Medical improvisation training to enhance the antenatal counseling skills of neonatologists and neonatal fellows: a pilot study

Introduction: Neonatologists must be skilled at providing antenatal counseling to expectant parents of premature infants at the limits of viability. We conducted a medical improvisation workshop with the objective of enhancing antenatal counseling skills.

Methods: Pre- and postworkshop questionnaires were collected to examine the impact of the training. A follow-up survey was distributed 3 months after the workshop to examine the impact of the training on antenatal counseling skills.

Results: Nine neonatologists and three neonatal fellows participated in the workshop. Participants reported the skills learned in the workshop could enhance the quality of antenatal counseling. On follow-up survey, 90% of subjects reported improvements in the quality of their antenatal counseling.

Discussion: Participation in a medical improvisation workshop resulted in enhancements of self-perceived antenatal counseling skills. Medical improvisation training may provide a feasible and effective method of communication training for neonatologists. Further research into this innovative method are needed.     

Postgraduate Training in Pediatric and Adolescent Gynecology: Trainees' Perspectives

ObjectiveThe purpose of this study was to evaluate resident trainees’ perspectives on the pediatric and adolescent gynecology (PAG) training in obstetrics and gynecology training programs in Europe.Study DesignThis study was a cross-sectional survey using an online questionnaire, on the basis of the PAG training in obstetrics and gynecology section of the European Board & College of Obstetrics and Gynaecology Project of Achieving Consensus in Training curriculum. We aimed to survey the national programs in 35 European Network of Trainees in Obstetrics and Gynaecology (ENTOG) member countries. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG online platforms.ResultsNinety obstetrics and gynecology trainees in 33 of 35 countries responded to our questionnaire. Of the 35 ENTOG member countries, 33 participated in the survey, and a total of 90 responses were collected, giving a response rate of 9% of all European trainees and representing 94% of the member countries. Only 27% of trainees reported having a PAG rotation during their training program, and a PAG elective was only available to 34% of the trainees. Forty-one percent reported that PAG training was not included in their curriculum (no official rotations or lectures planned). Despite the lack of formal training, 72% of trainees felt able to diagnose and manage prepubertal vaginal bleeding and adnexal masses in children and adolescents by the end of their training. Most (58%) also confirmed that they could determine indications for treatment of vulval, vaginal, perineal, and rectal conditions.However, despite scoring positively for the management and counseling of subjects that often overlap with adult patients, such as “contraception in adolescents with health problems,” “acute abdominal pain,” “menstrual abnormalities,” and “vaginal discharge,” the study revealed poorer scores when the trainees were asked about more specific PAG topics such as “premature puberty” and “developmental disorders of the genital tract.”ConclusionMost core training programs across Europe do not include formal PAG training, and trainees reported a need to improve the provision of core PAG training in Europe.     

Does Continuity of Care by Well‐Trained Breastfeeding Counselors Improve a Mother's Perception of Support?

Abstract: Background: Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care. Method: Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process‐oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales. Results: Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both control groups. Conclusions: After implementation of a process‐oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care, the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care. (BIRTH 33:2 June 2006)     

Work-related musculoskeletal injuries amongst obstetrics and gynaecology trainees in East Midland region of the UK

Purpose

Work-related musculoskeletal injuries (WRMSI) have been well known amongst obstetrics and gynaecology (O&G) practitioners, but limited data have been reported. Our aim is to determine the prevalence, severity and characteristics of WRMSI amongst O&G trainees.

Methods

A musculoskeletal ergonomic survey was conducted amongst the O&G trainees in the East-Midlands region of United Kingdom (UK). The survey comprised of demographic details, year of training, previous manual handling training, any work-related orthopaedic injury, the type of injury, any treatment received in addition to any sick leave incurred after the injury were also documented.

Results

The response rate for the survey was 76% (59/78). The majority (22%) were senior specialist trainee, seventh year (ST7) and between 30 and 34 age groups. Approximately 90% of the trainees reported to have experienced pain in the last year. The most common site was the back, which was followed by the shoulders and the upper limbs. 63% of trainees reported injuries that were attributed to WRMSI. One in ten of the trainees needed time off work due to injury. A total of 20 days were lost in the last 12 months as a result of pain or discomfort attributed to obstetric work.

