Navigating interprofessional boundaries: Midwifery students in Canada.

The literature on professional socialization focuses on how students adopt and internalize professional identities and values, and assumes that boundary work is essential to learning how best to practice their profession. However, a focus on boundary work in the context of midwifery training - which is embedded in the gendered and hierarchical landscape of maternity care - is lacking. Thus, this article examines how Canadian student-midwives learn to navigate and negotiate interprofessional boundaries. Grounded in a symbolic interactionist approach, it draws on 31 semi-structured qualitative interviews from a mixed-methods national study on midwifery retention, explores how midwifery students make sense of the tensions among midwives, physicians, and nurses, and describes what strategies they utilize when navigating boundaries. Our analysis, based in constructivist grounded theory, revealed that participants learned about interprofessional tensions in clinical placement encounters via direct or indirect interactions with other healthcare professionals, and that strategies to navigate these tensions included educating others about midwifery training and adopting a learner identity. This article proposes that the process of professional socialization enables to reshape professional boundaries and that students are not only learners but also agents of change. These findings may yield practical applications in health education by highlighting opportunities for improving interprofessional collaborations.

Can peers improve student retention? Exploring the roles peers play in midwifery education programmes in Canada.

PROBLEM: Peer support is understudied as a factor that can impact midwifery student retention. BACKGROUND: Retention of midwifery students is essential for creating a sustainable maternity care workforce. Research shows that peer support positively influences students' experiences, but it needs more focus on the role peers play in student retention. AIM: We aimed to examine how peer support can facilitate midwifery students' retention by exploring the role peers play in students' experiences and identifying the types of support students offer each other. METHODS: We conducted 31 semi-structured interviews with students attending Midwifery Education Programmes across Canada. Data were analysed inductively, following the constructivist grounded theory method. FINDINGS: While motivated and engaged peers improved students' learning experiences and desire to remain in their program, peers who created an overly competitive academic environment hindered learning. Students also noted that a lack of diversity, particularly of Black and Indigenous peers, limited their ability to learn about culturally safe care. Most students felt a sense of community and relied on one another for emotional, academic, and instrumental support. DISCUSSION: Peer support has mostly positive effects on student learning and should be formalized by midwifery educators to improve retention. Reducing pressure to succeed, targeting recruitment of students who are Black, Indigenous, and People of Colour, and establishing formal mentorship programmes could enhance the role peers play in student retention. CONCLUSION: While retention of students is a complex issue, positive interactions with peers can create a stimulating learning environment and increase students' desire to stay in their programme.

Differential Relationships Between Work-Life Interface Constructs and Intention to Stay in or Leave the Profession: Evidence From Midwives in Canada.

This paper investigates how positive and negative work-personal life interface constructs are differentially associated with intentions to stay in or leave the profession. The findings help map work-personal life interface constructs on the typology of determinants of intention to stay and intention to leave (disengagers, retainers, criticals, and neutrals). The ordered logistic regression (ologit) modelling of cross-sectional data from a representative sample (n = 601) of midwives in Canada shows that work interference with personal life is a disengager, which has a stronger association with intention to leave than with intention to stay in the profession. Among the work-personal life interface constructs, work enhancement of personal life seems to be the most critical determinant, showing the most substantive association with both intention to stay and intention to leave. This finding suggests that interventions to increase midwives' intention to stay and decrease their intention to leave should focus on amplifying the enhancing effects of working on midwives' personal lives. Interventions that aim to reduce work interference with personal life might be more effective in decreasing intention to leave the profession than increasing intention to stay.

Hours of work and on-call weeks preferences of Canadian midwives: relationships with intention to stay in the profession.

