Course Syllabus ©National College of Midwifery 2017 01/2017

Course Title: MSM MW550- Evidence Based Practice in Midwifery CareCourse Credit: 3

Course Description: This course builds on the concepts covered in the course Midwifery research methodologies. Students learn to analyze and understand research and medical literature through the development of critical appraisal skills. In this course the area between research and practice is bridged giving students practical tools for problem-solving clinical questions and converting research into practice. This course culminates in a critical appraisal assignment that requires the student to apply all of the concepts they have learned in both MW570 and MW550 thus far.

Course Objectives: After completing this course students will: Understand how to effectively read scientific literature Understand how to use available tools to analyze the efficacy of a study design Be able to evaluate a study for its rigor and quality Be familiar with the peer review process required for publication Understand the significance of a systematic research review Understand how to turn clinical problems into research questions Be able to critically appraise systematic reviews Be able to present research on a research question so that it can be understood

by the wider clinical community

Learning Materials / Resources: Please use textbooks less than 5 years old or most recent edition. 1. (Online Resource) BioMed Central Pregnancy and Childbirth.

http://www.biomedcentral.com/bmcpregnancychildbirth/

2. (Textbook) Jirojwong, S et al. Research Methods in Nursing and Midwifery: Pathways to evidence-based practice. Oxford University Press. 2011

3. (File Downloadable from NCM website) Cluett, Elizabeth. “Chapter 2: Evidence Based Practice”. Principles and Practice of Research in Midwifery. 2nd edition. Churchill Livingstone Elsevier. 2006

4. (File Downloadable from NCM website) Abalos E, Carroli G, Mackey ME, Bergel E. Critical appraisal of systematic reviews: The WHO Reproductive Health Library, No 4, Geneva, The World Health Organization, 2001 (WHO/RHR/01.6).

5. (File Downloadable from NCM website) Buckman, et al. Evidence Based Medicine: A Mini-manual. University of Alberta. 2008

Course Syllabus ©National College of Midwifery 2017 01/2017

6. (File downloadable from NCM website) Appendix 5 Systematic Review Proposal Outline: Developing a Protocol for a Systematic Review Using the Joanna Briggs Institute (JBI) Method

7. (File downloadable from NCM website) Holly, Salmond, and Saimbert. Comprehensive Systematic Review

for Advanced Nursing Practice. Springer publishing Company. 2012

A note about the textbook:As is made obvious by the title of the main text used for this course, it is based in a perspective of hospital-based midwifery and references the field of nursing extensively. Unfortunately, the field of direct-entry midwifery research in the US is still in the early stages of development, therefore we have no academic texts that reflect the principles and values of our own profession within the field of research. This text was chosen because it is accessible and written for teachers and learners. Please bear in mind that although it may not always speak directly to midwifery practice the concepts provided can, in most cases, be applied to research in the field of midwifery. Please also note that the resources numbered 7,8, and 11 are accessory resources. These resources go beyond the scope of the primary text and are meant to supplement learning for those students who are interested. These resources are more in-depth then the basic concepts that are required for this course. Please use them with the understanding that they may go beyond the scope of this course in detail and complexity.

Learning Activities: (See Course Assignments)

1. Student reads appropriate sections from the Learning Materials/Resources.2. Student evaluates research and scenarios.3. Student answers questions.4. Student writes critical reviews.5. Student creates posters and charts.6. Student presents work.

Evaluation Tools / Methods:Minimum passing grade for all courses is a cumulative 80% / B-. Students and preceptors are encouraged to work together until the student masters 100% of the information.

Evaluation is based on demonstration of comprehension of concepts and completion of written assignments. The preceptor will evaluate the written activities for each lesson for completeness, comprehension, and professional presentation. Answers should be referenced when appropriate and written work should be typed and well organized. Lesson 8 is culmination of the competencies learned in this course, therefore it should be graded as 40% of the students’ final grade. This course is graded on a pass/fail

Course Syllabus ©National College of Midwifery 2017 01/2017

scale. The student must achieve a grade of at least 80% to pass. The difference between undergraduate and graduate credits is not one of quantity, but of quality, as assessed by the preceptor.

