Diane J. Angelini

Obstetric triage revisited: update on non-obstetric surgical conditions in pregnancy.

New findings and diagnostic advances warrant revisiting key features of acute non-obstetric abdominal pain in pregnancy. Four of the most frequently seen conditions warranting surgical intervention are: appendicitis, cholecystitis, pancreatitis, and bowel obstruction. Because pregnancy often masks abdominal complaints, effectively assessing and triaging abdominal pain in pregnant women can be difficult. Working in obstetric triage settings and triaging obstetric phone calls demand continual updating of abdominal assessment knowledge and clinical skills.

Obstetric Triage: Models and Trends in Resident Education By Midwives

Four models of resident education in obstetric triage with midwifery faculty consultants are presented. Common trends in the structure and function of these models are reviewed. The four models represent diverse settings where midwives serve as clinical teachers primarily for first-year obstetric residents and residents from other subspecialties. Each model supports a growing number of midwives working in the triage setting, functioning as both teacher and consultant for new residents. This expanded midwifery teaching role extends beyond labor assessment to include a wide range of common obstetric and gynecologic conditions in the triage setting. Additional advantages include the ability of the midwife to bill for triage services and to provide a safety net to decrease medical errors which, in a busy triage unit, occur most often during patient transfers.

A National Survey of the Midwifery Director Role in Academic Midwifery Practices Involved in Medical Education in the United States

A survey to explore the role characteristics and key responsibilities of midwifery directors in academic practices involved in medical education in the United States was undertaken. Six key content areas were investigated: role responsibilities and characteristics, interaction with other medical divisions and committees, budgetary structure, interaction with learners, clinical schedules, and job satisfaction. A mail-based descriptive survey was distributed to 112 midwifery directors with a 56% response rate (N = 63). The results show a composite profile of academic midwifery practice directors involved in medical education that work primarily for departments of obstetrics and gynecology, are championed by the departmental chairperson, and have budgetary placement under this department. Collaboration with the residency director has not been fully realized, thereby limiting midwifery exposure and input regarding medical education, curricula changes, and access to key education committees. National changes in resident work hours had both a positive and negative impact on the director and overall midwifery practices. Job satisfaction documents both positive and challenging aspects to the director position, and most directors felt successfully integrated with physician colleagues.

Midwifery and Medical Education: A Decade of Changes

Midwives practice in a variety of settings and have many different roles. This issue of the Journal of Midwifery & Women’s Health focuses on one role that is receiving increasing attention: midwives’ contributions to medical education. A 1998 survey found 176 midwives who participated in medical education at that time. The new survey data published in this issue show that the number of midwives involved in medical education has tripled in the past 10 years. The Journal of Midwifery & Women’s Health is pleased to highlight ways in which midwives work with and educate physician learners today. Documenting this role is important not only to understand its current implementation, but also to help the continued development of interdisciplinary models in medical education. Additionally, these articles provide a starting point to further investigate outcomes in interdisciplinary education and identify strategies that optimize teaching and learning for all disciplines involved. Although interdisciplinary practice models vary in structure and function, certain commonalities are found in the studies and reports in this issue: 1) this midwifery role appears well established, and midwives in medical education have been growing in number since 1998; 2) midwifery’s involvement in medical education has positive implications for billing and reimbursement; 3) midwives serving as educators and consultants for medical student and resident learners is well received by everyone involved; 4) as these models develop, there is a trend toward an integrated, universal curriculum for all learners; and 5) more recently, the growth of this model has been facilitated by the decrease in resident work hours. As midwives work in medical education, new avenues for learning emerge. These are two-lane highways in that learning is shared between the midwives and the medical students and residents who are involved. Obstetric residents will soon be our obstetric consultants. As we each learn more about the professional cultures of our respective disciplines, we not only improve education but also grow closer to the ideal practice environment wherein interdisciplinary teams work in harmony without the burden of territorial boundaries and conflicts. What does the future hold for interdisciplinary education? With further refinements looming regarding resident work hours, more opportunities to be involved in medical education may present themselves, and we can expect new initiatives that will start by meeting the needs of the institutions that include midwives in medical education. However, medical student and resident teaching needs to be balanced by the concern that midwifery faculties not become overextended or overburdened. As midwifery involvement in medical education matures in individual sites, those involved can share ideas and work to collectively identify and initiate new and better ways of teaching and learning. Interdisciplinary education and practice benefit physicians, midwives—and ultimately—the women we serve.