [email protected]

 Blackwell Publishing Ltd M ED I C A L E D UC A T I O N 2003;37:913–920

913

914

Medical students and midwifery preceptors



J A Quinlivan et al.

Key learning points Midwives are involved in the education of medical students in obstetrics. The role of midwives in such education has been poorly evaluated. Midwives and medical students do not share common learning objectives. Failure to address these differences may harm working relationships.

of opinion about medical student involvement may lead to dissatisfaction and turn a potentially positive experience into a negative one. Despite this, there has been little exploration of what is and is not a reasonable objective of a medical student’s clinical labour ward attachment. The aim of the current survey was therefore twofold: firstly, to evaluate medical student and midwifery staff opinions of strategies to maximise the involvement of medical students in the intrapartum care of women, and secondly, to examine to what extent midwives and medical students agreed on learning objectives and core competencies.

Methods A descriptive cross-sectional survey study was undertaken. The study venue was an Australian teaching and tertiary referral obstetrics and gynaecology hospital. All midwives employed on the labour ward were required to supervise and teach students. About 5–10% of midwives had undertaken a short training course in preceptorship and adult education in the preceeding 3 years, but the majority had received no formal teaching training. However, copies of the medical student curriculum that outlined core competencies for the labour ward attachment were available to students and staff. Two groups of participants were surveyed: all midwives employed on the labour ward and medical students who had just completed a 10-week clinical attachment in obstetrics and gynaecology during the fifth year of a 6-year undergraduate medical curriculum. The questionnaires completed by the 2 groups were complementary and asked parallel questions about strategies to increase student involvement in women’s care and attitudes towards core competencies of the

student curriculum. Use of the questionnaire has been previously described.6 Briefly, the questionnaires were designed with input from staff involved in the education of both medical and midwifery students and the postgraduate education of midwives and medical staff. Once the questionnaires were drafted, they were circulated to 10 members of staff for feedback. The amended questionnaires were then piloted within a focus group that included 20 midwives and medical students. Based on feedback from the focus group, the wording of some questions relating to specific clinical competencies was amended to coincide with exact terms used in the curriculum. The questionnaire contained information on 12 competencies, of which 10 were defined as core competencies in the curriculum. The 2 items that were not core competencies referred to the ability to suture a tear or episiotomy. Formal approval of the project was obtained from the university and hospital. After consultation with the university ethics committee, individual consent forms were required from each participating medical student. During the last week of their clinical placement, medical students were given a consent form, the questionnaire and a covering letter inviting their participation in the study. Consent forms and questionnaires were collated separately to preserve confidentiality. In contrast, consultation with the chair of the hospital ethics committee determined that the project met the criteria of audit under committee guidelines and individual consent forms were not required from midwives. Questionnaires for midwives were posted through the internal mail service of the hospital and were accompanied by a covering letter inviting participation in the project and a reply addressed envelope. For the purposes of the study, return of the completed survey was considered to represent consent to participation. Data were entered into a database and analysed using SPSS Version 10. Descriptive statistics were performed to determine the proportions of respondents selecting specific options. Discrete data were compared using either the chi-square or Fisher’s exact test, according to cell size. A P-value of 0Æ05 was considered significant.

Results Of 100 questionnaires distributed to midwives, 6 were returned as the recipients had left the hospital. Therefore, 94 eligible questionnaires were distributed. Of these, 63 were returned, giving a response rate of 67%. There was no statistical difference in the employment status of responders compared to that of the

 Blackwell Publishing Ltd ME D I C AL ED U C AT I ON 2003;37:913–920

Medical students and midwifery preceptors



J A Quinlivan et al.

