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Descriptors:
Pregnancy; Helping Relationship; Program Implementation; Social Work; Home Visits; Quasiexperimental Design; Fidelity; Dropout Rate; Parent Education; Females; Caseworkers; Foreign Countries; Obstetrics; Comparative Analysis; Dropouts; Program Effectiveness; Correlation

Abstract:
As different competencies or professional backgrounds may affect the quality of program implementation, staffing is a critical issue in home visiting. In this study, N = 430 women received home visits delivered either by a tandem of a midwife and a social worker or by only one home visitor (primarily midwives, continuous model). The groups were compared in a quasi-experimental design on level of participation, implementation of the contents, and clients' responsiveness during pregnancy and child's first year of life. Trends towards a higher dropout rate and lower ratings of the helping relationship indicate an increased challenge to retain a strong working alliance in the tandem model. This is attributable to a stronger orientation towards the participants' interest in the continuous model, whereas treatment fidelity in the tandem model is higher. Recommendations to improve the helping relationship in the tandem model are given. (Contains 5 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Obstetrics; Nursing; Masters Programs; Nurses; Higher Education; Females; Prenatal Care; Patients; Health Services; Health Education; Pregnancy

Abstract:
With Boston serving as a hub of both educational and medical excellence, it's no wonder that New England has a high reputation to uphold in both of these areas. However, Boston and the rest of the region lack a specific degree program that is putting New England below the radars of potential midwives. Certified nurse-midwifery is a popular field with registered nurses seeking higher education who wish to have a larger role in managing prenatal patient care than they would as labor and delivery nurses. Expectant mothers are also showing interest in using the midwife model for a more holistic method of perinatal care than they might get with the traditional obstetric approach. But New England, home to more than 250 colleges and universities, offers this degree in only two places: (1) a satellite program at Baystate Medical Center in Springfield, Massachusetts (in which the degree-granting institution is Philadelphia University); and (2) Yale University. With the nation focused intensely on the cost of healthcare, it would be beneficial for New England to train and employ nurse-midwives, who have proven to provide clinically competent perinatal care to women at a lower price. So why don't New England's colleges and universities see the potential in educating certified nurse-midwives? If there's interest and support from the midwifery community, it seems like the decision would be an easy one. Unfortunately, programs in the region have found that it's not that simple. Despite the fact that a school gets inquiries from interested students, a master's program in nurse-midwifery is an expensive program to run and without the proper funding it just isn't feasible. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Pregnancy; Females; Substance Abuse; Student Attitudes; Control Groups; Obstetrics; Gynecology; Clinics; Medical Students; Drug Rehabilitation; Attitude Change; Graduate Medical Education; Surveys; Patients; Barriers; Disclosure

Abstract:
Objective: The study objective was to determine whether medical students' attendance at a rehabilitation residence for pregnant women with substance-use disorders yielded changes in their attitudes and comfort levels in providing care to this population. Methods: This randomized educational trial involved 96 consecutive medical students during their obstetrics and gynecology clerkship. In addition to attending a half-day prenatal clinic designed for women with substance-use disorders, every student was randomly assigned either to attend (Study group) or not to attend (Control group) a rehabilitation residence for pregnant women with substance-use disorders. The primary objective was to measure differences in responses to a confidential 12-question survey addressing comfort levels and attitudes, at the beginning and end of the clerkship. Results: Survey responses revealed improvements in students' comfort levels and attitudes toward pregnant women with substance-use disorders by attending the clinic alone or the clinic and residence. Those who attended the residence reported becoming more comfortable in talking with patients about adverse effects from substance abuse, more understanding of "street" terms, and stronger belief that patients will disclose their substance use to providers. Residents expressed more openly their hardships and barriers while trying to set therapeutic goals. Conclusions: Medical students became more comfortable and insightful about pregnant women with substance-use disorders after attending a rehabilitation residence in addition to a prenatal clinic dedicated to this population. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Foreign Countries; Obstetrics; Sustainability; Nursing Education; Clinical Experience; Pilot Projects; Problems; Program Development; Program Implementation; Computer Assisted Instruction; Instructional Design; Educational Technology; Electronic Learning; Technology Integration; Computer Simulation; Simulated Environment; College Instruction; Case Studies; Clinical Teaching (Health Professions); Allied Health Occupations Education

