Celia Woolf¹ & Adele Hamilton²¹Institute of Health Sciences Education, Queen Mary University of London

²School of Community & Health Sciences, City University London_______________________________________________________________________________

We piloted interprofessional peer-learning for fourth year medical and final year midwifery students on practice placement in the maternity unit of a busy London teaching hospital.

Aims• Enhance understanding of professional roles• Challenge negative stereotypes• Create opportunities for interprofessional team working in practice

Rationale • Good communication and collaboration between doctors and midwives improves women’s experience of labour and birth • Poor interprofessional teamwork contributes to serious failures in care of mothers and babies(e.g. Lewis, 2005) • Interprofessional education aims to improve collaboration and the quality of care (Barr, 2005) • Peer learning benefits students as teachers and learners.

References:Barr, H (2005) Interprofessional education: today, yesterday and tomorrow: a review. London, UK : Higher Education Academy, Health Sciences and Practice Network.Lewis G (Editor) (2005) The Confidential Enquiry into Maternal and Child Health (CEMACH). Why Mothers Die 2000-2002. London: RCOG Press

ParticipantsStudent volunteers gave informed consent to take part.• Peer learning group n = 38• Control group n = 26

Peer learning programme• Practice-based reciprocal peer teaching between medical and midwifery students• Students explored medical and midwifery roles in antenatal care, normal labour and complicated labour through• joint clinical observations• working together to care for women on labour ward• interviewing woman about experience of maternity care and consequences of teamwork• researching information together• Peer-learning handbook gave guidance

• Students gave case presentations focusing on interprofessional teamwork in maternity care.

• Students also attended joint weekly facilitated seminars on:

• normal labour• pregnancy induced hypertension• diabetes in pregnancy• complicated labour and assisted birth

• 4 weeks duration x 3 student cohorts

Evaluation• Role Perception Questionnaire pre and post• Student feedback questionnaires • Student focus groups

Control data from students on the same maternity unit allowed between-group comparisons to explore whether the peer learning experience enhanced learning compared with opportunistic interprofessional contact.

A. Role Perception Questionnaire (McKay, 2004) Pre-training : students held preconceptions about both professions, including some negative stereotypes

Medical students considered doctorscompared to midwives as

Midwifery students considered doctors compared to midwives as

more collaborative

more effective in teams

having equally good interpersonal skills

more objective and more medically focused

equally holistic

having a more transparent role

having a higher opinion of their own profession

requiring a higher level of intellectual skills

having a less caring and more technical role

tending to work in teams more

more able to refer patients to other disciplines

equally collaborative

equally effective in teams

having poorer interpersonal skills

more objective and more medically focused

less holistic

having a more transparent role

having a higher opinion of their own profession

requiring a similar level of intellectual skills

having a less caring and more technical role

tending to work in teams equally

equally able to refer patients to other disciplines

Post-training some of these preconceptions changed and some differences emerged between students in the peer learning and control groups.

For instance:

• medical students in both groups showed increased awareness of medical aspects of the midwifery role.

• midwifery students in the peer learning group felt that the professional role of doctors became more transparent , while those in the control group rated it as less transparent.

• medical students in the peer learning group perceived both professions as working more autonomously than before training.

• medical students in the control group strengthened their view that midwives work less effectively in teams than doctors. This negative stereotype did not increased among the peer learning students.

B. Student Feedback Questionnaires

Medical and midwifery students valued the peer learning experience equally:

Students deepened their understanding of the role of other health professionals:

Students believed that they learned to collaborate more effectively with other team members:

0

20

40

60

80

100

Negative Neutral Positive

%

Midwifery Medicine

02

468

10

1214

Disagreed Neutral Agreed

Peer learning Group

0

5

10

15

Disagreed Neutral Agreed

Peer Learning Group

C. Student Focus Groups

____________________________________________________________________________________________________________________

The qualitative data from group feedback was analysed using the Framework approach (Ritchie and Spencer, 1994).

1. Involvement Medical students in the peer learning group found that working with midwifery students helped them get more involved in practice:

“Made me more part of the team” “Able to get into labour ward more easily”

This contrasted with the experience of some students in the control group:

“I always feel in the way as a medical student – I don’t like to push – I don’t like to be underfoot”. “In most …. ways I cause more trouble than help – makes me feel like I am wasting my time … Everyone’s so busy. I feel like I’m imposing”

2. Role ClarificationStudents in the peer learning group learnt about each other’s roles and perspectives:

“We have common ground” “Was good to get midwives view of doctors, sticking people on IV drugs”. “Because we all have a better understanding of each other’s roles and have more respect for each other, will work better together in multidisciplinary team”

3. LearningStudents in the peer learning group felt that the interprofessional exchange of knowledge enhanced their learning:

“Was useful to see that midwives and medical students asked different questions and have different perspectives”.“I am learning from midwifery students, for example how to assess the placenta. Midwives can also learn from medics… was good”“By teaching it to someone else it affirms it in your own mind”

4. Interprofessional experience

Students in the peer learning group valued the interprofessional contact

“Much better than other IPE experiences” “joint teaching sessions really good, much better than any teaching we have had”

Students in the control group would have liked more opportunities to learn interprofessionally:

“It would be useful to have student doctors and student midwives meeting together”

Peer learning between medical and midwifery students had additional benefits beyond those gained through opportunistic interprofessional contact in practice. Peer learning:

• was valued and enjoyed by students• helped clarify professional roles• developed understanding of how doctors and midwives collaborate in practice• helped medical students get greater experience of involvement with women during labour and childbirth• broke down barriers between the professions.

The peer learning model has potential for extending to other practice areas.

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