915

Table 1 Opinions of medical students and midwives about how to involve students in the intrapartum care of women

Question

Medical students n ¼ 93 (%)

1 Who should ask a woman whether she will accept a medical student (a) The midwife directly responsible for her intrapartum care (b) The pre-admission staff (c) The medical student (d) The midwife co-ordinating the labour ward (e) The consultant co-ordinating her antenatal care (f) Other

for 44 3 15 7 5 19

Qualified midwives n ¼ 63 (%)

her labour and delivery care? (47%) 45 (71%) (3%) 4 (6%) (16%) 2 (3%) (8%) 3 (5%) (6%) 3 (5%) (20%) 5 (8%)

P-value

0.004 0.28 0.02 0.70* 1.00* 0.05

2 When should a woman be asked whether she will accept a medical student for her labour and delivery care? (a) On arrival in the delivery suite 54 (58%) 18 (29%) (b) In the antenatal clinic 7 (8%) 15 (24%) (c) In the pre-admission clinic 5 (6%) 14 (22%) (d) Anytime 17 (19%) 7 (11%) (e) At the time of referral to hospital 2 (2%) 4 (6%) (f) Other 6 (7%) 5 (8%)

< 0.0001 0.008 0.004 0.32 0.2* 0.97

3 How should a medical student be introduced to a woman? (a) As a person training to become a doctor (b) As a medical student ⁄ student doctor (c) Other (d) No fixed policy, leave it up to each individual (e) As a junior member of the medical team

(48%) (30%) (5%) (12%) (5%)

0.04 0.03 0.74* 0.18 0.36*

4 Should a woman in a teaching hospital be able to refuse to let a medical student observe her care? (a) Definitely Yes 19 (20%) 36 (57%) (b) Yes 42 (45%) 20 (32%) (c) Not sure 13 (15%) 1 (2%) (d) No 19 (20%) 6 (9%) (e) Definitely No 0 (0%) 0 (0%)

0.001 0.13 0.01 0.1

5 Should a woman in a teaching hospital be able to refuse to let a medical student be actively involved in her care? (a) Definitely Yes 27 (29%) 39 (62%) (b) Yes 43 (46%) 21 (33%) (c) Not sure 19 (20%) 1 (2%) (d) No 4 (5%) 2 (3%) (e) Definitely No 0 (0%) 0 (0%)

0.001 0.15 0.001 1*

28 45 6 5 9

(30%) (48%) (6%) (6%) (10%)

30 19 3 8 3

*Fisher’s exact test.

entire cohort (responders full-time 49%, part-time 38%, casual 11%, not disclosed 2%; entire cohort full-time 48%, part-time 39%, casual 13%; P ¼ 0Æ81). Of 130 questionnaires distributed to medical students, 93 were returned, giving a response rate of 72%. No statistically significant differences were identified in the race or gender of responders compared to those of the entire cohort (responders: white 57%, male 49%; entire cohort: white 55%, P ¼ 0Æ77, male 48%, P ¼ 0Æ87). Medical students were uniform in age, falling into the 20–24 years age bracket. In contrast, midwives were older, with only 27% falling into the 20–24 years age bracket, and 37%, 24% and 10% falling into the age brackets of 25–30, 35–45 and 46 years and over,

respectively. Age was not stated in 2% of replies. The majority of both medical students and midwives were white, although this was significantly less common in medical students (medical students 57%, midwives 80%; P ¼ 0Æ001), where nearly 40% were of Asian background (medical students 41%, midwives 8%; P < 0Æ0001). The remaining respondents were of indigenous Australian background or did not disclose their ethnic origin. All medical students were university educated and full-time in status. In contrast, the educational backgrounds of midwives were divided between university (46%) and hospital (54%). Table 1 outlines the opinions of medical students and midwives about how to involve students in the

 Blackwell Publishing Ltd M ED I C A L E D UC A T I O N 2003;37:913–920

916

Medical students and midwifery preceptors



J A Quinlivan et al.

Skill to be performed Provide support to a woman through her labour Perform the regular and required observations throughout a labour Discuss options for pain relief with a woman in labour Administer pain relief in the form of nitrous oxide or pethidine to a woman in labour Perform a blood test if indicated on a woman in labour Insert an intravenous cannulae if indicated on a woman in labour Observe a delivery Perform a delivery Perform a baby check Suture a simple tear Suture an episiotomy Provide advice on breastfeeding technique and attachment

Medical Qualified student midwives n ¼ 93 (%) n ¼ 63 (%) P-value 87 (94%) 87 (94%)

60 (95%) 57 (90%)

0.74* 0.55*

77 (83%) 78 (84%)

27 (43%) 18 (29%)