Course credit:One Academic credit equals approximately 15 hours of formal time plus 30 hours of additional study or homework. Formal time is defined as the amount of time taken to answer the Learning Objectives to the level of 80% and to complete any learning activities to the preceptor's satisfaction, including any time spent face to face with the preceptor. Informal time includes any time spent actively reading relevant sources and textbook/s, researching Learning Objectives, and studying for examinations.

Course Assignments:

Reading and writing assignments are to be completed by the student with supervision of the preceptor. Read each chapter or article carefully and follow the directions outlined in the lessons. Focus on learning the key concepts and terminology of each lesson before answering the questions or completing assignments. We encourage students to spend time reviewing these concepts with the preceptor to ensure that each is well understood.

Lesson 1: Read Chapter 11: Qualitative data analysis1. Discuss the three broad approaches to qualitative data analysis and the stages

of the analysis process.2. Discuss the process of thematic analysis and how it is undertaken.3. Discuss the process of data analysis for grounded theory research. What stages

are undertaken and how is the analysis unique to this type of research approach?

4. Discuss the most commonly used approach to analyzing data in a phenomenological study.

5. Discuss data analysis for ethnographic studies. What are the common ways that the outcomes of ethnographic research are presented?

6. What are two ways that visual data can be analyzed?7. Describe the ways in which a researcher can build the trustworthiness of their

qualitative data analysis.8. Discuss how computer software can be used to analyze qualitative data.9. Many women experience postpartum depression after birth and have difficulty

managing the stress of life with a newborn. A researcher wishes to pose the question “What factors influence parents’ ability to cope with stress and depression postpartum?”

a. What data collection methods could be used to explore this question?b. List 4 sources from which data could be collected.c. List the ways in which this data would be best analyzed.

10.Conduct a research interview:

Course Syllabus ©National College of Midwifery 2017 01/2017

a. Find a willing participant to take part in an informal interview. b. Choose a comfortable topic such as “how do you define good health?”c. Conduct the interview for 10 minutes, using questions that relate to your

chosen topic.d. Record the interview and transcribe it.e. Write down your own reflections about the interview.f. Review the information you have documented g. Analyze your own interview style. What were your strengths and

weaknesses?h. Highlight the recurring themes in your transcript and identify which topics

drove the conversation in answering your question.

Lesson 2: Read chapter 12: Quantitative Data analysis

1. Why is statistics important to the analysis of quantitative research?2. Describe the difference between categorical and numerical variables.3. What is the purpose of using descriptive statistics to describe quantitative data?4. Discuss the purpose of graphical displays for quantitative data.5. Describe a scenario in which a scatter graph would be the most useful display of

data.6. Describe the use of inferential statistics in health sciences data.7. Discuss what is meant by a confidence interval.8. Describe how statistics could be used to test a hypothesis in the midwifery.9. Discuss how the appropriate bivariate test can be identified for analyzing

quantitative data.10.Give an example of one and two-sided scientific questions.11.What is the difference between a paired and unpaired test.12.When is it necessary to use a multivariate statistical analysis?13.Discuss the steps involved in a multivariate analysis.14.A midwife-researcher is investigating the difference in perceived pain of

contractions during labor for women who use aquatherapy during labor and those that use massage. Data is collected on the following characteristics: age, ethnicity, body mass index, parity, pain score (0= no pain while 100=worst pain) and perceived pain tolerance (low, moderate or high). Which group of bivariate statistical tests would be appropriate for investigating relationships between the following variables?

a. Pain score and type of pain reliefb. Pain score and BMIc. Age and perceived pain toleranced. Parity and agee. Parity and type of pain relieff. Parity and pain score

Lesson 3: Read Chapter 13: Critical Review of Research1. Discuss the skill sets that are helpful to employ in the reading of the scientific

literature when preparing for a systematic review.

Course Syllabus ©National College of Midwifery 2017 01/2017

2. Discuss the importance of evaluating the quantity and general quality of the research available on a given topic before beginning a full review.

3. What are some ways that students can become familiar with the process of critical review?

4. What are some critical appraisal tools that are used to critique literature?5. Discuss some ways the entry-level researcher can critically appraise the

statistical portion of a study without extensive knowledge of statistics.6. Discuss the sections of a critical appraisal. Name each section and briefly

describe what will be talked about in that section.7. How is graphing or diagraming concepts important to a critical appraisal?8. What are the areas in which you should be able to discuss the available research

on a given topic after having completed a critical appraisal?