Conclusions

Our results demonstrate the prevalence of work-related injuries and its detrimental effects. Such injuries are underreported on incident reporting system. Ergonomics and WRMSI prevention in obstetrics and gynaecology is an area seldom discussed. Obstetric training sessions should incorporate ergonomic interventions. Further research is required to establish relevant aetiological factors related to WRMSI in this specialty.

     

European Network of Trainees in Obstetrics and Gynaecology—ENTOG Exchange 2017: an experience report from Slovenia outlining the different trainee situations around Europe

Purpose

The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) is a non-profit, independent organisation that represents young trainees in obstetrics and gynaecology around Europe. At present, ENTOG has 32 member countries. The organisation was founded in 1997 and shall assure the exchange of experiences between young physicians all over Europe. The aim is to improve the quality of traineeship in all participating countries and consequently enhance the standards for women’s healthcare.

Methods

This article reports about the experiences of trainees during the ENTOG Exchange 2017 in Slovenia and gives an overview of the trainee situations in different ENTOG member countries.

Results

The ENTOG exchange in Slovenia was a unique opportunity to get insights to the Slovenian medical system. Reflecting about their training situations, the participants found considerable differences in the training of young gynaecologists throughout Europe.

Conclusions

Working on the ENTOG goal of raising the quality of training is still highly relevant. The ENTOG exchange is an excellent way to build a network among trainees and stimulate their commitment to improve women’s healthcare in their home countries and beyond.

     

Suspicious Findings in Antenatal Care and Their Implications from the Mothers’ Perspective: A Prospective Study in Germany

ABSTRACT: Background: Antenatal care services are well established in Germany, with at least 10 routine antenatal consultations per pregnancy. Although many individual antenatal screening procedures and tests have been assessed in clinical trials, little is known about the overall prevalence of suspicious findings in routine antenatal surveillance and about related effects on psychological maternal well‐being. The objectives of this study were to evaluate the views of pregnant women on prevalence, type, and consequences of suspicious findings during antenatal care; to assess related worries and anxiety; and to compare the reports of risk factors by these women with the antenatal records. Methods: We enrolled 360 pregnant women participating in antenatal classes in the Rhein‐Neckar area, Germany. They were followed up from the beginning of antenatal classes to the puerperium using self‐administered structured questionnaires that covered previous antenatal consultations and related worries. The Spielberger State‐Trait Anxiety Inventory was used to assess current and general levels of anxiety. Antenatal records were also analyzed. Postnatally, pregnancy outcomes were assessed by telephone interviews. Results: Two‐thirds (67.2%) of antenatal care attendees reported suspicious or abnormal findings, almost half of which (45.1%) resulted from routine ultrasound scans. More than half (53.2%) of those with suspicious findings reported that they were acutely worried. The suspected problem often did not materialize: 13 (81.3%) of 16 suspected malformations and 34 (81%) of 42 suspected growth‐retarded babies were in the normal range. Many suspicious findings reported by mothers were not documented in the antenatal records. Conclusions: Contrary to their expectation of reassurance, most antenatal care attendees are warned about possible abnormalities, which often lead to further investigations and cause considerable worries. More research is needed to evaluate the long‐term impact and consequences of suspicious or false screening results in routine antenatal care. (BIRTH 35:1 March 2008)     

European Network of Trainees in Obstetrics and Gynaecology: experiences from the 2016 exchange programme in Turin,Italy

Introduction

The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) is an organization representing trainees from 30 European member countries. Together with the European Board and College of Obstetrics and Gynaecology (EBCOG), it seeks to achieve the highest possible standards of training and consequently to improve the quality of medical care in the field of gynaecology and obstetrics. Every year, the ENTOG council meets and holds a scientific meeting in a different European country. To coincide with this, the host country arranges an exchange, to which each member country can send two trainees. This exchange allows trainees to gain insight into both daily clinical work and the structure of the health care system.

Methods

This article reports the experiences of participants in the May 2016 ENTOG exchange to Turin, Italy. The aim is to outline differences in training between Germany and Italy as well as some striking differences with other European countries.

