rpa women and babies · midwives this scorpio enabled participants to have intensive training in...

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RPA Women and Babies

Medical Education Report2004

Dr Kirsty Foster,Medical Educator

RPA Women and Babies, Medical Education Report 2004

Research Education

Clinical Area

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RPA Women and BabiesMedical Education Report 2004

Contents

Introduction 3In house

Neonatal 4Obstetrics and gynaecology 6

Educational developmentNeonatal 4Obstetric and gynaecology 6

Medical Students 7Physiology students 8Honours, PhD and Masters Students 9Rural Outreach Program 10Overseas trainees and visitors 11Academic program 12Presentations and Publications 13Future Developments 15Limitations 16Acknowledgements 16Appendices 17


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Introduction2004 has seen continued enthusiastic support for the medical education programin RPA Women and Babies. This report outlines the medical educational activityin the Neonatal and the Obstetrics and Gynaecology units during the second fullyear of a fulltime medically qualified educator with clinical experience being inpost.

Throughout the year weekly formal education sessions have been run in bothneonatology and obstetrics. A comprehensive academic meeting programcomplements these sessions and quality of learning is steadily becoming apriority in preparation and running of these meetings.

The national and international reputation of the unit for education continues togrow with a steady stream of overseas postgraduates keen to work here andrequests for educational advice and consultancy increasing.


Dr Antoinette Anazodo demonstrating neonatal examination to a small group of medical students

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In house neonatal

The weekly SCORPIO program in RPA Newborn Care ran for the fourth yearoffering interactive, small group, interprofessional learning.

Sessions : 99Average attendance : 11.6

Tutors were senior medical and nursing staff in the department and the numberof sessions taught by each tutor is given in Appendix 1.

Following feedback from nursing staff scheduling of sessions has been reviewedand from July 2004 they have been held on Monday and Tuesday afternoons.This has facilitated more nursing staff to attend the sessions and has freed upWednesdays for the junior medical staff.

Educational Development: Neonatal

Two new neonatal SCORPIOs were developed during the year:

Error reduction: in response to findings of the quality improvement committeeas part of the quality improvement initiative in the unit an educational sessionwas developed to highlight areas where errors most commonly occur and toreduce the risk. The SCORPIO was run four times in the second six months ofthe year and to date 79% of full-time staff in the nursery have attended.


Natalie Crewe RN and colleagues practise administering medication as part ofthe Error reduction SCORPIO. Tutor Dr Sandie Bredemeyer gives feedback.

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Practical Introduction to Neonatal Practice: developed to allow coverageof basic but essential practical topics for junior doctors at the start of theirattachment.

newborn examinationcorrectly filling in formsappropriately ordering and administering fluids to a preterm infantprotocol for investigation of jaundice on the postnatal ward.

Using Best Evidence CourseA discrete course to develop skills in literature-searching, critical appraisal andintegrating evidence into practice was run for a group of eight doctors andneonatal nurses. The course consisted of modules run once a week for eightweeks and encouraged interaction and discussion around searching and criticallyappraising the literature. Of the five who sat a formal assessment oncompletion, three achieved the required standard. The two who did not achievethe standard had not been able to attend the whole course and will have theopportunity to complete it next year. The course was evaluated and considered asuccessful pilot.

Junior staff orientationThe formal orientation period has been extended to part of the first twomornings of term and a system introduced to ensure that all paperwork iscompleted promptly on arrival. Close monitoring of the progress of the juniors isconducted throughout the term so that any areas of concern can be dealt with ina timely fashion. A log of procedures done by each registrar and resident iskept and they are asked to self assess their experience in key procedures at thestart and again half way through the term. All junior staff have a formal exitinterview prior to leaving the unit.


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Obstetrics and gynaecology educationTuesday afternoons have been almost cleared of clinical work to free registrarsand residents for education.

Sessions RPAH : 45Average attendance : 7.9

There were also two sessions on Electronic Fetal Monitoring held at CanterburyHospital.

