Medical student and midwife interactions in the labour ward: A New Zealand experience

Abstract

Introduction New Zealand medical students are involved in the intrapartum care of women in the labour ward. When labour and birth are medically uncomplicated, midwives provide the majority of intrapartum care and hence oversee the learning experiences of medical students. International literature has identified misunderstandings between medical students and midwives regarding their respective roles in the labour ward. The New Zealand model of maternity care is unique with midwives practising with a high level of autonomy and independence. Obtaining information specific to the unique New Zealand environment could assist in optimising medical student labour ward learning experiences. Objectives • To identify incentives and barriers to meaningful medical student involvement in the labour ward. • To assess and compare medical student and midwife perceptions toward clinical skills and tasks that can be undertaken by medical students in the labour ward. • To design an instrument that could measure these participant perceptions. Methods A mixed-methods study was undertaken using a postal questionnaire sent to midwives and medical students from two New Zealand hospitals. The questionnaire contained questions regarding beliefs about medical students’ involvement in specific clinical skills and scenarios as well as qualitative questions regarding incentives and barriers to student involvement. An exploratory factor analysis was performed on the clinical skills data to identify underlying skill domains. Results Study participants totaled 125 with 92 midwives and 33 medical students. The response rates were 35% and 36% respectively. Both groups felt that it was important for medical students to have clinical experience in the labour ward. Participant perceptions toward medical student involvement into intrapartum care fell into three skill domains: observational, non-intimate procedural and intimate procedural. In all three domains, medical students were more likely to think that they should perform specific tasks than midwives did and these differences were statistically significant in the procedural domains. Reported barriers to medical student involvement included students being unable to provide continuity of care, midwives unaware of intended student learning objectives, competition for clinical experience, interdisciplinary tension between doctors and midwives and male gender. Incentives included the desire to expose medical students to physiological labour and birth, satisfaction from contributing to a well-trained workforce, medical student and midwifery enjoyment, and medical students feeling useful. Conclusion Midwives and medical students had divergent views on the appropriate role of medical students in the labour ward with midwives perceiving a lesser role for the students than the students themselves. These differences led to misunderstandings and frustrations. Recommendations to enhance medical student experiences and learning in the labour ward are provided.