The Mexican Experience Adapting CenteringPregnancy: Lessons Learned in a Publicly Funded Health Care System Serving Vulnerable Women

Group antenatal care is an innovative model of health care in which all components of antenatal care—clinical, educational, and supportive—happen in a group context with health care professionals as facilitators. CenteringPregnancy is the most studied model of group antenatal care, now widely implemented in the United States. This model has been shown to be effective in improving health and behavioral outcomes in the United States, but there is less known about the experience adapting group antenatal care in settings outside the US health care system. This article describes the adaptation of the CenteringPregnancy model to a Mexican context. We describe the Mexican health care context and our adaptation process and highlight key factors to consider when adapting the content and modality of the CenteringPregnancy model for diverse populations and health systems. Our findings are relevant to others seeking to implement group antenatal care in settings outside the US health care system.     

INITIATION AND MAINTENANCE OF CLINICAL LEARNING SITES IN NURSE-MIDWIFERY*

This article describes in practical terms the approach to selection and maintenance of clinical experience sites for nurse-midwifery educational programs. The responsibilities of clinical instructors, University programs, and student nurse-midwives in clinical settings are examined. Guidelines are offered to assist in providing a sound educational environment for the learning of the role of the nurse-midwife.     

The effects of pregnancy complications on the parental adaptation process

The current study examined the effects of high-risk pregnancies on the adaptation process of parents of full-term healthy infants. Gender similarities and differences were also addressed to determine the adaptation process of parents who experience a high-risk pregnancy. The sample consisted of 68 high-risk and 59 low-risk pregnancy couples, making a total of 254 new parents. Questionnaires measuring general issues related to the parental adaptation process as well as several specific components dealing with parental role attainment were administered. An effect of risk status and gender was detected on the parental adaptation process. The experience of high obstetrical risks also appeared to have an effect on the perception of life changes and on the development of a sense of competence among parents. Moreover, the findings demonstrated that the gender of the parent contributed to parental experience. Women experienced significantly more life changes than did men. Mothers also differed from fathers in the sense of satisfaction they experienced in their roles as parents.     

Participation in and a critical review of educational audit

In this reflection I discuss my first engagement with the educational audit process. Audit of the environment is a crucial element in the education of student midwives; educational audit is complex as placement areas are dynamic, fast-changing environments. It is important for all involved parties to recognise that the quality of the learning experience is far more reliant on the 'virtual environment' provided by quality mentors rather than on the more concrete practice setting.     

Longitudinal impact of a female pelvic medicine and reconstructive pelvic surgery fellowship on resident education

OBJECTIVE: The purpose of this study was to assess residents' perceptions of the impact of a new fellowship on their educational experience.Study Design: A voluntary questionnaire was administered to residents in obstetrics and gynecology that assessed how they felt fellowships in female pelvic medicine and reconstructive surgery had an impact on their education. The initial questionnaire was given within 1 month of the beginning a new 3-year fellowship and then annually for 3 years. RESULTS: The mean response rate was 32%. In the initial questionnaire, the fellowships were perceived as detracting from the educational experience. Thereafter, there was a positive increase in the perceived impact of fellowships that was sustained for 3 years. Residents also reported higher self-assessments of the quality of their education during this period. Residents' surgical volume did not change with the introduction of the fellowship. CONCLUSION: Although at the outset residents anticipated the addition of a fellowship to have a negative impact on their educational experience, they consistently reported a positive impact after the fellowship was instituted.     

Midwifery education roundtable discussion: transitions to the workplace

A snapshot of four graduates' views on their educational experience at a research institution as well as their perspective on how it prepared them for the challenges they faced in entering the workplace is presented. Discussants stated that research knowledge is a critical aspect to clinical practice. Their educational experience provided them with the ability to understand information technology applications, identify and access relevant scientific research, evaluate the integrity and comparability of research findings, and apply research findings to clinical practice. Areas within the curriculum that were identified as needing more content and/or greater emphasis included primary health care, how to work competently and effectively with persons from diverse cultural, socioeconomic, and racial and ethnic backgrounds, experience with public health providers, and content such as intimate partner violence and adolescent behaviors.     

FACULTY BURN-OUT IN NURSE-MIDWIFERY EDUCATION

A summary of an educational session on faculty burn-out presented at the ACNM annual meeting in Minneapolis, May 1980. The authors explore the burn-out phenomenon as it relates to their experience with nurse-midwifery education in tertiary care settings. Factors involved, consequences to the profession, and means of alleviating the problems are identified.     

The impact of regionalization programs on patterns of perinatal care.

A questionnaire developed to assess changes in patterns of perinatal care related to regionalization programs was sent to all 505 members of The American College of Obstetricians and Gynecologists in the state of Massachusetts. Respondents reported changes in facilities, services, educational experience, and referral and transfer patterns. The implications of these changes are discussed.     

Evolution of the Gynecology Teaching Associate: an education specialist

The traditional pelvic examination instruction methods were reviewed and found to be deficient: the student learning experience was compromised by the triangular setting of patient, student, and instructor for early pelvic examination instruction. Over the past decade, a new education specialist, the Gynecology Teaching Associate (GTA), has evolved to help improve the initial gynecology teaching experience. The evolution of the GTA is described. The qualities she brings to the instructional system include sensitivity as a woman, educational skill in pelvic examination instruction, knowledge of female pelvic anatomy and physiology, and, most important, sophisticated interpersonal skills to help medical students learnin in a nonthreatening environment. Reinforcement learning theory is the foundation of this educational system. Student acceptance of this system is documented.     