Educational Development: Obstetrics & Gynaecology

Two new SCORPIO sessions were developed:

Hypertensive Disease of Pregnancy: developed jointly with the renal teamthis eight station SCORPIO was run in two parts on consecutive Tuesdays

Instrumental Delivery : developed and delivered jointly by obstetricians andmidwives this SCORPIO enabled participants to have intensive training inpractical skills of forceps delivery and vacuum extraction with immediatefeedback on technique from very experienced staff .


Dr Wal Birrell assists Dr Thi Ngo with application of forceps

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O&G residents and registrars also attended :

Wednesday morning 7am sessions coordinated by Dr Alec Welsh coveringcurriculum for the RANZCOG examination"Neonatal Resuscitation" SCORPIO (run by neonatal staff)"Optimal Management of the Drug-using Mother and her Infant" SCORPIO(run by obstetric, midwifery, neonatal, drug health and social work staff)

Most of the Tuesday afternoon education sessions are run by one tutor fromsenior medical or nursing staff or outside specialists depending on topic. Thenames of tutors and number of sessions taken by each of them is shown inAppendix 3. Several VMOs have taken an active part in delivering the program.The program is constantly evaluated and is well received especially when thesession is practical or interactive.

In preparation for the changes to the RANZCOG training requirements, sessionson conducting research were included in the program and the research educationcomponent of the program will be developed during next year.

Medical StudentsMedical and nursing staff of RPA Women and Babies play a fundamental part indelivering the Perinatal and Women's Health component in the final year of theUniversity of Sydney Medical Program.Staff specialists, Career Medical Officer, Medical Educator and Fellows provideformal education in several aspects of the rotation including:

OrientationProblem based learning group tutoringSmall groups sessions including a “Careers in Medicine” sessionSupervision of clinical attachmentsBedside tutorialsAssessment

Registrars, residents and nursing staff provided support and clinical supervisionduring the clinical part of the rotation. USydMP students consistently rate thePWH rotation highly and in 2004 Dr Antonia Shand (Obstetrics), Dr KirstyFoster (Medical Educator) and Dr David Osborn (Neonatology) were nominatedby students for tutor awards.

Dr Kirsty Foster and Dr Phillippa Ramsay undertook interview training and tookpart in interview panels for the admission of new students to the University ofSydney Medical program.


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Physiology StudentsFollowing previous successful sessions for students, the department ofphysiology at Sydney University requested a session for current students.Because of numbers, two workshops on “applied physiology and research inperinatal medicine” were run and attended by 56 students. Stations were onvarious clinical research topics;

A rapid bedside test to diagnose surfactant deficiencyBlood pressure in infantsCardiopulmonary adaptation at birthSleep and breathingApplied research in perinatal care

Evaluation of these sessions is so positive that they are now a regular annualevent.


Dr Gary Cohen demonstrating infant blood pressure monitoringequipment

Dr Girvan Malcolm discussing adaptation at birth with physiology students

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Honours StudentProfessor Heather Jeffery and Dr Girvan Malcolm were joint supervisors toUniversity of Sydney Honours BSc student, Nicola Moore, who carried outresearch in the Department of Neonatal Medicine during the year. Nicolaachieved a First Class Honours for her work on the coordination of breathingsucking and swallowing in breastfeeding infants. The title of her thesis is“Ventilatory Control during Breastfeeding in Term and Preterm Infants”.Nicola was awarded the Dunlop Prize in Physiology for her work.

PhD StudentsTwo students were supervised within the department in carrying out their PhDStudiesDr Mary Paradisis, supervised by A/Prof Nick Evans, is studying the effects ofMilranone on blood flow in premature infantsDr Monica Lahra, supervised by A/Prof Heather Jeffery is examining“Histological chorioamnionitis and fetal and neonatal outcomes”.

Professor Jeffery also supervised Dr Adrienne Gordon's postgraduate traineeresearch project for the Royal Australian College of Physicians. Dr Gordoncarried out a cohort study and literature review on the need for a paediatricpresence at caesarean section. The American Journal of Obstetrics andGynaecology has accepted the article for publication.

