Gayle McLelland

Crossing professional barriers with peer-assisted learning: Undergraduate midwifery students teaching undergraduate paramedic students

BACKGROUND Peer assisted learning (PAL) has been shown in undergraduate programmes to be as effective as learning from instructors. PAL is a shared experience between two learners often with one being more senior to the other but usually both are studying within the same discipline. Interprofessional education occurs when two or more professionals learn with, from and about each other. Benefits of PAL in an interprofessional context have not been previously explored. As part of a final year education unit, midwifery students at Monash University developed workshops for second year undergraduate paramedic students. The workshops focused on care required during and after the birth of the baby. AIM To investigate the benefits of an interprofessional PAL for both midwifery and paramedic students. METHODS Data for this project were obtained by both quantitative and qualitative methods. Questionnaires were distributed to both cohorts of students to explore experiences of peer teaching and learning. Results were analysed using Statistical Package for Social Sciences (SPSS). Focus groups were conducted separately with both cohorts of students and transcripts analysed using a thematic approach. FINDINGS Response rates from the midwifery and paramedic students were 64.9% and 44.0% respectively. The majority of students regardless of discipline enjoyed the interprofessional activity and wanted more opportunities in their curricula. After initial anxieties about teaching into another discipline, 97.3 (n = 36) of midwifery students thought the experience was worthwhile and personally rewarding. Of the paramedic students, 76.9% (n = 60) reported enjoying the interaction. The focus groups supported and added to the quantitative findings. Both midwifery and paramedic students had a new-found respect and understanding for each others disciplines. Midwifery students were unaware of the limited knowledge paramedics had around childbirth. Paramedic students admired the depth of knowledge displayed by the midwifery students. IMPLICATIONS This study indicates both educational and professional benefits for undergraduate students from different disciplines having shared PAL activities.

No fixed place of birth: Unplanned BBAs in Victoria, Australia

OBJECTIVES the primary objective-to present data on the incidence of unplanned births before arrival (BBAs) in Victoria between 1991 and 2008. The secondary objective-to provide an extensive literature review highlighting the issues surrounding an unplanned BBA. SETTING the incidence of BBAs in Victoria published in the relevant government reports. DESIGN data were extracted from published government reports pertaining to perinatal statistics in Victoria-The Australian Institute of Health and Wellbeing and the Perinatal Data Collection Unit of Victoria. Data on place of birth for each year from both sources was identified and tabulated. Comparisons between the data sources were undertaken to provide a picture of the scope of out of hospital birth. FINDINGS the incidence and absolute numbers of unplanned birth before arrival (BBA) to hospital in Victoria, are low compared to the total births. However, this number is comparable to unplanned BBAs in other developed countries with similar health systems. The incidence of unplanned BBAs has slowly but steadily doubled since 1991-2008. The two data sources almost mirror each other except for 1999 when there was an unexplained difference in the reported incidence in unplanned BBAs. Maternal and neonatal outcomes are disproportionally much poorer after unplanned BBAs than either planned home births or in hospital births. Various maternal factors can increase the risk of an unplanned BBA. KEY CONCLUSIONS multiple approaches should be adopted to manage unplanned BBAs. Antenatal screening should be undertaken to identify the women most at risk. Strategies can be developed that will reduce poor neonatal and maternal outcomes, including education for women and their partners on immediate management of the newborn; ensuring paramedics have current knowledge on care during childbirth; and maternity and ambulance services should develop management plans for care of women having unplanned BBAs.

Involvement of emergency medical services at unplanned births before arrival to hospital: a structured review