The value of clinical experience to a non-clinician: combining midwifery practice with teaching.

This paper explores the value of clinical experience to midwives and other health care providers who work in other than clinical situations. The value of this experience may relate to personal or educational goals. Due to the lack of attention to this topic in the midwifery literature, the author recounts her own experience and compares it with the nursing and health visiting literature. Differing expectations feature as an issue. The value of this arrangement, for teaching, research and personal development more than compensate for the difficulties identified.     

NURSE-MIDWIVES AS FACULTY PRECEPTORS IN MEDICAL STUDENT EDUCATION

Certified nurse-midwives (CNMs) are specialists in normal obstetrics and women's health care. In this capacity, CNMs have been actively involved in the education of nurses and student nurse-midwives. Nurse-midwives also have been consultants and mentors for medical students and residents during their clinical experiences. However, the nurse-midwife's contribution to the formal medical education process has not received the appropriate formal recognition that it deserves, nor has this contribution been utilized to its maximum potential. This article describes the development, philosophy, and implementation of an educational program utilizing nurse-midwives as the primary clinical preceptor for the obstetric rotation for third-year medical students. The long-range impact of this educational experience on the nurse-midwife/physician relationship is also explored.     

Ultraschall-Teaching mit elektronischer Unterstützung

Three-dimensional or volume ultrasound acquisition, analysis and display have enhanced the understanding of complex anatomical relationships in the fetus, both normal and pathological. Exemplary or very educational datasets can be transferred to a simple data and display format with small file sizes by creating virtual reality object movies. These provide a new viewing and learning experience described in this article, enabling experienced users to create such object and interested viewers to interactively experience normal and abnormal anatomy.     

Lactation Education for Resident Obstetricians: Promoting Breastfeeding Advocates for the Future

Obstetrics and gynecology residency training programs are historically lacking in breastfeeding education and advocacy. Healthy People 2020 supports interventions that promote breastfeeding as a primary care strategy with significant health benefits to the newborn and woman. Midwives are well poised to engage obstetrics and gynecology residents in lactation education. A few educational interventions have been described in the literature to increase knowledge, confidence, and behavior related to lactation among residents. This article describes a breastfeeding education curriculum developed by midwifery faculty at Boston University School of Medicine. The project included 3 lectures and a simulation center workshop covering topics including lactogenesis, prenatal, intrapartum, and postpartum interventions that promote or limit lactation, hands‐on latch assistance, hand expression, use of breast pumps and storage of human milk, and common disorders of lactation. Postintervention evaluations demonstrated improvements in knowledge and confidence. Providing breastfeeding education to resident physicians may be an intervention to promote patient breastfeeding education and support and close the gap of disparities in breastfeeding rates.     

Physiologie der Plazenta

The placenta is a complex organ with a limited lifespan. It sustains its own as well as fetal development and in doing so interacts with the mother and fetus. The interaction with the mother is particularly pronounced in the first half of gestation during which placental hormones promote the adaptation of maternal physiology and metabolism. Moreover, locally produced cytokines and growth factors induce immunological tolerance for the semiallogenic fetus. During the course of gestation fetal signals gain increasing influence on placental development and mediate adaptation of the placenta to fetal requirements. The specialization of the placenta during pregnancy mostly serves to optimize the supply of nutrients and oxygen to the fetus. Impaired maternal-fetal transport is often associated with pregnancy problems, such as fetal growth restriction.     

Education for ECMO providers: Using education science to bridge the gap between clinical and educational expertise

A well-organized educational curriculum for the training of both novice and experienced ECMO providers is critical for the continued function of an institutional ECMO program. ELSO provides guidance for the education for ECMO specialists, physicians and staff, which incorporates “traditional” instructor-centered educational methods, such as didactic lectures and technical skill training. Novel research suggests utilization of strategies that align with principles of adult learning to promote active learner involvement and reflection on how the material can be applied to understand existing and new constructs may be more effective. Some examples include the “flipped classroom,” e-learning, simulation, and interprofessional education. These methodologies have been shown to improve active participation, which can be related to improvements in understanding and long-term retention. A novel framework for ECMO training is considered. Challenges in assessment and credentialing are also discussed.     

Competencies for midwifery teachers

Saving women's lives with cost-quality effective midwifery care is based on sound pre-service and ongoing education. Effective midwifery education requires competent, caring, and compassionate teachers. In this paper, I address the basic competencies required of midwives who teach others to be midwives. These competencies are important regardless of level of student taught, type of educational programme, or number of years of midwifery experience that learners bring to the educational setting. The competencies are based on the midwifery philosophy, values and model of care. Competent midwifery teachers must be competent midwifery clinicians for their primary role is to set the boundaries of safety for each level of learner. Formal preparation for teaching, understanding how adults learn, understanding how to develop an appropriate plan for learning (curriculum), and developing competency in a variety of teaching methods for both theory and clinical practice are included in the competencies discussed in this paper.