0.0001 0.0001

86 (92%) 83 (89%)

30 (48%) 20 (32%)

0.0001 0.0001

93 93 85 64 47 66

62 59 41 7 5 11

0.4* 0.025* 0.0001 0.0001 0.0001 0.0001

(100%) (100%) (91%) (69%) (50%) (71%)

(98%) (94%) (65%) (11%) (8%) (17%)

Table 2 Comparison of medical students’ and midwives’ opinions of whether medical students should perform specific duties during their clinical attachment

*Fisher’s exact test.

intrapartum care of women. Significantly fewer medical students than midwives believed that the midwife should be responsible for asking a woman whether she would accept a medical student during her intrapartum care (47% versus 71%; P ¼ 0Æ004). Furthermore, significantly more medical students than midwives thought that they should play a role in asking a woman whether she would accept their involvement in her care (16% versus 3%; P ¼ 0Æ02). Significantly more medical students than midwives thought that a woman should be asked to accept a medical student on arrival in the delivery suite (58% versus 29%; P < 0Æ0001). In contrast, midwives were more likely than medical students to suggest approaching women at other locations such as the antenatal or preadmission clinics (antenatal clinic: 24% versus 8%; P ¼ 0Æ008; pre-admission clinic: 22% versus 6%, P ¼ 0Æ004). There were also significant differences between medical students and midwives in their opinion of the ideal terminology to use when introducing a medical student to a woman. Although 78% of both groups favoured the terms person training to become a doctor or medical student ⁄ student doctor, medical students preferred the latter (P ¼ 0Æ03) and midwives the former (P ¼ 0Æ04). The majority of both medical students and midwives believed women have a right to refuse both observation and active involvement in their care from a medical student (observation: 65% and 89%; involvement: 75% and 95%). However, medical students were significantly more likely than midwives to express doubt or uncertainty over this issue (observation

not sure: 15% versus 2%, P ¼ 0Æ01; involvement not sure: 20% versus 2%, P ¼ 0Æ001). Table 2 charts the opinions of medical students and midwives on possible learning objectives or skills to be acquired by medical students during their labour ward clinical attachment. There was consensus between medical students and midwives that medical students should provide support to a woman in labour, perform the regular and required observations throughout labour and observe a delivery. In contrast, there were significant differences between medical students and midwives in their expectations of medical students in the core competencies of facilitating a delivery (P ¼ 0Æ02), performing a well baby check (P <0Æ0001), and providing advice on breastfeeding (P < 0Æ0001). In the latter duty, only 17% of qualified midwives felt that medical students should be involved in providing advice on breastfeeding technique and attachment compared to 71% of medical students. Midwives were also less likely to consider that medical students should engage in discussion of options for pain relief with a woman in labour (P < 0Æ0001), administer pain relief in labour (P < 0Æ0001), perform a blood test or intravenous cannulation (both P < 0Æ0001), or suture a tear or episiotomy (both P < 0Æ0001). Medical students and midwives were presented with clinical scenarios of varying complexity and asked whether they considered it reasonable to have medical student involvement, assuming the woman provided consent. The results are summarised in Table 3. As the

 Blackwell Publishing Ltd ME D I C AL ED U C AT I ON 2003;37:913–920

Medical students and midwifery preceptors



J A Quinlivan et al.

917

Table 3 Medical students’ and qualified midwives’ opinions of whether it is reasonable for a medical student to be involved in the intrapartum care of a women in various clinical scenarios

Clinical scenario A 25-year-old woman in her first pregnancy who presents in early labour at term, with no antenatal problems A 25-year-old woman in her first pregnancy who presents in early labour at term with an uncomplicated twin pregnancy A 25-year-old woman in her first pregnancy who requires a forceps delivery for delay in the second stage of labour and with whom the student has been present in early labour A 25-year-old woman in her first pregnancy who presents at term, and in whom an elective caesarean section is planned in view of breech presentation of the fetus A 25-year-old woman in her first pregnancy who presents in early labour at term with severe proteinuric pre-eclampsia, oliguria and clonus A 25-year-old woman in her first pregnancy who presents in early labour at term and the fetal heart is found to be absent

