Round up of developing a midwifery practice skills course for flexible delivery.

Image: Pohutakawa, the NZ Christmas tree. from Andy Eakin’s photos on Flickr.com


As the year comes to a close Lorna and I have been making great progress towards the midwifery practice skills course we are developing in a blended delivery format. I have not been blogging much because I have been so busy working on this but I now need to record what I have been up to for the last few weeks. So to bring you up to speed on what this is all about here is a brief outline of the programme.

Background

We have been developing a midwifery program to be delivered in a blended format over the last couple of years. We start at the beginning of 2009. Students will be located in groups or cohorts in various rural towns as well as the main centers. Otago Polytechnic are developing this in collaboration with Christchurch polytechnic. The process we have developed is as follows

We are using the moodle LMS for the online course delivery. All content is being developed in modular format using EXE as a development tool. We are using a mix of written material, links to online content and free online resources. We are also using powerpoints with voice over, converted into shockwave flash files with ispring and either embedded or hyperlinked to exe files. Students are given a plan for progress through these modules although they can also work at their own pace if they wish. It is expected that they will progress through this material ready to attend the face to face components ready to discuss and debate the theory they are learning and to gain experience with the practical skills they will need for midwifery practice.There are formative assessments, such as quizzes and interactive games, to support learning in the online resources. Each section has clear learning outcomes to help students understand what they are expected to learn from the resources.

Students will meet in their local groups once a week with a local midwife/educator who will facilitate their discussion, direct them to learning support services if they are having difficulty with the learning and provide teaching and guidance with selected midwifery practice skills. The facilitator will also encourage the students to share and support each other through their learning experience and will coordinate placements in the various clinical or midwifery practice areas, liaising with midwives and other health care providers.

In addition the entire class will come together at four two week blocks in the year. At the start of the year they will be introduced to each other, the courses, the technology and support services they can access. Some face to face teaching and team building and group activities will be scheduled. Later their will be more face to face teaching and at the final two week block examinations and summative assessments will take place. In addition to this teaching and learning students will have midwifery practice placements in a variety of settings.

Progressing to this point

As we approach the start of this new programme. I am feeling very positive about it. We have been working very hard to structure our course in a logical way which should clearly link theory and practice and progress the students through from the basics to to more complex practice skills, while keeping these firmly linked to the context of midwifery practice.

As I have recorded in previous posts we separated the skills into modules which made sense in terms of midwifery practice. These are, antenatal, labour and birth, postnatal mother and child and therpeutics. More recently we realised we needed another module for the core component which overrides all of these others, that is communication. In this fifth module we will have material on communication skills and also include material on documentation, which is another form of communication. We were going to put material about the components from this course which will fit into the student developing portfolio, either paper based or electronic. However at the moment we feel that we will keep this alongside the course information, which is where the students will enter the course.

I have been working on the EXE files, which are on my hard drive, developign the course content. I then felt I needed a better overview of how the students would actually move through the course material. Which aspects would be taught face to face in the intensives. Which would be taught face to face in the tutorial groups and which would be principally online learning. I sat down and worked out where all these components would fit within the year of the course. At this point we hit a small block as we were not all thinking along the same lines here. My boss, head of the school of midwifery and head of the health group at Otago Polytechnic, Sally Pairman, obviously liked the way I had shaped this up and developed this further alongside all of the other courses the first year students will be involved in.

Earlier this week I flew up to Christchurch and had a meeting with Lorna. This was very positive. Lorna and I share very similar ideas about how the course will work and so we have very few problems in working alongside each other. It was lovely to spend some time with her and her family, she gave me a bed for the night. We have negotiated with the math department from CPIT to run the examination of Math for our students and to take a couple of tutorial sessions with them as well. This is fantastic and will definitely be a bonus for us.

So now the road ahead is very clear, there is still some development needing to be done with the online resources but I am feeling confident and positive about the programme.

What have been the highs a lows of the development process.

Highs

I have been very lucky to be working alongside Lorna in CPIT. It has been great that we agree so well on so much. Lorna identified EXE which has been a godsend for course development and also ispring which has been great for converting power point to shockwave flash files.

I am sooo… glad I participated in the Facilitating online learning communities course with Leigh Blackall and Bronwyn Hegarty and also the Design for Flexible Learning also with Leigh and Bronwyn. I would not be nearly so able to engage with this process without the learning I did in these courses.

Finding all the great stuff that is out there on the internet, free for anyone to use has been just amazing. The generosity of those who have developed these resources is amazing. I wish we were able to reciprocate, perhaps in time??

Lows

The main point of difference is with our institutions and the way that they perceive students should engage with learning. OP has an open policy where we as lecturers own the material we develop, we can take it with us when we go as long as we acknowledge OP if we use it. We can make it freely available on the internet if we wish to. CPIT on the other hand have a closed policy, all of their resources belong to CPIT and cannot be shared in an open environment. None the less I have loaded some of the content I have developed onto wikieducator and slide share etc, and I hope to do more development of this as time permits.