Lesson 4: Read Chapter 14: Undertaking a systematic review in Research Methods in Nursing and Midwifery and Evidence based practice by Elizabeth Cluett

1. Why are systematic reviews considered the highest forms of evidence?2. What are some of the ways that systematic reviews impact policy

development?3. Discuss the steps in developing a protocol for a systematic review.4. Why is it important to develop a good research question for a systematic

review?5. Describe PICO research question framework.6. How does a PICO question influence the inclusion of studies in a review?7. Describe a good approach to a comprehensive search of the literature on a

given topic. Where should a researcher look to find as much research on a given topic as possible?

8. Describe ways to document a search strategy so that others might replicate that search if needed.

9. Discuss effective ways to search electronic research databases.10. What is grey literature?11. How can a researcher access grey literature?12. How are studies included or excluded from a review after the comprehensive

search phase?13. Describe what is meant by data extraction.14. Describe the use of summary tables in presenting data.15. Discuss the significance of a meta-analysis.16. Briefly discuss how a meta-synthesis of qualitative data is carried out.17. Where are systematic reviews often published?

Lesson 5: Creating a PICO question1. Read the tutorial How to form an answerable clinical question and take notes.2. Generate three clinical scenarios from your own practice that have lead you to

question what advice or treatment you should give a client.3. Create a chart for each of the clinical scenarios that answers the follow

questions:

Course Syllabus ©National College of Midwifery 2017 01/2017

a. What is your clinical question in PICO format?b. What type of clinical question is it?c. What is the best study design for answering this question?

Lesson 6: Critical appraisal of a systematic reviewRead the critical appraisal of systematic reviews guide from the WHO library.

1. Using the WHO guide conduct a critical appraisal of the Wax et al article on Planned homebirth vs. hospital birth listed in the resource section.

2. Write up your critical appraisal following the guidelines and drawing on the textbook and other resources listed in the resource section.

3. After your critical appraisal is finished, do a search for critical discussion of the Wax et al article and compare this discussion to your critical appraisal with your preceptor.

Lesson 7: Creating a systematic research review proposal 1. Using the guidelines “Appendix 5 Systematic Review Proposal Outline

Developing a Protocol for a Systematic Review Using the Joanna Briggs Institute (JBI)Method” and “Comprehensive Systematic Review for Advanced Nursing Practice” write a systematic research review proposal on a midwifery topic of your choice. Follow all the guidelines outline in the proposal outline. Your preceptor will use this document to grade your final work for quality and completion.

Lesson 8: Read chapter 15: Disseminating Research1. What is a poster presentation?2. How is a poster presentation used to share results of research?3. Discuss how peer review is used in journal publication?4. What are some of the barriers faced by direct-entry midwives in the United States

to publishing?5. Why is it important for midwives to engage in publishing research despite some

of the barriers?6. Identify 2 journals that are relevant to midwifery practice. Answer the following

questions:a. Are the instructions for authors clear?b. What type of referencing style is required?c. What are the format and word limit guidelines provided?

Lesson 9: Poster project

1. Using one of your PICO questions perform a mini-review and present it as a poster presentation following these guidelines:a. State the Pico question and give a short description of problem and its

significance. b. Perform a critical appraisal of 3-5 studies related directly to your PICO

question.

Course Syllabus ©National College of Midwifery 2017 01/2017

c. Present a synopsis of this critical appraisal in your poster including: article citations, level of evidence of the study, conclusions drawn by the study, relevance of the study to your PICO question, and any significant research flaws in the study.

d. Synthesize recommendations for clinical practice that can be created based on the studies that have been analyzed. Illustrate areas where evidence is not conclusive for creating practice recommendations.

e. Organize the poster in a way that is professional, attractive and easy to read. Provide drawings or pictures where necessary for clarification. (For example of poster formatting you can reference the Natural Sciences Guidelines for undergraduate research conference: guidelines for poster presentations http://www.pitt.edu/~etbell/nsurg/PosterGuide.html or The Vanderbilt University Medical Center Evidence Based Practice and nursing research resources on poster presentations www.mc.vanderbilt.edu/root/vumc.php?site=evidencebasedpractice&doc=37886

f. Write a 350 word abstract for the poster that provides introductory information on the research review and implications for clinical practice.

Present this poster project at a regional or national midwifery or maternal child health venue. Document your participation in this event.