BACKGROUND: Midwives have long workdays and work many weeks on call. There is a concern that these extended work schedules can negatively affect their intention to stay in the profession. PURPOSE: This study provides evidence on Canadian midwives' preferences for and experiences with policies and guidelines which limit the hours of work and weeks per year preferred to be on call, and examines the relationship between preferences and midwives' intention to stay in the profession. METHODS: Data come from our 2018 pan-Canadian survey of midwives. Descriptive statistics of 720 midwives' preferences and experiences are provided. In the correlations followed by the OLS regressions, 596 midwives' data are used to test the associations between preferences and intention to stay in the profession. STATA (version 15) is used. A thematic analysis of 274 midwives' responses to the open-ended survey question is conducted to give voice to midwives on what can be done for retention. RESULTS: Three quarters of the 720 respondents prefer policies and guidelines to limit hours of work in a 24-hour period, though less than half have policies and guidelines on hours of work. More than half prefer to have fewer on-call weeks or never to be on call, less than a third prefer same number of on-call weeks, and only 2% prefer more weeks to be on call. Midwives are currently working on average 33 weeks per year on call. OLS regression analysis shows that 'met preference' for hours of work and on-call weeks are positively associated with intention to stay. In responding to the open-ended survey question, midwives recommend limiting the consecutive hours of work and on-call weeks to manageable hours and weeks to retain them in the profession. CONCLUSION: Midwives whose preferences are met are the ones intending to stay in the profession. There is, however, a large number of midwives with 'unmet needs' preferring to have policies and guidelines to limit the hours but do not have that currently, and would like to work fewer weeks on call than currently. These are the midwives who are not intending to stay in the profession.

"They hold your fate in their hands": Exploring the power dynamic in the midwifery student-preceptor relationship.

AIM: To examine (1) what role preceptors play in students' learning; (2) how student-preceptor relationships can impact students' views of the profession and their decision to leave the program; and (3) what strategies can be used to improve the preceptor-student relationship to facilitate student retention. RESEARCH DESIGN AND PARTICIPANTS: We used a qualitative methodological approach utilising semi-structure interviews with 31 midwifery students across Canada. Participants were recruited from all midwifery education programs and were in various stages of their educational journey. The interviews were conducted in English and French. Inductive analysis followed Charmaz's guidelines moving from line-by-line to focused coding and development of analytical categories. FINDINGS: The results show that positive relationships with preceptors boosted students' confidence and contributed to the constructive learning experiences among trainees. Students pointed out that their best learning experiences were facilitated by preceptors who created a safe space to make mistakes and were knowledgeable and invested in students' learning. Students also suggested that power imbalance is embedded in student-preceptor relationships and can negatively impact students' learning experiences and their decision to stay in the program. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is important to consider how to mitigate the power imbalance embedded in preceptor-student relationship. Offering more training to preceptors, oversight of preceptors' mentorship skills by midwifery educators, and creation of ombudsperson's position might mitigate some of the power differential and facilitate students' ability to complete midwifery training.

Does an alignment of employment policies and individual preferences affect intention to stay in the profession? Evidence from Canadian Midwives.

BACKGROUND: This study examines whether alignment of actual and preferred employment policies, including compensation method, employment status, and work schedule, affect midwives' intention to stay in the profession. The study further investigates the moderating effect of financial-rewards satisfaction and compares midwives' policy preferences in urban/rural practices. METHODS: Cross-sectional survey data from 549 midwives across Canada were analysed through descriptive statistics, bivariate correlations, and hierarchical linear regressions. Further regression analysis separated data for urban/rural practicing midwives. RESULTS: Three-quarters of the respondents are paid through a billable-course-of-care, while only one-third prefer this model. Another one-third prefer a combination of salary and billable-course-of-care. More than three-quarters of the respondents are independent contractors, but half prefer other forms of employee status. Lastly, half prefer a part-time work schedule, while others prefer full-time. Alignment of actual and preferred employment policies significantly explains midwives' intention to stay in the profession. Intentions to stay in the profession for urban midwives is significantly affected by the alignment of actual and preferred compensation methods, but not for rural ones. Both urban and rural midwives report similar preferences for employment status and work schedule policies. Furthermore, satisfaction with financial rewards is significantly associated with their intention to stay. CONCLUSION: Policymakers can positively influence midwives' intention to stay in the profession by facilitating alignment of their actual and preferred employment policies.

Work-life interface and intention to stay in the midwifery profession among pre- and post-clinical placement students in Canada.