Masters StudentsDr Kirsty Foster graduated Master of Education (Adult Learning and GlobalChange) from the University of Technology SydneyKerry Watson graduated Master of Nursing (Education) from AustralianCatholic UniversitySian Rudge graduated Master of International Public Health from the Universityof SydneyDr Adrienne Gordon completed her treatise for the Masters of Public HealthHonours degree. The treatise is a Cochrane Systematic review on antibioticregimens for suspected late onset infection in newborn infants.


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Rural New South Wales Perinatal Outreach EducationFollowing the successful pilot scheme in 2003 further educational outreach wasconducted in 2004. All four education days were on Neonatal Resuscitation.Three took place in rural areas and one at a level 2 metropolitan hospital.

Locations in 2004 were:February - HornsbyMarch - Wagga WaggaOctober - CoomaNovember - Moruya

A total of 129 participants, including GPs, obstetricians, emergency departmentdoctors, anaesthetists, midwives, paediatricians and ambulance officers weretrained and reached the required level of competence on those days.Funding for manikins was received from the Australian Stockbrokers'Foundation and the scheme is also supported by NSW Pregnancy and NewbornServices.


Dr David Osborn, Jan Nash, Dr Adrienne Gordon, Jan Polverino, DrKirsty Foster and Dr Girvan Malcolm at Bankstown Airport ready to take

off for Moruya

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Overseas traineesDuring 2004 several international visitors were welcomed to RPA Newborn Care.

Dr Sharifah Huda, Paediatrician, Kuala Trengannu State Hospital, Malaysia1 year training completed in October.

Dr Inger-Elisabeth Silberg, Neonatologist, University of Oslo, Norway 3months observer completed March

Dr Pieter Koorts, Fellow at Royal Children's Hospital Melbourne: two weeksechocardiography course November.

4 nurses from Taksin Hospital in BangkokNonggluck SakkawatArrunya NgamvitayapongDmangruethai JanliewSomjit Warmakhow

visited for 4 weeks training with special emphasis on infection control.

Visitors and Seminars

Professor Michael Marsh, Chair of the Department of Anaesthesiology at WayneState University and Detroit Medical Centre visited on 23rd January 2004 andparticipated in a research and education seminar in RPA Newborn Care.

Dr Seroj Saigal, neonatologist, Professor of Pediatrics at McMaster Universityand Director of the Growth & Development Clinic, a follow-up facility for high-risk infants visited in March and spoke at a seminar organised by RPA Newborn


Dr Sharifah Huda demonstrating intubation to assessorDr David Osborn in an Objective Structured Clinical

Examination setting

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Care, entitled, "Ethics and Outcomes: Dilemmas in the Modern NeonatalIntensive care Unit"

Academic program

Throughout 2004 RPA Women and Babies has run a comprehensivemultidisciplinary academic program. This includes:

Monday meeting: Covering quality improvement issues, criticalappraisal and morbidity and mortality review.

Fetomaternal meeting: Multidisciplinary clinical forum for discussion ofchallenging cases and follow-up

Research meeting: For presentation of proposed and completedresearch initiatives

GRIP meeting: The practical aspects of getting research intopractice - review and development of policies andguidelines (mainly neonatal)


Professor Seroj Saigal speaking at an RPA Seminar

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Educational Expertise

Associate Professor Heather Jeffery, Dr Kirsty Foster, Dr Girvan Malcolmand Kerry Watson presented a seminar on “Effective Education in theWorkplace” at NSW Pregnancy and Newborn Services Network Seminar, May2004.Dr Kirsty Foster ( Postgraduate Medical Educator)completed her Masters ofEducation (Adult Learning and Global Change) and Kerry Watson (NurseEducator) completed her Masters of Nursing (Education).Dr Foster provided educational expertise to the Perinatal Society ofAustralia and New Zealand (PSANZ) being on the organising committee forthe eighth annual congress in Sydney and is a founder member of the CentralClinical School Education Committee.Associate Professor Jeffery chairs the NSW Pregnancy and NewbornServices Network Education Committee of which Dr Foster is a memberAssociate Professor Nick Evans travelled to Wellington and Christchurch asthe Eric Burnard Fellow