Perspective

The participants’ personal benefit from this unique experience was not only to get familiar with the Italian trainee programme and health care system, but also to exchange experiences among representatives from other European countries and build up a young gynaecological network within Europe.

     

Obstetrician-initiated counseling and testing for HIV infection: a cross sectional study

Abstract

Objective: To assess the practice of provider-initiated counseling and testing (PICT) for HIV infection by Nigerian Obstetricians and estimate missed opportunities at the gynecological and family planning clinics.

Methods: Online cross-sectional survey of members of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) over a 4-week period using SurveyMonkey®. Frequencies were used to present responses of participants.

Results: There were 201 (29%) respondents. Participants’ mean age was 46?±?7.2 (SD) years and majority (93.3%) held consultant positions. Most respondents (92.2%) cared for HIV-infected pregnant women with dedicated HIV counselors (77.4%), and in dedicated counseling rooms (71%). Majority (75.7%) had been trained on HIV management in pregnancy and 95.3% routinely counseled and tested women attending the booking antenatal clinic. Fourteen per cent (14%) and 16% of respondents conducted routine counseling and testing for women attending the gynecological and family planning clinics, respectively, for the first time. For every 100 women tested at the antenatal clinic, 317 women were missed at each of the two clinics.

Conclusions: PICT of HIV infection in Nigeria has focused on pregnancy. To eliminate new HIV infections in children, PICT should be routine at the gynecological and family planning clinics.     

Review of subspeciality training in obstetrics and gynaecology

Despite the changes that have occurred in the way that medical education is managed in the UK, the aims of subspecialisation, outlined by the RCOG over 25 years ago, remain. A close working relationship between the RCOG and postgraduate Deans will ensure satisfactory quality assurance of curricula and training programmes. It is important to confirm that the variety of training opportunities available to trainees meets the needs of the service and future developments in the NHS. The proportion of trainees undergoing subspeciality training compared with advanced training, with at least two ATSMs, needs to be driven by patient care requirements for planned developments of the clinical service. With the requirement of all trainees not doing subspeciality training to complete at least two ATSMs, it is important that the training opportunities focus on the needs of the trainees so that they are equipped to deliver high-quality care to patients as consultants. The implications of the EWTD and changes in clinical practice may mean that the length of subspeciality training may need to be increased; however, innovative ways of delivering training should also be considered. Models of ways how to adjust workforce requirements need to be explored so that whatever training pathway is chosen, trainees have a realistic chance of a consultant post. Links between academic medicine and subspecialisation will help to support innovation and high-quality training and research.Practice points

• Management of subspeciality training should follow the principles outlined by PMETB and the Gold Guide.

• The postgraduate Deans require reassurance from the RCOG and specialist societies of the quality of subspeciality programmes.

• There should be a coordinated approach to the allocation of training opportunities to subspeciality training and ATSMs to meet service needs.

Research agenda

• Formalise the place of academic medicine in subspeciality training.

• Agree upon an approach to match the number of subspeciality training posts to consultant job opportunities.

• Assess how new training techniques will ensure that trainees complete the curriculum within the PMETB approved time frame.

• Re-evaluate the PMETB requirement that trainees need to complete both the approved speciality and subspeciality curricula.

Does the antenatal detection of fetal growth restriction (FGR) have a prognostic value for mortality and short-term morbidity for very preterm infants? Results from the MOSAIC cohort

Objective: We investigated the impact of antenatal diagnosis of fetal growth restriction (FGR) on the risks of mortality and morbidity for very preterm infants given actual birthweight percentiles.

Methods: Data on 4608 live born infants 24–31 weeks of gestational age (GA) in 10 European regions in 2003 were used to compare in-hospital mortality, bronchopulmonary dysplasia (BPD) and severe neurological morbidity by birthweight percentiles and antenatal diagnosis of FGR. Other covariates were GA, sex, multiplicity, maternal complications, antenatal corticosteroids, birth in a level III center and region.

Results: Sixteen percent (n?=?728) of all infants and 72%, 30% and 6%, respectively, of those with birthweight percentiles <10th, 10th–24th and ≥25th had an antenatal diagnosis of FGR. After adjustment for clinical factors, antenatal diagnosis of FGR was not associated with mortality for infants with a birthweight ≥10th percentile (OR [95% CI]: 0.9 [0.5–1.9] and 1.0 [0.6–1.8] for birthweights between the 10th–24th percentile and ≥25th percentile, respectively), but infants with a birthweight <10th percentile had higher mortality (OR [95% CI]: 2.4 [1.0–5.8]). No association was observed at any birthweight percentile with BPD or severe neurological morbidity.