The time frame has been tight, the pressure has been quite enormous, and the workload allocation for development in no way related to the reality of the job. It has also been a struggle to do this and keep our existing students ontrack. I have to say our first year students this year have been a group of wonderful women and have been enthusiastic is supporting us as we have worked to develop the new course materials. Some of this new work has also filtered through to them to their benefit also I think.

A times I have felt quite alone and isolated. It is hard to get the IT support needed as we are experts in midwifery and so we really have to develop things ourselves. I do think the IT support has been less than it could have been at times however.

Conclusion

So now I am on leave for abpout 3 weeks. I am going to have a total rest from this and back into it on January 5th.

Merry Christmas ( or happy celebration of whatever you celebrate at this time of year). Happy holidays to all.
This post is also on my other blog Fled: Flexible learning education design. All hyperlinks are included there.

Lactation conference online: Gold 09

As part of my role as a midwife working in a rural maternity unit I have been enrolled in a lactation course. I have only just enrolled and have not traveled very far with the course yet, however there are a couple of things I want to comment on at the moment.

The course has been developed by a group called Health E learning and has been developed on the Moodle platform. This interests me as we are developing our new midwifery programme through Moodle. The course looks professional and engaging and may have some ideas which I can incorporate into the work I am doing.

Health E learning seem to be a commercial group who are engaged with producing learning resources for lactation consultants. These courses are available for a fee. I realise that there is a cost in developing these resources, however it does seem a shame that only those who can afford to pay will have access to them. In my case my employer is paying.

The Health e learning group are running an online conference (Gold 09)which can be attended, once again for a fee. As they say, the cost will be significantly cheaper than actually flying overseas and attending a conference. I am very interested to see how this goes and to find out how the networking opportunities compare with face to face opportunities at a conference.

It is exciting to see that rural health groups are taking advantage of the learning opportunities afforded by the internet. This is the third year that the Gold conference has been run but it is the first time I have heard of it. I think this is a great initiative and hope that all midwives have an opportunity to attend, supported by there employers, not only with the fees but also with time off for the conference.

I will let you know how i go with the course as I work through it.

Image: woman breast feeding baby, from hdptcar's photos on flickr.com

My E-Portfolio

I am well behind my colleague Sarah Stewart in terms of online presence and developing and e-portfolio but I have made a start with this on the Wetpaint wiki site.Wetpaint have agreed to provide an advert free site for educational sites. You have to apply for this and I have been granted this status for my site.

Your thoughts comments and suggestions are very welcome.



This post also appears on my Fled blog

Best outomes from midwifery care

A Cochrane systematic review. Which is internationally recognised as the best available evidence on a topic, has found that women who have midwifery led care have fewer antenatal problems and as good or better outcomes than other models of care. The reviewers conclude that all women should have the option of midwifery led care.
Below are the main results of this study from the reviewers

We included 11trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), the use of regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), to feel in control during labour and childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76). In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks' gestation (RR 0.79, 95% CI 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85). There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).

Great news for New Zealand where all women do have access to midwifery led care. We have a huge responsibility to make sure that this does result in the best possible outcomes for mothers and babies.

I just have to put this video in here again. Midwives Rock!!

Routine epidural denied. Is this a problem?

A news item today discusses women in the UK being denied epidurals because of a lack of anaesthetists. Epidurals are a local anaesthetic injected into the epidural space in the spine near to the spinal cord, which provides numbing and therefore relief of pain in labour. This emotive article quotes the Vice President of the Royal college of Obstetricians saying that epidurals should be routine in birth.

There are clear associations between epidural anaesthetic and the need for other interventions in labour, such as instrumental birth with forceps or ventouse(suction cap applied to the babies head)or caesarean section.

The article sites the Cumberland Royal Infirmary as being particularly affected by this inability to provide epidural. It is not so strange then that the Cumberland Royal Infirmary has a lower level of intervention in childbirth compared with other local hospitals. Cumberland Infirmary has a 50% normal vaginal birth rate, Cresswell maternity has a 30.8% normal birth rate and Furness has a 44.4% normal birth rate. Normal vaginal birth leads to lower incidence of complications in the postnatal period for both mother and child. There are also fewer complications with following pregnancies. Do women want pain free birth at this price? What do women think about 'routine' epidural? How do staff support women to birth normally and without intervention if they expect every woman to have a epidural? How do they walk alongside women through the triumphant process of normal and natural labour and birth?

Do you have any thoughts or comments about this? Are women told enough about what to expect in childbirth and the effects of interventions such as Epidural?

Baby wearing sling

For midwives who are interested in supporting women with this and for women who want to know how to do this. This is a great video about how to position a baby comfortably in length of cloth.

NZCOM prsentation: rural midwives network

Nzcom Presentation 2

View SlideShare presentation or Upload your own.

Click To Play

This is the presentation I gave at the NZCOM conference in Auckland in September 2008. The sound file are on the wee TV screen from Blip TV, click here to start thw sound then work through the slideshow. If you are interestead in brainstorming ideas for a rural midwives networ please contact me at cardacs@gmail.com. Thanks for your interest.