Pam Parker

Effectiveness of vaginal breech birth training strategies: An integrative review of the literature.

BACKGROUND The safety of vaginal breech birth depends on the skill of the attendant. The objective of this review was to identify, synthesize, and report the findings of evaluated breech birth training strategies. METHODS A systematic search of the following on-line databases: Medline, CINAHL Plus, PsychINFO, EBM Reviews/Cochrane Library, EMBASE, Maternity and Infant Care, and Pubmed, using a structured search strategy. Studies were included in the review if they evaluated the efficacy of a breech birth training program or particular strategies, including obstetric emergency training evaluations that reported differentiated outcomes for breech. Out of 1040 original citings, 303 full-text articles were assessed for eligibility, and 17 methodologically diverse studies met the inclusion criteria. A data collection form was used to extract relevant information. Data were synthesized, using an evaluation levels framework, including reaction, learning (subjective and objective assessment), and behavioral change. RESULTS No evaluations included clinical outcome data. Improvements in self-assessed skill and confidence were not associated with improvements in objective assessments or behavioral change. Inclusion of breech birth as part of an obstetric emergencies training package without support in practice was negatively associated with subsequent attendance at vaginal breech births. CONCLUSIONS As a result of the heterogeneity of the studies available, and the lack of evidence concerning neonatal or maternal outcomes, no conclusive practice recommendations can be made. However, the studies reviewed suggest that vaginal breech birth training may be enhanced by reflection, repetition, and experienced clinical support in practice. Further evaluation studies should prioritize clinical outcome data.

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Mechanisms that support the assessment of interpersonal skills: A Realistic Evaluation of the interpersonal skills profile in pre-registration nursing students

In many health professions, experienced practitioners assess students’ or inexperienced practitioners’ clinical skills but do not formally or explicitly rate their interpersonal skills, even though it is often suggested that failing or struggling students have poor interpersonal skills. The Interpersonal Skills Profile (ISP) has been widely used in UK health care programmes. The tool allows assessors to select five statements from a list, which they feel reflect the student’s achievement. These are usually graded from fail to excellent. Using a Realistic Evaluation approach this study examined how the ISP was used to assess interpersonal skills in a university pre-registration nursing programme. The use of the ISP was investigated through interviews with clinical nursing mentors, practice education facilitators and education champions as well as a documentary analysis of student assessment booklets. The findings led to the development of three middle range theories which may be useful in other contexts. These focus on: 1) overt assessment of interpersonal skills, 2) providing support to mentors and 3) feedback and ‘feeding-forward’ to students.

Deliberate acquisition of competence in physiological breech birth: A grounded theory study

PROBLEM Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems. BACKGROUND Due to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear. QUESTION How do professionals develop competence and expertise in physiological breech birth? METHODS Nine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition. RESULTS Among the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners. DISCUSSION The results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices. CONCLUSION Deliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way.

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Effectiveness of Vaginal Breech Birth Training Strategies: An Integrative Review of the Literature

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DEVELOPING EDUCATIONAL LEADERSHIP

Developing effective leadership within an academic setting is becoming increasingly important in the UK with the changes in the higher education sector. This is particularly pertinent in relation to the leadership of learning and teaching activities, where, for the first time, there will be more systematic external review and benchmarking of academic practice through the introduction of the Teaching Excellence Framework (TEF). However, ensuring that we are giving our current and future leaders’ appropriate development, both in terms of relevance and timeliness, is more challenging. Stefani [1] identifies this as being an under researched area and, anecdotally, the two principal investigators know that many programme leaders and those in head of department roles often have received little or no development for their role. However, leading education is central to the development of high quality programmes and student success and satisfaction. McInnis, Ramsden and Maconachie [2] outline the need for robust leadership if colleagues are to be inspired and influenced. In order to prepare our staff more effectively for the requirements of educational leadership, at City, University of London, we are undertaking research to explore what knowledge, skills, support and preparation staff need for these roles. This project involves a range of data collection from both existing leaders and those either new or aspiring to these roles. This paper discusses our initial data gathered from a survey via an online questionnaire of open questions with 17 education leaders. The paper will outline their views of the knowledge and skills needed to undertake such a role, the support and preparation they had for their role and what support and preparation they believe new leaders need. The paper will then conclude with some recommendations arising from this data and outline the next stages of the research.

Personal Tutoring enhancing staff and student experiences

This paper reports on the review of a personal tutoring policy in one United Kingdom Higher Education Institution. In order to review the policy a stakeholder group was set up and some empirical data was collected and analysed alongside a literature review. Whilst there were a range of data sources this paper will focus on the data that was collected from individual and focus group interviews with 19 academic staff and 34 students. The themes that arose from the data included allocation of personal tutors, the role and process of personal tutoring, other sources of support, record keeping and references and staff development and recognition. Overall there were many positives findings in relation to personal tutoring but there were some suggestions that would enhance this process further. These were mostly to provide further clarity over around the whole process and provide additional support for the role in relation to record keeping and ensuring staff had the knowledge to undertake the role competently. The paper concludes with an overview of the recommendations and changes to the policy which are now in place.

Mechanisms that support the assessment of interpersonal skills

In many health professions, experienced practitioners assess students’ or inexperienced practitioners’ clinical skills but do not formally or explicitly rate their interpersonal skills, even though it is often suggested that failing or struggling students have poor interpersonal skills. The Interpersonal Skills Profile (ISP) has been widely used in UK health care programmes. The tool allows assessors to select five statements from a list, which they feel reflect the student’s achievement. These are usually graded from fail to excellent. Using a Realistic Evaluation approach this study examined how the ISP was used to assess interpersonal skills in a university pre-registration nursing programme. The use of the ISP was investigated through interviews with clinical nursing mentors, practice education facilitators and education champions as well as a documentary analysis of student assessment booklets. The findings led to the development of three middle range theories which may be useful in other contexts. These focus on: 1) overt assessment of interpersonal skills, 2) providing support to mentors and 3) feedback and ‘feeding-forward’ to students.