Conclusion: Antenatal diagnosis of FGR did not influence risks of mortality or morbidity when birthweight was ≥10th percentile; however, mortality risk was higher in antenatally detected infants with birthweight below the <10th percentile.     

New Developments in Education and Training in Sexual Medicine

Introduction.The past 12 months have been historic ones for the field of Sexual Medicine in that we have seen the creation of the European Board examination in Sexual Medicine with the title of “Fellow of the European Committee on Sexual Medicine” (FECSM) offered to successful candidates.Aim.The study aims to promote a high standard of care in Sexual Medicine.Methods.An important way of promoting high standards of care is by the development of training, regulation, and assessment framework. The background to these developments and the recent educational activities of the European Society for Sexual Medicine (ESSM) are described in this article.Results.The creation of the Multidisciplinary Joint Committee on Sexual Medicine (MJCSM) under the auspices of the European Union of Medical Specialists, with the primary purpose to develop the highest possible standards of training in Sexual Medicine in Europe, made it possible to create a process for qualification in Sexual Medicine. The ESSM educational activities created opportunities to support trainees in Sexual Medicine and the first MJCSM exam was held in Amsterdam with a high overall success rate.Conclusion.These activities are intended to improve quality. The FECSM examination is the first of its type and provides a real opportunity for Sexual Medicine physicians to demonstrate and document their knowledge.     

Fetal outcome of cases with diaphragmatic hernia

Abstract

Objective: The aim of this study is to report the short-term morbidity of congenital diaphragmatic hernia at a tertiary referral center in Karachi, Pakistan.

Methods: It is a retrospective cohort study of fetuses with congenital diaphragmatic hernia from January 2001 to December 2011. This includes all cases with prenatal diagnosis and those presenting in the postnatal period. This study analyses the survival of these cases and assesses the prognostic factors associated with the mortality of this condition.

Results: During the 11 year study period, 65 cases of diaphragmatic hernia were identified. Among these, 41 cases were diagnosed in the antenatal period while the rest of the 24 presented in the postnatal period. Fifty-eight out of the 65 (89%) were born alive. Only 38% of these survived beyond 28?days of life. Factors like antenatal diagnosis and birthweight significantly influenced the outcome while mode of delivery, site of lesion and gestational age at delivery did not affect the prognosis.

Conclusion: The overall mortality of congenital diaphragmatic hernia remains high. Survival rate of isolated hernia was substantially higher than those who had associated anomalies. The data from this study will provide the basis for counseling women in our setup.     

Cytomegalovirus (CMV) infection and pregnancy-potential for improvements in Australasian maternity health providers’ knowledge

Purpose: To assess the knowledge, practice and attitudes of maternity clinicians regarding congenital cytomegalovirus (CMV). It is the most common congenital infection, and well-recognized cause of neurodevelopmental disability and hearing loss. New consensus recommendations state all pregnant women and health-care providers should be educated about congenital CMV infection and preventive measures.

Materials and methods: An email questionnaire was distributed in October 2015 to specialists, diplomates (general practitioners), and trainees of the Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and Victorian and New South Wales midwives.

Results: 774 responded: (37.3% specialists, 17.3% diplomates, 16.8% trainees, 28.6% midwives). Clinicians had variable knowledge of fetal sequelae, transmission routes and prevention. Overall, 30.2% felt confident about discussing CMV in pregnancy: less than 10% of midwives (7.4%) and less than half of specialists (47.1%, p?Conclusions: Australasian maternity clinicians lack confidence and knowledge about congenital CMV. Few (<10%) routinely provide advice on prevention. There is urgent need for clinical guidance and patient information to reduce the burden of disease.     