BACKGROUND: Midwifery students' intention to stay in the profession can be influenced by how the interface of their work and personal life is affected by their clinical placement experience. The purpose of this study is to compare the intention to stay in the midwifery profession and its association with three work/personal life interface constructs among pre- and post-clinical placement midwifery students in Canada. The constructs investigated are work interference with personal life, personal life interference with work, and work/personal life enhancement. METHODS: Quantitative cross-sectional data were collected through two separate online surveys completed by pre- and post-clinical placement students. In total, 456 midwifery students attending six different midwifery education programs responded to the surveys. RESULTS: Compared to pre-clinical placement students, post-clinical placement students had significantly lower intention to stay in the profession. For pre-clinical placement students, higher personal life interference with work was significantly associated with lower intention to stay in the profession. For post-clinical placement students, higher work interference with personal life was associated with lower intention to stay in the profession. We did not find any significant relationships between work/personal life enhancement and intention to stay in the profession in pre- or post-clinical placement students. CONCLUSION: Pre- and post-clinical placement students have different intentions to stay in the profession. For pre-clinical placement students, those who report that their personal lives highly interfere with work are less likely to want to stay in the midwifery profession. Post-clinical placement students reported that when working interfered with their personal lives they were less likely to want to stay in the profession. Our findings highlight the importance of offering students a realistic preview of the required commitment, workload, and personal involvement in the midwifery profession prior to applying or accepting a spot in a midwifery education program. Furthermore, facilitating the development of skills to better manage the expectations in midwifery work and personal lives might help with maintaining positive intentions to stay in the profession.

A Dynamic Compliance Cervix Phantom Robot for Latent Labor Simulation.

Physical simulation systems are commonly used in training of midwifery and obstetrics students, but none of these systems offers a dynamic compliance aspect that would make them more truly representative of cervix ripening. In this study, we introduce a unique soft robot phantom that simulates the cervix softening during the latent labor phase of birth. This proof-of-concept robotic phantom can be dilated by 1 cm and effaced by 35% through the application of a Foley catheter-like loading mechanism. Furthermore, psychophysics trials demonstrate how untrained subjects can identify hard and soft states of the phantom with specificities of 91% and 87%, respectively. Both results indicated the appropriateness for application of this soft robot technology to birth training simulators.

Student attrition in the Ontario midwifery education programme.

OBJECTIVE: to identify the factors associated with student withdrawal during their university training. DESIGN: an Internet-based survey questionnaire was designed and administered. SETTING: two universities in Ontario, Canada. PARTICIPANTS: senior level students in years three and four, graduates of the programme and those students that withdrew prior to graduation. FINDINGS: students who withdrew from the programme were more likely to report not feeling academically supported and not being prepared for the time commitments required. Students with the greatest risk for leaving the programme were those that took a leave of absence, over half of which were maternity leaves. CONCLUSION: having identified those significant factors associated with student attrition, we can now begin to develop specific interventions to improve retention rates.

RETRACTED: Student attrition in the Ontario Midwifery Education Programme.

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Membrane receptors: structure and function of the relaxin family peptide receptors.

The receptors for members of the relaxin peptide family have only recently been discovered and are G-protein-coupled receptors (GPCRs). Relaxin and insulin-like peptide 3 (INSL3) interact with the leucine-rich-repeat-containing GPCRs (LGRs) LGR7 and LGR8, respectively. These receptors show closest similarity to the glycoprotein hormone receptors and contain large ectodomains with 10 leucine-rich repeats (LRRs) but are unique members of the LGR family (class C) as they have an LDL class A (LDLa) module at their N-terminus. In contrast, relaxin-3 and INSL5 interact with another class of type I GPCRs which lack a large ectodomain, the peptide receptors GPCR135 and GPCR142, respectively. These receptors are now classified as relaxin family peptide (RXFP) receptors, RXFP1 (LGR7), RXFP2 (LGR8), RXFP3 (GPCR135) and RXFP4 (GPCR142). This review outlines the identification of the peptides and receptors, their expression profiles and physiological roles and the functional interactions of the peptides with their unique receptors.

Expression and actions of transforming growth factors during human follicular development.