Objective While infrequent, unplanned births before arrival (BBAs) are clinically significant events at which, conceivably, paramedics will be the first health professionals in attendance. This review aims to demonstrate that paramedics not only attend and transfer birthing women, but also use critical clinical and decision-making skills. It further proposes strategies that will support paramedics manage out-of-hospital obstetric emergencies. Design The bibliographic databases EMBASE, MEDLINE, CINAHL and Maternity and Infant Care were searched from 1991 to 2012 for relevant English language publications using key words and Medical Subject Heading (MeSH) terms. Data were extracted with respect to study design, incidence of BBAs, attendance of paramedics, complications and recommendations. Results Fourteen studies were selected for inclusion arising from the US, UK and Europe. While all studies acknowledged paramedics attend BBAs, seven reported the incidence of BBAs attended by paramedics, and two discuss issues specifically encountered by paramedics. Paramedics attended between 28.2% and 91.5% of all BBAs. While the articles reviewed noted that most of the births encountered by paramedics were uncomplicated, they all reported maternal or neonatal complications. Eight articles reported the most common maternal complication was excessive bleeding after birth, and nine reported the most frequent neonatal complication was hypothermia regardless of gestation. Conclusions Paramedics need to be adequately educated and equipped to manage BBAs at both undergraduate and graduate levels. Protocols should be developed between health and ambulance services to minimise risks associated with BBAs. A dearth of information surrounds the incidence of BBAs attended and the management performed by paramedics highlighting the need for further research.

Can we teach core clinical obstetrics and gynaecology skills using low fidelity simulation in an interprofessional setting

Core clinical skills acquisition is an essential component of undergraduate medical and midwifery education. Although interprofessional education is an increasingly common format for learning efficient teamwork in clinical medicine, its value in undergraduate education is less clear. We present a collaborative effort from the medical and midwifery schools of Monash University, Melbourne, towards the development of an educational package centred around a core skills‐based workshop using low fidelity simulation models in an interprofessional setting. Detailed feedback on the package was positive with respect to the relevance of the teaching content, whether the topic was well taught by task trainers and simulation models used, pitch of level of teaching and perception of confidence gained in performing the skill on a real patient after attending the workshop. Overall, interprofessional core skills training using low fidelity simulation models introduced at an undergraduate level in medicine and midwifery had a good acceptance.

A demographic snapshot of midwives in Victoria.

Midwifery in Victoria has experienced significant change over the last twenty years. Over more recent years, midwifery workforce issues have become prominent with studies highlighting an ageing midwifery population and a high proportion of part time employment. During a study conducted in 2005 that explored midwives’ attitudes to online and computer based learning the demographic data proved to warrant more detailed analysis. This paper presents a discussion on that data. Participants for the study were drawn from the membership of the Australian College of Midwives (ACM)Victorian branch. However, while the sample was small (n=169), the findings presented in the paper add to the existing body of knowledge around the midwifery workforce in Victoria. They reinforce that the midwifery workforce remained an ageing one, predominantly female, and a significant percentage were employed on part time or casual bases. With graduates emerging from recently introduced undergraduate midwifery programs, it is argued that it is timely for larger studies of the midwifery workforce to be conducted. Studies should seek to explore a range of factors such as reasons why midwives are choosing not to work in full time employment.

Embedding assessment in a simulation skills training program for medical and midwifery students: A pre- and post-intervention evaluation

Simulation‐based programs are increasingly being used to teach obstetrics and gynaecology examinations, but it is difficult to establish student learning acquired through them. Assessment may test student learning but its role in learning itself is rarely recognised. We undertook this study to assess medical and midwifery student learning through a simulation program using a pre‐test and post‐test design and also to evaluate use of assessment as a method of learning.

Paramedics' involvement in planned home birth: A one-year case study

OBJECTIVE to report findings from a study performed prior to the introduction of publicly funded home birth programmes in Victoria, Australia, that investigated the incidence of planned home births attended by paramedics and explored the clinical support they provided as well as the implications for education and practice. METHODS retrospective data previously collected via an in-field electronic patient care record (VACIS(®)) was provided by a state-wide ambulance service. Cases were identified via a comprehensive filter, manually screened and analysed using SPSS version 19. RESULTS over a 12-month period paramedics attended 26 intended home births. Eight women were transported in labour, most for failure to progress. Three called the ambulance service and their pre-organised midwife simultaneously. Paramedics were required for a range of complications including post partum haemorrhage, perineal tears and neonatal resuscitation. Procedures performed for mothers included IV therapy and administering pain relief. For infants, paramedics performed intermittent positive pressure ventilation, endotracheal intubation and external cardiac compression. Of the 23 women transferred to hospital, 22 were transported to hospital within 32minutes. CONCLUSIONS findings highlight that paramedics can provide clinical support, as well as efficient transportation, during perinatal emergencies at planned home births. Cooperative collaboration between ambulance services, privately practising midwives and maternity services to develop guidelines for emergency clinical support and transportation service may minimise risk associated with planned home births. This could also lead to opportunities for interprofessional education between midwives and paramedics.