Educational Presentations and PublicationsStaff from RPA Women and Babies presented educational work at conferencesboth nationally and internationally during 2004

Perinatal Society of Australia and New Zealand,8th Annual Congress, SydneyFoster K, Jeffery HE, Malcolm GA "Maximising learning in neonatal& Watson K. healthcare"Platform presentation

Association for Medical Education in Europe, Edinburgh, UK. September

Platform presentationFoster K, Jeffery HE & Malcolm GA. "Structured, multiprofessional,

postgraduate educational programversus traditional apprenticeshipteaching"

Fringe eventsMalcolm GA "Magical thinking and medical

education"

Foster K & Malcolm GA "Teambuilding Aussie style"

Australian Neonatal Nurses' Association State Conference NSWFoster K "Learning far beyond the NICU”


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PublicationsJeffery HE, Kocova M, Tozija F, Gjorgiev G, Pop-Lazarova M, Foster K, PolverinoJ & Hill DA. "The impact of evidence-based education on a perinatal capacity-building initiative in Macedonia" Medical Education 38(4):435-47, 2004 Apr.

Foster K, Craven P & Reid S. Neonatal resuscitation educational experience ofstaff in NSW & ACT hospitals (Submitted for publication)

Standards and QualityOngoing evaluation of the formal education sessions occurs routinelyAt the end of a 3 month period feedback is sought from junior medical staffand nursing staff about the education program in neonatal medicine.The graph below shows the percentage of participants who either 'stronglyagreed' or 'agreed' with each of the following statements.

Q1 The topics were relevant to meQ2 The education helped me do my work betterQ3 The education will help me with postgraduate qualificationsQ4 I enjoyed the educational sessionsQ5 I felt encouraged by senior staff to attend


0102030405060708090

100

Q1 Q2 Q3 Q4 Q5

percent strongly agree oragree (n=64)

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When asked to rate the various educational modalities available during theattachment participants consistently rate the Postgraduate education program(PEP) much more highly than any of the more traditional methods used.

Future developments

Review of resourcesPlans have been made for formal review and updating of neonatal educationalresource material to take place in parallel with protocol review

Learning packagesFunding has been obtained from the Australian Stockbrokers Foundation toenhance computer resources to enable development of CD ROM type learningpackages to support learning in neonatal resuscitation.

ResearchEducational research exploring the aspects of small group interactive teachingwhich are effective in improving performance is planned.

Journal ClubPlanned for Obstetric registrars to increase their knowledge of currentresearch and of appraising the literature.


0

20

40

60

80

100

PEP

Ward RoundsTutorials

Research meetings

Grand Rounds

Excellent or > average

Average

<Average or Poor

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Limitations

Lack of continuity in the neonatal Nurse Educator position has slowed thedevelopment of multiprofessional educational initiatives which had beenprogressing well

Lack of computer and LCD projection facilities in Obstetrics means muchtime is spent organising rooms with audiovisual facilities or finding andsetting up equipment

The obstetric program is limited by lack of senior staff availability onTuesday afternoons. While the seniors who are keen to teach organise theirother commitments well in advance to free up a teaching session it leaves noflexibility to fill last minute cancellations. The senior registrar has been veryhelpful in standing in on several occasions when this has occurred.

Lack of adequate administrative support for the education programs severelylimits time for the educator to develop learning and research initiatives andfor carrying out research and preparing papers.

Rapid increase in teaching in obstetrics and gynaecology has resulted in arather fragmented program. While the increase in the number of educationalopportunities is very welcome there is a need for a cohesive educationalstrategy and continued evaluation of quality.