Group Counseling for Mothers After Emergency Cesarean Section: A Randomized Controlled Trial of Intervention

Abstract: Background : An emergency cesarean section is often a traumatic experience for women, and can be associated with postnatal depression and posttraumatic stress. Various types of interventions have been tested to prevent such consequences. The purpose of this study was to test a model of group counseling for mothers after emergency cesarean section, and to examine its possible effects. Method : After undergoing an emergency cesarean section, 162 Swedish‐speaking women were randomized to group counseling or the control group. The participation rate was 75 percent. The counseling consisted of 2 sessions, conducted at about 2 months postpartum; 72 percent of the women randomized to the counseling group actually attended the sessions. At 6 months postpartum, all study participants completed a postal questionnaire (response rates were 92% in the counseling group and 89% in the control group). Results : No difference between the groups was found in terms of the level of fear after childbirth, symptoms of posttraumatic stress, or postnatal depression at 6 months after the emergency cesarean. The group counseling was much appreciated by the participating women, some of whose experiences are reported in this paper. Conclusion : Group counseling for mothers after emergency cesarean section did not influence their views on the recent delivery or prevent symptoms of posttraumatic stress or postnatal depression. It was, however, appreciated and did no harm. In future studies, other outcomes should be measured.     

Effects of antenatal education on fear of childbirth,maternal self-efficacy and parental attachment

Objectiveto examine the effects of antenatal education on fear of childbirth, maternal self-efficacy, and maternal and paternal attachment.Designquasi-experimental study, comparing an antenatal education group and a control group.Participants63 pregnant women and their husbands.Measurementsdemographic data forms, the Wijma Delivery Expectancy/Experience Questionnaire, the Childbirth Self-Efficacy Inventory, the Maternal Attachment Inventory and the Postnatal Paternal–Infant Attachment Questionnaire were used for data collection.Findingsantenatal education was found to reduce the fear of childbirth and to increase childbirth-related maternal self-efficacy. However, antenatal education was found to have no effect on parental attachment.Key conclusionsit is recommended that widespread antenatal education programmes should be provided in developing countries, and the content of the education programme about parental attachment should be increased.Implications for practicethis study found that antenatal education has no influence on maternal and paternal attachment. As such, there is a need to increase the content of the education programme about parental attachment.     

“Are you doing your pelvic floor?” An ethnographic exploration of the interaction between women and midwives about pelvic floor muscle exercises (PFME) during pregnancy

ObjectiveMany women experience urinary incontinence (UI) during and after pregnancy. Pelvic floor muscle exercises (PFME) can prevent and reduce the symptoms of UI. The objective of the study was to explore challenges, opportunities and concerns for women and health care professionals (HCPs), related to the implementation of PFME training for women in current antenatal care.DesignAn ethnographic study design was used. Researchers also formed and collaborated with a public advisory group, consisting of seven women with recent experiences of pregnancy, throughout the study.ParticipantsSeventeen midwife-woman interactions were observed in antenatal clinics. In addition, 23 midwives and 15 pregnant women were interviewed. Repeat interviews were carried out with 12 of the women postnatally. Interviews were also carried out with other HCPs; four physiotherapists, a linkworker/translator and two consultant obstetricians. Additional data sources included field notes, photographs, leaflets, policy and other relevant documents.SettingData were collected in three geographical areas of the UK spanning rural, urban and suburban areas. Data collection took place in antenatal clinics, in primary and secondary care settings, and the majority of women were interviewed in their homes.FindingsThree broad and inter-related themes of “ideological commitment”, “confidence” and “assumptions, stigma and normalisation” were identified. The challenges, opportunities and concerns regarding PFME implementation were explored within these themes.Conclusions and implications for practiceAlthough HCPs and some women knew that PFME were important, they were not prioritised and the significant benefits of doing PFME may not have been communicated by midwives or recognised by women. There was a lack of confidence amongst midwives to teach PFME and manage UI within the antenatal care pathway and amongst women to ask about PFME or UI. A perceived lack of consistent guidelines and policy at local and national levels may have impeded clear communication and prioritisation of PFME. Furthermore, assumptions made by both women and midwives, for example, women regarding UI as a normal outcome of pregnancy, or midwives’ perception that certain women were more likely to do PFME, may have exacerbated this situation. Training for midwives to help women in the antenatal period to engage in PFME could address challenges and concerns and to help prevent opportunities for women to learn about PFME from being missed.