Medical student n ¼ 93 (%)

Qualified midwife n ¼ 63(%)

P-value

92 (99%)

61 (97%)

0.56*

82 (88%)

53 (84%)

0.62

79 (85%)

56 (89%)

0.64

85 (91%)

57 (90%)

0.93

68 (73%)

27 (43%)

0.0001

47 (51%)

14 (22%)

0.0001

*Fisher’s exact test.

cases became more complex, both medical students and midwives were less likely to feel that it was reasonable for the medical student to be involved in the care. However, in the most difficult clinical scenarios, medical students were more supportive of their involvement compared to midwives (severe preeclampsia: medical student 73%, midwife 43%, P < 0Æ0001; fetal death in utero: medical student 51%, midwife 22%, P < 0Æ001). Table 4 summarises the opinions of medical students with respect to the assistance from staff in learning about normal labour. Most students found both midwives and medical staff to be helpful (72% and 93%, respectively). However, significantly more medical students reported that midwives were unhelpful compared to medical staff (midwives 18%, medical staff 1%; P ¼ 0Æ001). Labour ward exposure was considered to represent a worthwhile educational experience by the majority of medical students (79%), but 10% judged it to be unhelpful in its current format. Midwives’ opinions of medical students are summarised in Table 5. Medical students were perceived as being mostly interested (66%). However, midwives reported that 25% of students were neutral and 9% disinterested in the labour ward experience. Midwives regarded clinical experience in both labour and nonlabour obstetric wards as important for medical students. However, almost a quarter of midwives (22%) over-estimated the duration of time medical students were allocated for training in obstetrics and gynaecology

Table 4 Opinions of medical students with respect to the helpfulness of colleagues Question

Responses

1 What is your overall impression of the midwives you have encountered over the past term in respect to their assisting you with your midwifery education? (a) Very helpful 17 (18%) (b) Helpful 50 (54%) (c) Neither helpful nor unhelpful 9 (10%) (d) Unhelpful 7 (8%) (e) Very unhelpful 9 (10%) 2 What is your overall impression of the medical staff you have encountered over the past term in respect to their assisting you with your midwifery education? (a) Very helpful 36 (39%) (b) Helpful 50 (54%) (c) Neither helpful nor unhelpful 5 (6%) (d) Unhelpful 0 (0%) (e) Very unhelpful 1 (1%) 3 How useful do you regard labour ward exposure in terms of your formal education? (a) Very helpful 35 (38%) (b) Helpful 38 (41%) (c) Neither helpful nor unhelpful 10 (11%) (d) Unhelpful 4 (4%) (e) Very unhelpful 6 (6%)

and a similar proportion (24%) did not understand the seniority of students undertaking the obstetrics and gynaecology term.

 Blackwell Publishing Ltd M ED I C A L E D UC A T I O N 2003;37:913–920

918

Medical students and midwifery preceptors



J A Quinlivan et al.

Table 5 Opinions of qualified midwives about medical students Questions

Responses

1 What is your overall impression of the medical students you have encountered over the past term? (a) Very interested 6 (10%) (b) Interested 35 (56%) (c) Neither interested nor disinterested 16 (25%) (d) Disinterested 2 (3%) (e) Very disinterested 4 (6%) 2 How important is clinical exposure to the labour ward? (a)Very important 20 (32%) (b) Important 29 (46%) (c) Others 14 (22%) 3 How important is clinical exposure to non-labour wards areas in the hospital? (a) Very important 15 (24%) (b) Important 32 (51%) (c) Not sure 9 (14%) (d) Not important 7 (11%) 4 How long is the medical student course? (a) Correct (b) Incorrect

54 (86%) 9 (14%)

5 What year of their training are medical students in when they undertake a term in obstetrics and gynaecology? (a) Correct 48 (76%) (b) Incorrect 15 (24%) 6 How many terms in obstetrics and gynaecology do medical students have before graduating? (a) Correct 49 (78%) (b) Incorrect 14 (22%)

Discussion Midwives are frequently involved in the supervision and teaching of medical students during their clinical attachments to labour wards and, although this relationship is recognised in an informal manner, there is usually no structured teaching programme provided to guide midwives. The survey identified several strategies to improve women’s acceptance of medical student involvement. The questionnaire also highlighted differences in the support for core competencies to be achieved by medical students. Involving students in patient care