Investigation of the self-reported health and health-related behaviours of Victorian mothers of school-aged children

Lifestyle may influence many health-related issues currently facing Australian women. The extent to which women with school-aged children attend to their own health is unknown and the associations between health behaviours and health status requires investigation. This study aimed to investigate the prevalence of health behaviours (alcohol consumption, health-promoting activities) and their impact on self-reported health (weight, sleep quality, mental health) among mothers of school-aged children in Victoria. Mail-out survey design (n=263) including the Depression Anxiety Stress Scale (DASS) and Health Promoting Activities Scale was used to explore issues. The results indicated that substantial numbers of mothers reported moderate to extreme DASS scores: depression (n=45, 17%); anxiety (n=41, 15.6%); stress (n=57, 21.7%). The majority participated in physical activity less often than daily. High rates of daily alcohol use (20%) and poor sleep quality were reported. Nearly one-half (n=114, 46%) of the sample were overweight or obese and also reported poorer mental health than other women in the sample (P<0.001). Significant associations were detected between maternal weight, mental health and participation in health-promoting activities. The findings indicate that there is a need for increased health education and services for women with school-aged children. Direct services and population-based health promotion strategies may be required to address healthy lifestyle issues and educate mothers about the possible health legacy of poor health behaviours.

Antenatal Emergency Care Provided by Paramedics: A One-Year Clinical Profile

Abstract Objective: To report on clinical and socio-demographic factors of a one-year caseload of women attended by a statewide ambulance service in Australia, who presented during pregnancy, prior to the commencement of labor. Methods: Retrospective clinical data collected via in-field electronic patient care record (VACIS®) by paramedics during clinical management was provided by Ambulance Victoria. Cases were electronically extracted from the Ambulance Victoria Clinical Data Warehouse via comprehensive filtering followed by case review. Results: Over a 12-month period, paramedics were called to 2,098 women with pregnancy as a primary or non-primary clinical consideration. Womens ages ranged from 14 to 48 years. The majority were multigravidas (86%). There was a greater chance that ambulance services would be required during business hours than any other time of the day. Paramedics noted pregnant women required ambulance services for a range of primary presenting symptoms both obstetric (n = 1137) and non-obstetric (n = 961). Some women had pre-existing conditions including asthma, hypertension, and diabetes potentially complicating their pregnancies. Paramedics administered analgesia to one third of the women. Paired t-tests revealed significant improvement in the pain relief and overall vital signs of the women encountered. Less than half the women (n = 986, 47%) required interventions. Conclusions: This is a unique population wide analysis of ambulance service resource use exploring the clinical profile of pregnant women requiring ambulance services in one calendar year. To manage obstetric and non-obstetric complications in this population safely and effectively, paramedics require an understanding of the unique physiological adaptions during pregnancy. This study therefore has both educational and practice implications.

Interprofessional education and practice guide No. 9: Sustaining interprofessional simulation using change management principles

ABSTRACT Collaboration between teams is an essential component of patient safety in the complex ever-changing environment of healthcare. Collaborative practice requires training, which needs to start prior to registration for it to be established in the clinical workforce by graduation. Despite the perceived value and motivation of course coordinators, interprofessional training programs often struggle to sustain, due to various reasons related to logistics of timetabling, staff availability and/or absence of institutional support. We present a guide, outlining the lessons learned from implementing a sustainable change from our 6-year experience of the Women’s Health Interprofessional Learning through Simulation (WHIPLS) program. The WHIPLS program was initially piloted to teach clinical skills in an interprofessional environment for pre-registration medical and midwifery students and has become a core component of the clinical curriculum. We describe the steps that were required to attain this outcome using the Kotter’s 8-step plan for management change. The key lessons learned were identifying overlaps in course curriculum, planning for leadership and implementation, creating institutional “buy-in”, aligning with national goals, focusing on the learner, translating into routine clinical practice, keeping the program simple, accepting innovation and considering a strategic evaluation.