Document Type : Original Article
Authors
1 1 Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Urology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
Abstract
BACKGROUND: Clinical training during internship is an important part of medical education. The
maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology
internship to obtain competencies in this field. The present study was conducted to explain medical
interns’ manner of learning in the maternity ward.
MATERIAL AND METHODS: The present study was conducted using a qualitative approach with
the inductive content analysis method. This study observed the maternity wards of teaching hospitals
affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through
observation and semi‑structured individual interviews.
RESULTS: Two main categories and seven subcategories emerged from the analysis of the data.
Inadequate participation in learning opportunities included the following three subcategories: the
incongruousness of the learning opportunities with the educational goals, inadequate readiness for
participation in learning opportunities, and the overlap between learning opportunities and diminished
autonomous practice. Inadequate formal and structured education included the following four
subcategories: inadequate learning support and direction, subordinate roles and aimless presence,
the pale educational role played by the attendants and senior residents, and learning through the
support of midwifery educators.
CONCLUSION: Participation in and access to learning opportunities in the maternity ward are very
difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and
in the company of training supervisors or competent educators to obtain the required competencies
in pregnancy and childbirth.
Keywords
- Gallagher P, Carr L, Weng SH, Fudakowski Z. Simple truths from
medical students: Perspectives on the quality of clinical learning
environments. Med Teach 2012;34:e332‑7.
2. Bates J, Ellaway RH. Mapping the dark matter of context:
A conceptual scoping review. Med Educ 2016;50:807‑16.
3. Liljedahl M, Boman LE, Fält CP, Bolander Laksov K. What
students really learn: Contrasting medical and nursing students’
experiences of the clinical learning environment. Adv Health Sci
Educ Theory Pract 2015;20:765‑79.
4. Olmos‑Vega FM, Dolmans DH, Vargas‑Castro N, Stalmeijer RE.
Dealing with the tension: How residents seek autonomy and
participation in the workplace. Med Educ 2017;51:699‑707.
5. Boor K, Scheele F, Van Der Vleuten CP, Teunissen PW,
Den Breejen EM, Scherpbier AJ. How undergraduate clinical
learning climates differ: A multi‐method case study. Med Educ
2008;42:1029‑36.
6. Dornan T, Boshuizen H, King N, Scherpbier A. Experience‐based
learning: A model linking the processes and outcomes of medical
students’ workplace learning. Med Educ 2007;41:84‑91.
7. Cheng HC, de Costa C, Woods C. Medical students and
midwives ‑ How do they view each other? Aust N Z J Obstet
Gynaecol 2018;58:586‑9.
8. Pierides K, Duggan P, Chur‑Hansen A, Gilson A. Medical
student self‑reported confidence in obstetrics and gynaecology:
Development of a core clinical competencies document. BMC
Med Educ 2013;13:62.
9. Cotter D, Turner MJ, McAuliffe FM, Higgins MF. Medical students
learning experiences of the labour ward: A qualitative research
study. Eur J Obstet Gynecol Reprod Biol 2016;206:204‑7.
10. Brunstad A, Hjälmhult E. Midwifery students learning
experiences in labor wards: A grounded theory. Nurse Educ
Today 2014;34:1474‑9.
11. Rahimi M, Haghani F, Kohan S, Shirani M. The clinical learning
environment of a maternity ward: A qualitative study. Women
Birth 2019;32:e523‑9.
12. Vermeulen J, Beeckman K, De Clercq G, Vandelannoote I,
Gucciardo L, Laubach M, et al. Inter‑professional perinatal
simulation training: A valuable educational model to improve
competencies amongst student midwives in Brussels, Belgium.
Midwifery 2016;33:49‑51.
13. Dayal AK, Fisher N, Magrane D, Goffman D, Bernstein PS,
Katz NT. Simulation training improves medical students’ learning
experiences when performing real vaginal deliveries. Simul
Healthc 2009;4:155‑9.