Feedback from the survey suggested that midwifery staff felt that the midwife responsible for a woman’s intrapartum care should be responsible for asking the woman for consent to student participation. However, it was suggested that the subject of medical student involvement should be raised earlier in the antenatal or

pre-admission clinic. This would allow women to gain a greater understanding of the role of the medical student. It would also enable the concept of a teaching hospital to be addressed whilst reassuring women that acceptance of medical student involvement would not affect their privacy or the level of care they receive from midwifery and medical staff. These findings mirror an earlier survey that explored the opinions of women towards the involvement of medical students in their intrapartum care. In a survey of 203 consecutive women attending antenatal clinics, nearly half commented that they had experienced a positive encounter with a medical student in an antenatal setting and felt that the question of intrapartum student involvement could have been raised at this time.5 The main reasons for declining student involvement were fears over privacy or the number of people who would be in attendance at the birth, concerns that they would receive suboptimal care or that their partner would object, and medical complications in the current pregnancy. Only 3 women refused student involvement because of an adverse experience with a medical student.5 Attitudes towards clinical competencies

All the clinical duties listed in the questionnaire, with the exception of suturing tears and episiotomies, were core competencies of the medical curriculum.6 However, midwives had consistently and significantly lower expectations than medical students in all areas except supporting a woman during labour, taking observations and observing a delivery. The opportunity for a medical student to perform a delivery under supervision has long been considered fundamental to the medical school curriculum; it is also one of the rarest and most enriching opportunities of the medical school experience. However, as birth rates in developed nations fall and mean maternal age increases, opportunities to facilitate an uncomplicated vaginal birth have become more limited. Medical students actively compete with midwifery students for available births. They also battle trends in consumerism that are resulting in more women declining student involvement in their care.5 In the face of resistance some midwives are re-evaluating the importance of medical students facilitating deliveries and this is creating conflict in the labour ward. We found that 6% of midwives no longer identified a role for a medical student in a delivery. This divergence of opinion needs to be evaluated in more depth. Does the general public still expect that all doctors are able to assist at an uncomplicated birth, or have times changed?

 Blackwell Publishing Ltd ME D I C AL ED U C AT I ON 2003;37:913–920

Medical students and midwifery preceptors



J A Quinlivan et al.

It is of concern that only 65% of the midwives felt that medical students should learn to perform a well baby check. Most women visit their general practitioner (GP) for a 6-week postnatal check as hospitals no longer provide this service. Many hospitals have an early discharge programme, which means that early problems in the neonate may also present to the family doctor. General practitioners have consistently expressed anxiety about examining neonates and their role in detecting congenital abnormalities, in particular heart conditions and congenital hip dislocation.7,8 Although the most serious forms of congenital heart disease usually present within the first few days of birth, some may not be noted until the closure of the ductus arteriosus and present between 2 and 10 weeks of life.7 It is therefore important that not only paediatricians but also obstetricians and GPs are competent to examine the newborn heart. Screening for congenital hip dislocation by examination is not perfect, and therefore ongoing surveillance for this condition in the community is an essential complement to hospital screening.9 It has been argued that poor technique, due to inadequate training opportunities, is at least partly responsible for missed diagnoses.10 There are many other conditions that evolve over the early weeks of neonatal life, including metabolic, hepatic and neurological disorders.11 Knowledge of the normal neonatal examination would therefore seem imperative for all GPs and medical staff exposed to newborns. All major colleges of obstetricians and gynaecologists have recognised that breastfeeding is the preferred source of infant nutrition.12 To achieve the best outcomes, WHO emphasises that breastfeeding should be initiated on the labour ward,13 thereby providing an ideal opportunity for medical students to gain knowledge of, and practical exposure to, breastfeeding. Furthermore, there is evidence that counselling from medical staff can improve rates of breastfeeding initiation and duration.12,13 Adequate education of medical staff about breastfeeding is a priority of WHO and it is therefore of concern that only 17% of midwives saw a role for medical students in the counselling and commencement of breastfeeding on the labour ward. Given that several studies have suggested that doctors currently lack knowledge and understanding of the advantages of breastfeeding12,14 and management of common lactation problems,12 it is important that both medical students and midwives come to appreciate the potential learning experience that labour wards can provide. The divergence of opinion between midwives and medical students in other areas is also of concern.