AcknowledgementsMany thanks are due to the senior medical and nursing staff in RPA Women andBabies who support the medical education initiatives. Their committedinvolvement in the programs has made educational development to a very highstandard possible. Special thanks are due to RPA Newborn Care where theencouragement, support and enthusiasm for educational development is inspiring.


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Appendix 1: Neonatal Education sessions (in hospital) by tutor in 2004

Tutor Sessions HoursGirvan Malcolm 28 (25 + 3) 46.5David Osborn 23 (13 + 3 + 7) 39Kirsty Foster 19 (13 + 5 + 1) 36Kerry Watson 18 (15 + 3) 31.5Phil Beeby 17 (14 + 3) 30Adrienne Gordon 17 (14 + 3) 30Sandie Bredemeyer 15 (11 + 4) 28.5Crista Wocadlo 11 16.5John Levison 10 (9 + 1) 16.5Mary Paradisis 10 (9 + 1) 16.5Jan Polverino 9 (5 + 4) 19.5Nick Evans 9 13.5Trish Mumford 6 (3 + 3) 13.5Ingrid Rieger 8 12Vicky Wade 5 (3 + 2) 10.5Heather Jeffery 6 9Sian Rudge 4 6Mary Lantry 4 6Angela Smith 3 4.5Georgina Jandera 2 3

(Standard sessions 1.5 hours. Some tutors took part in 3 hour sessions)

Appendix 2: Out of hospital education days 2004Participation in outreach education days 2004 (maximum 4 days)In 2004 these were at Hornsby, Wagga Wagga, Cooma and Moruya)Name Days Name DaysKirsty Foster 4 Jan Nash PSN 2 (C&M)Heather Jeffery 4 Jennifer Dawson 1 (W)Girvan Malcolm 3 (H,W,M) Nick Evans 1 (H)David Osborn 3 (H,C,M) Adrienne Gordon 1 (M)Jan Polverino 3 (W,C,M) Sarah Kenny 1 (H)Kerry Watson 3 (H,W,C) Mary Paradisis 1 (W)John Levison 2 (W & C)


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Appendix 3: O & G Tuesday Education sessions by tutor in 2004Tutor Sessions HoursKate Griew 0 + 6 18Robert Ogle 3 + 4 16.5Joanne Ludlow 2 + 3 12Hannah Dahlen 2 + 3 12Antonia Shand 3 + 2 10.5Michael Whaites 0 + 3 9Alexis Upton 0 + 2 6Alex Welsh 2 + 1 6Charlene Thornton 0 + 2 6Annemarie Hennessy 0 + 2 6Heather Jeffery 0 + 2 6Emily Olive 0 + 2 6Karen Redrup 0 + 2 6Neonatal Team (GM, DO, JP, SB,KF, MP) 2 6Kirsty Foster 3 4.5Wendy Carroll 3 4.5Janet Vaughan 1 + 1 4.5Karuna Raja 2 3Phillippa Ramsay 2 3Sara Burrett 1 3Chris Stephens 1 3Adrian Gillin 1 3Katrina Finch 1 3Jock Murray 1 3Wal Birrell 1 3Andrew Child 1 3Nick Evans 1 3Louise Page 1 1.5Megan Halliday 1 1.5Barbara Hawkshead 1 1.5Jean Edwards 1 1.5Pam Irons 1 1.5Jo Kent Biggs 1 1.5Brendan Orr 1 1.5Peter Wood 1 1.5Gabrielle Dezarnaulds 1 1.5Andy Roberts 1 1.5Michael Cooper 1 1.5Loretta Healey 1 1.5Archana Rao 1 1.5Jules Black 1 1.5Bronwyn Cullings 1 1.5

(Standard sessions 1.5 hours. Some tutors took part in 3 hour sessions)


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Appendix 4

Overseas enquiries 2004, by country and type of training requested

Country Fellow Registrar MedicalStudent

Observer/Visitingscholar

Total

China 1 1Germany 5 5India 7 15 22Kuwait 1 1Malaysia 1 1Thailand 2 2UK 2 2Total 7 19 5 3 34


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