Introducing educational theory: vaginal examination

A vaginal examination (VE) is one of many core skills used in midwifery practice. Despite the controversy of whether it is necessary in all situations, in this article I take the standpoint that it is useful in providing a full clinical picture, especially at times when closer monitoring is recommended. Additionally, if the core skill is misinterpreted, the findings of the VE can distort the true clinical picture. To support the student, subjective assessment and individual learning pathways must be addressed to avoid unnecessary intervention and psychological impairment to the woman. This article explores some of the difficulties encountered with teaching and learning VE in clinical practice and offers concepts from educational theory to assist in clarifying the difficulties and offering new ways of thinking for both students and midwives

Thinking outside the box

The MEOWS chart is a valid tool in identifying physiological changes preceding critical care. But Jo Killingley questions whether it promotes the development of critical analysis in midwives

Training for resilience: why are you leaving, you have just got here? An examination of attrition in pre-registration and preceptorship midwives

Jo Killingley explores some of the factors that contribute to attrition in Midwifery

Sustainable birth:case-loading

The Better Births national maternity review (NHS England 2016) has been gratefully received as a chance to improve maternity services to support women-centred care for better birth experiences. As Baroness Cumberlege stated (NHS England 2016) the commitment, determination and passion from health professionals to improve outcomes for women, babies and their families have been crystal clear. Therefore this is a perfect opportunity to engage and encourage caseloading in maternity units as a sustainable and viable model of care which supports women and promotes midwives’ satisfaction

Student midwives' perspectives on the efficacy of feedback after objective structured clinical examination

Students’ experience of feedback is considered an indicator of the efficacy of the assessment process. Negative experiences of feedback are unproductive in terms of the likelihood that students will act upon and learn from assessment. To understand the impact of feedback on learning this study explored the experiences of student midwives after receiving feedback following Objective Structured Clinical Examination (OSCE). Data were collected from second year undergraduate student midwives who had recently completed OSCE, via a focus group. Students reported raised stress levels, concerns around legitimacy of feedback, and inconsistencies in the manner in which feedback was articulated. Assessment feedback in higher education should be used to empower students to become self-regulated learners. This is important for student midwives for whom a considerable amount of leaning is spent in practice. The study has implications for midwifery academics concerned with modes of assessment and quality of assessment feedback in midwifery education

RCM Conference poster: law and the midwife: collaborative working

Maternity claims account for the second most numerous but most costly negligence claims (NHSLA 2012). Existing research has identified links between the fear of litigation and defensive medicine (Symons 2006; 1998; Hood et al 2010). Prompted by Government calls for more collaborative working practices, lecturers from the Law and Midwifery departments united to explore and implement collaborative teaching and learning. The initial aim was to dispel fears of litigation by creating a teaching event involving final year law and midwifery undergraduate students. Interprofessional education (IPE) is when two or more professions learn with, from and about each other to improve collaboration and the quality of care (CAIPE). IPE has been found to enhance collaborative practice (WHO 2010). Hammick et al suggest that adapting Interprofessional education to show “reality of practice” and “authenticity” for specific groups of learners leads to beneficial results (Hammick et al 2007). Gilligan’s study noted that students found most valuable those sessions where they were able to work alongside other professional students on an actual problem thereby learning from each other. Interaction with other professional student groups was valued over a simple lecture by a lecturer from another professional group, for instance. (Gilligan et al 2014). We applied these examples of good practice to a law and midwifery setting in a combined workshop. The teaching event fostered an exchange of ideas through problem based learning, case study review and debate surrounding high profile cases. The debate was lively, analytical and reflective. This interprofessional learning was well received by both sets of students and they requested further sessions scheduled earlier in the academic year. These workshops are being planned using the same model of teaching both groups together working on solving problems ensuring interaction between the two professional groups. To encourage further communication between the professional cohorts, a series of evening seminars “Health and the Law: Round table discussions” are planned during 2014/15 to tackle complex topics medico-legal issues such as forced caesarean, mental health and vulnerable families. Speakers from multiple disciplines will discuss issues related to and seen from their professional perspective. The aim is to initiate contact and debate between the professions to enhance good practice in NHS trusts, give students further opportunities for interprofessional learning and to also provide a platform to assist staff in their Continuing Professional Development. The collaborative model has also led to a qualitative research project we are planning on assessing midwives’ fear of litigation matched against the actual incidence of litigation due to be completed by September 2015

Midwives fear of litigation: justified or not?

Existing research has identified links between the fear of litigation and defensive practice (Symons 2006; 1998; Hood et al 2010; Charles et al 1985). Although there have been studies of doctors perceptions of litigation little has been written about the position on midwives (Vincent et al 1994). Specifically there is a lack of research in England on measuring the actual likelihood of litigation set against midwives’ perceptions of the threat. This project explores midwives' fear of legal action, and if present, what they fear and their perceived assessment on how this may affect their practice. The project will assess whether fears match the reality as measured by the number and types of clinical negligence claims brought against midwives nationally in a specified period. The research strategy will use: (1) qualitative assessment of midwives’ perceptions in a focus group of a sample of midwives working in an NHS Trust (2) quantitative assessment of the extent of the identified fears (3) evaluation of the extent of fears against the actual incidences of litigation. The project challenges the perceptions, myths and misunderstandings midwives may have by reference to the likelihood of legal action and therefore its consequent impact on professional practice. The anticipated benefits of the research include additions to the body of knowledge which informs the training of midwives in respect of their perceptions of the threat of litigation as well as identifying any myths or misunderstandings

The Worthington Effect and the origin of the Younger Dryas

An increase in CO2 content of the atmosphere during deglaciation is explained by buildup of shelf carbonate with concomitant release of excess CO2 to the surrounding upper ocean, from whence some of it enters the atmosphere. Mixing with deep water removes excess CO2 to the abyss where it is used up in dissolving foraminifera and coccoliths...

18O fractionation in barnacle calcite: A barnacle paleotemperature equation

The calcitic shells of sessile barnacles (Balanomorpha) taken from ocean waters ranging in temperature from -2° to 26°C have a near constant 18O enrichment compared with mollusk values assumed to be at thermodynamic equilibrium…