919

There is evidence that medical student teaching of procedural skills is inadequate. In 1 study, 43% of new interns reported that their training in suturing, insertion of a catheter and intubation were poor.15 Although virtual reality programmes are being implemented in medical education, these may not translate easily into the physical setting. In a US study that tested intravenous catheter insertion skills, medical students and young doctors did not improve their insertion rates into live subjects despite training and improving in virtual reality sessions.16 The clinical attachment in obstetrics and gynaecology offers an opportunity to develop procedural skills and thus an effort should be made to facilitate teaching and supervision in this area. It is of concern that 18% of medical students reported finding midwifery staff unhelpful. Much of this dissatisfaction could stem from discrepancies in the expectations and realisations of their labour ward placement. Failure to address this dissatisfaction could lead to suboptimal interdisciplinary relationships in their future career. It may be that we ignore this finding only at our peril. Midwives play an important part in medical student training in obstetrics and gynaecology, yet their educational role is often under-recognised.1 Strategies to improve outcomes may include formal training for midwives in the principles of preceptorship and adult education; ensuring both midwives and students clearly understand the core competencies required from the labour ward placement; instigating ongoing monitoring of the achievement of core competencies, and the provision of incentives to encourage midwives with an interest in teaching to be given greater scope to exercise this interest. Mutual agreement over core competencies, within the principles of the wider curriculum, may reduce levels of dissatisfaction between students and staff. If agreement cannot be reached, and if the numbers of eligible women consenting to student involvement continue to fall, then it may be necessary to revisit the appropriateness of core competencies within the women’s health curriculum and devise alternative teaching experiences.

Contributors All authors were responsible for the study concept and design. JAQ was responsible for questionnaire design, statistical analysis, and drafting and revising the manuscript. KIB was responsible for statistical analysis and drafting the manuscript. RWP was responsible for questionnaire design and administration to students, and revising the manuscript for publication. LHK was

 Blackwell Publishing Ltd M ED I C A L E D UC A T I O N 2003;37:913–920

920

Medical students and midwifery preceptors



J A Quinlivan et al.

responsible for administering the questionnaire to midwives and revising the manuscript for publication. 8

Acknowledgements The authors would like to thank the staff and students who returned the questionnaires.

Funding

9

10

This work was not funded by an external grant. Salaries of staff, questionnaire printing and mailing costs were met by the University of Melbourne Department of Obstetrics and Gynaecology.

11

12

References 1 Harman PJ, Summers L, King T, Harman TF. Interdisciplinary teaching. A survey of CNM participation in medical education in the United States. J Nurse-Midwifery 1998;43:27–37. 2 Afriat CI. Nurse-midwives as faculty preceptors in medical education. J Nurse-Midwifery 1993;38:349–52. 3 Birkinshaw R, O’Donnell J, Sabir J, Green S. Patient’s attitudes to medical students in the accident and emergency department. Eur J Emerg Med 1999;6:109–10. 4 Nicum R, Karoo R. Expectations and opinions of pregnant women about medical students being involved in care at the time of delivery. Med Educ 1998;32:320–4. 5 Grasby D, Quinlivan JA. Attitudes of patients towards the involvement of medical students in their intrapartum obstetric care. Aust N Z J Obstet Gynaecol 2001;41:91–6. 6 Quinlivan JA, Thompson CM, Black KI, Kornman LH, McDonald SJ. Medical and midwifery students: how do they view their respective roles on the labour ward? Aust N Z J Obstet Gynaecol 2002;42:401–6. 7 Arlettaz R, Archer N, Wilkinson AR. Natural history of innocent heart murmurs in newborn babies: controlled

