News and Commentary Improving the Maternity Care Workforce through Interprofessional Education

The American College of Nurse-Midwives (ACNM) in partnership with the American College of Obstetrics and Gynecologists (ACOG) launched the Maternity Care Education and Practice Redesign project and is completing the first year of program development. The goal of the project is to developinterprofessional education (IPE) models that lead to an increase in the interprofessional maternity workforce by educating more midwifery students in residency clinical sites where space is available. Many national policy documents have called for improved health care quality in the U.S. along with lower cost. In 2017 ACOG reaffirmed its prediction that maldistribution as well as changing practice patterns of physicians will necessitate a more diverse cadre of women’s health care providers including midwives in the future. The number of childbearing women in the U.S. is also expected to increase. Our four demonstration sites, University of California San Francisco, Baystate Medical Center, University of Minnesota, and the Frontier Nursing University/Drexel University/Tower Health (formerly Reading Health System) partnership, are developing a series of interprofessional modules for use by graduate midwifery students and obstetrician-gynecologist (ob-gyn) residents.

Topics covered in the modules include:

  • Guiding principles for team-based care
  • Patient centered care
  • Roles and scopes of practice of midwives and obstetrician-gynecologists
  • Collaborative practice
  • History of obstetrics-gynecology and midwifery professions in the U.S.
  • Care transitions/situational leadership
  • Difficult conversations among care providers

These modules will be completed in Spring 2018 and then rolled out to ob-gyn residents and midwifery students during our implementation phase in Summer 2018. At the same time as these content modules are being developed, project leaders at each site are continuing to develop simulated and actual clinical opportunities to bring our learners together.

Recent examples of interprofessional activities at each site are:

  • University of California San Francisco: midwifery students, medical students and ob-gyn residents recently participated in a new discussion session on the labor unit that included identifying the roles, responsibilities and scope of practice of each profession. Learners appreciated the opportunity to discuss and deepen their knowledge about each professional’s role and scope of practice.
  • Baystate Medical Center: IPE communication simulations at Baystate have included the midwife student, OB intern, and third year resident. In these scenarios, the midwife student interviews a standardized patient who has needs outside of the certified nurse-midwife (CNM) scope of practice. The midwife student consults with the OB intern who also interviews the patient. The third-year resident is learning to critique as part of their curriculum in learning to teach. Residents observe the interaction with the standardized patient for effective communication style, both with the patient and inter-professionally, completeness of history taken and information provided, and effective feedback.
  • University of Minnesota: Midwifery students and ob-gyn residents participated in a new skills lab jointly taught by midwifery and ob-gyn faculty including amniotomy and scalp lead placement, labor support techniques, labor progress assessment and intrauterine pressure catheter placement, and manual removal of the placenta.
  • Frontier Nursing University/Drexel University/Tower Health System partnership: Frontier Nursing University and Tower Health Systems (previously Reading Health) are developing a joint proposal for Midwifery Clinical Scholars who would be chosen to participate in an expanded clinical experience including in-hospital and out-of-hospital birth opportunities and interprofessional learning activities with the ob-gyn residents. Additionally, Frontier students currently participate in an interprofessional emergencies simulation at Drexel University.

The Road Ahead
Additional goals planned for this three-year project include bringing together the related organizations that set program criteria and competencies, and accreditation standards, to look at developing common language related to interprofessional education requirements. We are also partnering with residency programs to examine strategies for increasing the number of midwifery graduates through providing additional clinical learning sites in an IPE model where possible. An overview of the project has been accepted for presentation at the Council on Residency in Obstetrics and Gynecology (CREOG) meeting in February and submitted to the American College of Nurse-Midwives annual meeting scheduled for May 2018.

Increasing the maternity care workforce to reduce shortages and planning for the future by working together while providing the best care to women and their families is a goal everyone can get on board with!

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