Abstract:
Pressures in terms of the availability of quality, real-life clinical experiences for students have resulted in increased interest in the use of simulation in a variety of healthcare disciplines. "Te wahi whanau: The birth place" is a Virtual Birth Centre (VBC) that was created in "Second Life" in 2009 as part of the Second Life Education in New Zealand (SLENZ) initiative. It was introduced to midwifery students at two New Zealand polytechnics, with the aim of exposing the students to a birth centre environment and providing them with an opportunity to practise midwifery through immersion and engagement in a number of clinical scenarios. It has been just over two years since the development of the VBC, yet it is no longer used in the midwifery programs in which it was introduced. Using the VBC as a case study, we recount its development and critically reflect on the factors impacting on its ongoing utilisation. We believe our reflections offer useful insight into issues relating more broadly to the sustainability of MUVE-based teaching and learning projects and initiatives. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Pregnancy; Physiology; Birth; Obstetrics; Females; Biology; Science Laboratories; Science Activities; Hands on Science; Science Instruction; Science Curriculum; College Students; High School Students

Abstract:
In this guided inquiry, students explore the complex hormonal regulation of the female reproductive cycle using inexpensive ovulation and pregnancy detection kits that are readily available over the counter. This hands-on activity engages students in the practice of doing science as highlighted by the "National Science Education Standards." The laboratory approach described is an effective alternative or complement to traditional lecture presentations of this challenging topic. The laboratory activities described are appropriate for both college and high school students, as reproductive physiology is covered in a wide variety of curricula. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Medical Education; Medical Evaluation; Psychosis; Physicians; Mental Health; Patients; Specialists; Depression (Psychology); Obstetrics; Gynecology; Professional Continuing Education; Females; Birth; Knowledge Level; Surveys; Primary Health Care; Beliefs; Correlation; Validity; Evaluation Methods; Information Dissemination

Abstract:
Introduction: Continuing medical education (CME) courses are an essential component of professional development. Research indicates a continued need for understanding how and why physicians select certain CME courses, as well as the differences between CME course takers and nontakers. Purpose: Obstetrician-gynecologists (OB-GYNs) are health care providers for women, and part of their purview includes mental health, such as postpartum depression (PPD) and psychosis (PPP). This study evaluated OB-GYNs' knowledge, attitudes, and behavior (KAB) regarding PPD/PPP, and compared characteristics of CME course takers and nontakers. Method: A survey was sent to 400 OB-GYNs. Results: Response rate was 56%. One-third had taken a CME course on PPD/PPP. Those who consider themselves a "specialist" were less likely to have taken a CME course on postpartum mental health than those who consider themselves "both primary care provider and specialist." Non-CME course takers rely on clinical judgment more. They also are less likely to track patients' psychiatric histories and they utilize validated assessments less frequently. However, CME course takers and nontakers did not differ on knowledge or belief items. Conclusion: CME courses on PPD/PPP were associated with increased screening and utilization of validated assessments. There was no association between having taken a course and several knowledge questions. It is unclear if CME courses are effective in disseminating information and altering KAB. (Contains 3 tables and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Females; Access to Health Care; Pregnancy; Health Facilities; Rural Areas; Foreign Countries; Obstetrics; Medical Services; Transportation; Sustainability; Interviews; Measures (Individuals); Community Surveys

Abstract:
We examined the continuation of community-organized and financed emergency transport systems implemented by the Community-Based Reproductive Health Project (CBRHP) from 1998 to 2000 in two rural districts in Tanzania. The CBRHP was a multipronged program, one component of which focused on affordable transport to health facilities from the villages. In 2006-2007, we assessed the existence and continuation of community-supported emergency transport systems. A total of 249 persons in 29 villages were surveyed, and qualitative data were collected to identify features of community-supported transport systems that have continued. Twelve villages reported having an emergency transport system for obstetrical/medical emergencies to a dispensary/district hospital. Six systems continue to be community supported and have been functioning since CBRHP activities ended in 2000. In these six villages, the modes of transport include tricycles with platforms, canoes, oxcarts, and stretchers. A total of 272 people have used the emergency transport system since its implementation; 47% were pregnant women experiencing obstetrical difficulties. In 2006, 35% (29/84) of users were women with obstetrical difficulties. The community-supported transport systems provide a critical service to villagers in rural areas who experience health emergencies that necessitate facility level care and while some communities continue to maintain support for these systems, other do not. Future research should focus on examining long-term sustainability of community level efforts aimed at increasing access to health care facilities and explore reasons for community level decisions to continue or discontinue activities over time, to fully understand the process of sustainability. (Contains 2 tables and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Graduate Medical Education; Intervention; Physicians; Drug Use; Psychiatry; Obstetrics; Internal Medicine; Gynecology; Program Effectiveness; Referral; Curriculum Development; Drinking; Primary Health Care; Pediatrics; Screening Tests; Medical Evaluation; Patients; Medical Students; Scores