OBJECTIVE: To correlate the temporal expression of transforming growth factor-alpha (TGF-alpha) and TGF-beta genes in granulosa cells (GC) and thecal cells from human follicles at various developmental stages and to determine their trophic effects on GCs. DESIGN: Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis of extracted RNA from follicular GCs and theca cells. SETTING: Academic endocrinology laboratory. PATIENT(S): Premenopausal women undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy for nonovarian reasons. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Confirmation by the RT-PCR product for TGF-alpha and TGF-beta gene expression in GC and theca cells from human follicles at various developmental stages and (3)H-thymidine uptake in vitro to assess growth effects on GCs. RESULT(S): The RT-PCR product indicating the presence of TGF-alpha messenger RNA (mRNA) was found consistently in theca from healthy antral follicles. In theca from large follicles (>1.0 cm) the TGF-alpha PCR product was of reduced intensity. The TGF-alpha was absent or undetectable in granulosa cells from all follicle sizes. The PCR product for TGF-beta was generated by all GC and thecal cell RNAs from all follicle sizes examined. The TGF-alpha promoted and TGF-beta inhibited human GC growth. CONCLUSION(S): The presence of TGF-alpha gene expression in thecal cells coincides with periods of follicular growth. The expression of TGF-beta occurs in both cell types throughout antral follicle development. The TGF-alpha and TGF-beta have opposing trophic effects on GCs.

Binding of progesterone to cell surfaces of human granulosa-lutein cells.

Progesterone is produced by granulosa cells under the influence of luteinizing hormone. Nuclear progesterone receptors have been found in rat granulosa cells. Human granulosa-lutein cells rapidly respond to progesterone with an increase in intracellular calcium suggesting the existence of a nongenomic mechanism. This study was conducted to determine whether binding of progesterone to granulosa cells could occur at the membrane. Granulosa cells were obtained from an in vitro fertilization program and examined immunohistochemically with an antiserum to membrane progesterone receptors. Approximately 14-70% of freshly harvested or cultured granulosa cells of six patients showed a positive reaction to the antiserum, limited to the cell membrane. Western blot analysis of homogenates of granulosa cells and a granulosa cell tumour confirmed the presence of progesterone receptors A, B and C and low amounts of a putative membrane receptor. These results demonstrate that the plasma membranes of human granulosa cells possess binding components for progesterone which may be involved in its nongenomic mechanism of action.

A simplified method for preparing IVF granulosa cells for culture.

PURPOSE: To validate an expedited method for the removal of erythrocytes when preparing IVF granulosa-luteal cells for culture. METHODS: Granulosa cells were enriched for culturing from follicular aspirates by density gradient centrifugation and by hypo-osmotic lysis treatments. RESULTS: Cells prepared by either method showed the same cell viability and produced progesterone in similar quantities. CONCLUSIONS: Using hypo-osmotic lysis to remove erythrocytes does not impair granulosa cell viability or steroidogenesis. It avoids multiple density gradient centrifugations and washings, and yields IVF granulosa cells ready for culture efficiently.

Problem-based learning and the medical school: another case of the emperor's new clothes?

For almost four decades, problem-based learning (PBL) has been the stated cornerstone of learning in many medical schools. Proponents of PBL cite the open nature of the learning experience where students are free to study in depth, unencumbered by the burdens of broad courses based on the memorization of facts; detractors, on the other hand, cite the lack of breadth and factual knowledge required for professional qualification. Both points of view have merit. Professional schools have a different set of needs and requirements, and it is these that drive the curriculum and learning philosophies. The constraints of the professional school are so different from those of the purely academic environment that PBL, while admirably suited to the latter, is just problem solving in the former.

Problem-based learning in reproductive physiology.

One of the most misunderstood concepts in progressive educational curricula is that of problem-based learning (PBL). Often confused with problem solving, the two are quite different. Courses conducted in a PBL format use problems as a launch pad for resulting study. This article reviews a course designed to enable students to learn and understand the principles of human reproductive physiology using PBL. The learning process is situation based, student directed, and takes place in small groups. The rationale for some of these innovations is discussed and the way in which they were implemented is described.