14. Gardner R, Raemer DB. Simulation in obstetrics and gynecology.
Obstet Gynecol Clin North Am 2008;35:97‑127.
15. Fialkow MF, Snead CM, Schulkin J. Benefits and barriers to
teaching medical students in an ob‑gyn clinic. Health Serv Res
Manag Epidemiol 2018;5:2333392817753518.
16. Dornan T, Tan N, Boshuizen H, Gick R, Isba R, Mann K, et al. How
and what do medical students learn in clerkships? Experience based
learning (ExBL). Adv Health Sci Educ Theory Pract 2014;19:721‑49.
17. Quinlivan JA, Thompson CM, Black KI, Kornman LH,
McDonald SJ. Medical and midwifery students: How do they
view their respective roles on the labour ward? Aust N Z J Obstet
Gynaecol 2002;42:401‑6.
18. DeketelaereA, KelchtermansG, StruyfE, De LeynP. Disentangling
clinical learning experiences: An exploratory study on the
dynamic tensions in internship. Med Educ 2006;40:908‑15.
19. Walsh K. editor.oxford Textbook of Medical Education: Oxford
University Press; 2013.
20. Sheehan D, Wilkinson TJ, Billett S. Interns’ participation and
learning in clinical environments in a New Zealand hospital.
Acad Med 2005;80:302‑8. - 21. Pimmer C, Pachler N, Genewein U. Contextual dynamics in
clinical workplaces: Learning from doctor‑doctor consultations.
Med Educ 2013;47:463‑75.
22. Koens F, Mann KV, Custers EJ, Ten Cate OT. Analysing the
concept of context in medical education. Med Educ 2005;39:1243‑9.
23. Pecci CC, Mottl‑Santiago J, Culpepper L, Heffner L, McMahan T,
Lee‑Parritz A. The birth of a collaborative model: Obstetricians,
midwives, and family physicians. Obstet Gynecol Clin North Am
2012;39:323‑34.
24. Durning SJ, Artino AR Jr, Pangaro LN, van der Vleuten C,
Schuwirth L. Perspective: Redefining context in the clinical
encounter: Implications for research and training in medical
education. Acad Med 2010;85:894‑901.
25. Dornan T, Hadfield J, Brown M, Boshuizen H, Scherpbier A.
How can medical students learn in a self‐directed way in
the clinical environment? Design‐based research. Med Educ
2005;39:356‑64.
26. Ebert L, Tierney O, Jones D. Learning to be a midwife in the
clinical environment; Tasks, clinical practicum hours or midwifery
relationships. Nurse Educ Pract 2016;16:294‑7.
27. Sheehan D, Jowsey T, Parwaiz M, Birch M, Seaton P, Shaw S, et al.
Clinical learning environments: Place, artefacts and rhythm. Med
Educ 2017;51:1049‑60.
28. Steinert Y, Basi M, Nugus P. How physicians teach in the clinical
setting: The embedded roles of teaching and clinical care. Med
Teach 2017;39:1238‑44.
29. McConaughey E, Howard E. Midwives as educators of medical
students and residents: Results of a national survey. J Midwifery
Womens Health 2009;54:268‑74.
30. Feinland JB, Sankey HZ. The obstetrics team: Midwives teaching
residents and medical students on the labor and delivery unit.
J Midwifery Womens Health 2008;53:376‑80.
31. Angelini DJ, O’Brien B, Singer J, Coustan DR. Midwifery and
obstetrics: Twenty years of collaborative academic practice. Obstet
Gynecol Clin North Am 2012;39:335‑46.
32. Cooper EM. Innovative midwifery teaching for medical students
and residents. J Midwifery Womens Health 2009;54:301‑5.
33. Blanchard MH, Kriebs JM. A successful model of collaborative
practice in a university‑based maternity care setting. Obstet
Gynecol Clin North Am 2012;39:367‑72.
)