Abstract:
The authors sought to evaluate the feasibility and acceptability of initiating a Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol and other drug use curriculum across multiple residency programs. SBIRT project faculty in the internal medicine (traditional, primary care internal medicine, medicine/pediatrics), psychiatry, obstetrics and gynecology, emergency medicine, and pediatrics programs were trained in performing and teaching SBIRT. The SBIRT project faculty trained the residents in their respective disciplines, accommodating discipline-specific implementation issues and developed a SBIRT training Web site. Post-training, residents were observed performing SBIRT with a standardized patient. Measurements included number of residents trained, performance of SBIRT in clinical practice, and training satisfaction. One hundred and ninety-nine residents were trained in SBIRT: 98 internal medicine, 35 psychiatry, 18 obstetrics and gynecology, 21 emergency medicine, and 27 pediatrics residents. To date, 338 self-reported SBIRT clinical encounters have occurred. Of the 196 satisfaction surveys completed, the mean satisfaction score for the training was 1.60 (1 = very satisfied to 5 = very dissatisfied). Standardized patient sessions with SBIRT project faculty supervision were the most positive aspect of the training and length of training was a noted weakness. Implementation of a graduate medical education SBIRT curriculum in a multispecialty format is feasible and acceptable. Future efforts focusing on evaluation of resident SBIRT performance and sustainability of SBIRT are needed. (Contains 2 figures and 3 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Foreign Countries; Evidence; Obstetrics; Writing Instruction; Academic Discourse; Nursing Education; Medical Education; Writing Skills; Transfer of Training; Technical Writing; Content Area Writing; Intellectual Disciplines; Epistemology; Undergraduate Students; College Instruction; Discourse Analysis

Abstract:
Generic attributes such as "holding a critical stance", "using evidence to support claims", and "projecting an impersonal voice" are central to disciplinary academic writing in higher education. These attributes, also referred to as "skills", have for a long time been conceptualised as transferable in that once learnt students are able to use them in a variety of contexts and for a range of needs. Over the past few years, however, the conceptualisation of these attributes as transferable has come under close scrutiny as they have been identified to be highly context-sensitive rather than context-flexible as they were once thought to be. Drawing on data from a 2-year study on undergraduate academic writing in nursing and midwifery at a university in the UK, this paper critically examines the role of disciplinary epistemologies in the conceptualisation of these attributes in the two disciplines, and demonstrates how these beliefs help to shape academic writing at undergraduate level, thus contributing to debates on generic skills and attributes and specificity in disciplinary discourses. The paper concludes by highlighting the importance for writers to examine how knowledge is displayed, constructed and communicated in their disciplines, and the significance of analysing the relationship between disciplinary epistemologies, generic attributes and academic writing as a way of gaining access to and producing central discourses in their professional community. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Workplace Learning; Expertise; Higher Education; Allied Health Occupations Education; Role Models; Obstetrics; Learning Experience; College Faculty; Universities; Career Change; Self Concept; Allied Health Occupations

Abstract:
This study investigates the workplace learning experiences of recently appointed lecturers in UK higher education in nursing, midwifery and the allied health professions. Health care practitioners, appointed to academic posts in Universities, are experts in their respective clinical fields and hold strong practitioner identities developed through professional socialisation. This study focuses on the first five years of experience after appointment to higher education and aims to inform strategies for academic induction. The new lecturers generally find their mid -career transition challenging but they feel well supported. They are strongly motivated by their contribution to the development of student practitioners. They tend to hold on strongly to their identity as a clinical practitioner rather than quickly embracing new identities of scholar and researcher. The implications include the need for university departments in health professional fields to provide clearer role models and more realistic expectations for new lecturers. (Contains 3 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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