13

14 15 16

echocardiographic study. Arch Dis Child Fetal Neonatal Ed 1998;78:F166–70. Dezateux C, Godward S. Screening for congenital dislocation of the hip in the newborn and young infants. In: David TJ, ed. Recent Advances in Paediatrics. Vol. 16. Edinburgh: Churchill Livingstone 1998;pp.41–58. Glazener CMA, Ramsay CR, Campbell MK et al. Neonatal examination and screening trial (NEST): a randomised, controlled, switchback trial of alternative policies for low risk infants. BMJ 1999;318:627–32. Hall DMB. The role of the routine neonatal examination: it has many aims, few of them evaluated. BMJ 1999;318: 619–20. Baker A, Hadzic N, Dhawan A, Mieli-Vergani G. Biliary atresia. In: David TJ, ed. Recent Advances in Paediatrics. Vol. 16. Edinburgh: Churchill Livingstone 1998;pp.25–40. Freed GL, Clark SJ, Cefalo RC, Sorenson JR. Breastfeeding education of obstetric-gynecology residents and practitioners. Am J Obstet Gynecol 1995;173:1607–13. Southall DP, Burr S, Smith RD, Bull DN, Radford A, Williams A, Nicholson S. The Child-Friendly Healthcare Initiative (CFHI): Health care provision in accordance with the UN Convention on the Rights of the Child; Child Advocacy International; Department of Child and Adolescent Health and Development of the World Health Organisation (WHO); Royal College of Nursing (UK); Royal College of Paediatrics and Child Health (UK); United Nations Children’s Fund (UNICEF). Pediatrics 2000;106:1054–6. Naylor A. Professional education and training for trainers. Int J Gynaecol Obstet 1990;31:25–7. Taylor DM. Undergraduate procedural skills training in Victoria: is it adequate? Med J Aust 1997;166:251–4. Prytowsky JB, Regehr G, Rogers DA, Loan JP, Hiemenz LL, Smith KM. A virtual reality module for intravenous catheter placement. Am J Surg 1999;177:171–5.

Received 25 March 2002; editorial comments to authors 16 August 2002 and 22 January 2003; accepted for publication 16 May 2003

 Blackwell Publishing Ltd ME D I C AL ED U C AT I ON 2003;37:913–920

Differences in learning objectives during the labour ...

Major differences in the expectations .... 80%; P = 0∆001), where nearly 40% were of Asian background ..... questionnaire design and administration to students,.

73KB Sizes 2 Downloads 162 Views

Recommend Documents

Differences in learning objectives during the labour ward clinical ...
preceptorship and adult education in the preceeding. 3 years, but the majority had received no formal. teaching training. However, copies of the medical.

Learning Goals and Learning Objectives
Apr 22, 2014 - to guide development of student learning goals. These goals ... Our students will know the professional code of conduct within their discipline.

Cause of kinematic differences during centrifugal ... - Semantic Scholar
dactics, San Francisco, 1999) we simulated the muscle forces during centrifugal and centripetal ..... passive force corresponds to a reduction in the net-force.

Cause of kinematic differences during centrifugal ... - Semantic Scholar
passive force corresponds to a reduction in the net-force .... in the net muscle force profiles shown in Fig. 14. ..... Pfann, K. D., Keller, E. L., & Miller, J. M. (1995).

Learning to perceive pitch differences
360, 2500, and 6000 Hz. It appeared that the effect of train- ing on the ... pothesized that the groups trained at 360 and 2500 Hz com- .... odological point of view.

THE GREAT RECESSION IN THE UK LABOUR MARKET
unemployment, GDP in the UK has fallen by 6 per ..... rise in the inflow rate into unemployment plus the .... 6. Actual vs. flow steady-state unemployment rates.

Labour Law in Tanzania Book.pdf
... was a problem loading more pages. Retrying... Whoops! There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Labour Law in Tanzania Book.pdf. Labour Law in Tan

1 Emotions during the Learning of Difficult Material ...
Sidney D'Mello. Department of Computer Science .... big six emotions do not frequently occur during the learning sessions of relevance to this chapter, ..... We have also collected data on learning environments without agents, such as problem.

Indian Officials in the ILO, 1919-c 1947 - International Labour ...
Mar 5, 2011 - and did a BSc in economics at the London School of Economics. (LSE) from ...... days to find work, often taking up manual jobs. Both made last-.