Leaders' experiences of embedding a simulation-based education programme in a teaching hospital: an interview study informed by normalisation process theory.

There is limited research on the experiences of people in working to embed, integrate and sustain simulation programmes. This interview-based study explored leaders' experiences of normalising a simulation-based education programme in a teaching hospital. Fourteen known simulation leaders across Australia and North America were interviewed. Semi-structured interviews were analysed using reflexive thematic analysis sensitised by normalisation process theory, an implementation science theory which defines 'normal' as something being embedded, integrated and sustained. We used a combined social and experiential constructivist approach. Four themes were generated from the data: (1) Leadership, (2) business startup mindset, (3) poor understanding of simulation undermines normalisation and (4) tension of competing objectives. These themes were interlinked and represented how leaders experienced the process of normalising simulation. There was a focus on the relationships that influence decision-making of simulation leaders and organisational buy-in, such that what started as a discrete programme becomes part of normal hospital operations. The discourse of 'survival' was strong, and this indicated that simulation being normal or embedded and sustained was still more a goal than a reality. The concept of being like a 'business startup' was regarded as significant as was the feature of leadership and how simulation leaders influenced organisational change. Participants spoke of trying to normalise simulation for patient safety, but there was also a strong sense that they needed to be agile and innovative and that this status is implied when simulation is not yet 'normal'. Leadership, change management and entrepreneurship in addition to implementation science may all contribute towards understanding how to embed, integrate and sustain simulation in teaching hospitals without losing responsiveness. Further research on how all stakeholders view simulation as a normal part of a teaching hospital is warranted, including simulation participants, quality and safety teams and hospital executives. This study has highlighted that a shared understanding of the purpose and breadth of simulation is a prerequisite for embedding and sustaining simulation. An approach of marketing simulation beyond simulation-based education as a patient safety and systems improvement mindset, not just a technique nor technology, may assist towards simulation being sustainably embedded within teaching hospitals.

Colposcopy performance in the new primary HPV screening in Australia: How to determine colposcopy competency?

AIMS: To assess colposcopic performance and determine indicators for competency within the new Australian primary human papillomavirus (HPV) cervical screening program. MATERIALS AND METHODS: A retrospective observational study of 4542 women seen at The Royal Women's Hospital Colposcopy Clinic in Melbourne, from 1 December 2017 to 31 July 2020 after a higher-risk cervical screening test (CST) result. RESULTS: Histological CIN2+ was detected in 25.1% up to two years from first colposcopy visit (FCV). The majority (86.7%) of CIN2+ was detected early within the first six months of presentation. Biopsy rate overall was 96.1% with abnormal colposcopic impression. Of four colposcopists with a lower biopsy rate, only one was able to achieve this early detection rate. Biopsy was also taken in over 30% of cases with negative reflex cytology and normal colposcopy, with CIN2+ detected in 5.0% among positive HPV16/18 and 3.8% with non-16/18 HPV. Positive predictive value of high-grade colposcopic impression at FCV averaged 66.4% (range: 54.9-81.6% among our colposcopists) and is poorly correlated with early detection rate of CIN2+. Overall accuracy of colposcopy is 84.5% (range: 78.7-90.3%), buoyed by high true negative colposcopic predictions secondary to high rates of negative reflex cytology referral with the new screening algorithm and is also unlikely to be a useful colposcopy indicator. CONCLUSIONS: Early detection rate of CIN2+ within the first six months of presentation is a useful measure of colposcopy competency and we would encourage our National Cancer Screening Register to explore this with the participating colposcopists.

What and when to debrief: a scoping review examining interprofessional clinical debriefing.

INTRODUCTION: Clinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts. METHODS: Articles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches. RESULTS: Forty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD. CONCLUSIONS: The proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.

Faculty development for translational simulation: a qualitative study of current practice.

BACKGROUND: Translational simulation is focused directly on healthcare quality, safety, and systems. Effective translational simulation design and delivery may require knowledge and skills in areas like quality improvement and safety science. How translational simulation programs support their faculty to learn these skills is unknown. We aimed to explore current faculty development practices within translational simulation programs, and the rationale for the approaches taken. METHODS: We used a qualitative approach to explore faculty development in translational simulation programs. We conducted semi-structured interviews with representatives who have leadership and/or faculty development responsibilities in these programs and performed a thematic analysis of the data. RESULTS: Sixteen interviews were conducted with translational simulation program leaders from nine countries. We identified three themes in our exploration of translational simulation faculty development practices: (1) diverse content, (2) 'home-grown', informal processes, and (3) the influence of organisational context. Collaboration beyond the historical boundaries of the healthcare simulation community was an enabler across themes. CONCLUSION: Leaders in translational simulation programs suggest a diverse array of knowledge and skills are important for translational simulation faculty and report a range of informal and formal approaches to the development of these skills. Many programs are early in the development of their approach to faculty development, and all are powerfully influenced by their context; the program aims, structure, and strategy.

Video telehealth to manage menopausal symptoms after cancer: a prospective study of clinicians and patient satisfaction.

OBJECTIVE: The aim of the study is to evaluate clinician and patient satisfaction with a novel video conferencing telehealth (VCT) service and barriers to use. METHODS: A prospective observational study (2018-2020) of a statewide VCT service using healthdirect was performed. Participants were clinicians and patients from the Menopausal Symptoms After Cancer service. Patients were cancer survivors aged 20 to 70 years referred to the Menopausal Symptoms After Cancer service to manage early menopause/menopausal symptoms or women at high inherited risk of cancer due to pathogenic gene variants, such as BRCA1/2 between September 2018 and May 2020. Data were analyzed descriptively. The main outcome measures for clinicians were clinician satisfaction and ease of use, duration of consultation, patient rapport and standard of care, and future intention to use VCT. Outcome measures for patients were reasons for choosing telehealth, preferred devices, ease of use, perceived benefits and standard of care, and future intention to use VCT. RESULTS: Data were available from 109 complete clinician surveys. Overall satisfaction was high (93%), but 32% reported technical difficulties and 42% found VCT distracting. Most reported that standard of care (91%), consultation duration (93%), and patient rapport (73%) were unaffected and 97% would use VCT again for patients not requiring examination. From 35 complete patient surveys, saving travel time and cost were the main reasons for choosing VCT (57%) and for convenience (31%). Most found the platform easy to use (83%) and were comfortable with the technology (83%) without technical difficulties (89%). All found the platform easier and less time consuming than in-person appointments. Most believed that the standard of care received was equivalent to an in-person consultation (94%), were satisfied with the consultation (97%), and would choose VCT again (97%). CONCLUSIONS: Clinician and patient satisfaction with VCT was high and clinical standards were maintained. However, technical difficulties and distractions were common for clinicians despite training.

Pregnancy and parental leave policies at Australian and New Zealand medical schools.

BACKGROUND: Research into how medical schools support students who are pregnant or with current parental responsibilities has been mostly limited to the US context. OBJECTIVES: To review pregnancy and parental leave policies for students at Australian/New Zealand medical schools. DESIGN: A cross-sectional survey. METHODS: Data were collected between June and September 2021. Websites of Australian/New Zealand medical schools (n = 23) were searched for freely available information on pregnancy and parental leave policies. Each school was contacted to provide supplementary information on the processes to support students who apply for pregnancy and/or parental leave. Outcome harvesting techniques were used to analyse the key attributes and processes used by medical schools. RESULTS: None of the 23 accredited Australian/New Zealand medical schools had specific pregnancy and/or parental leave policies. Fourteen of the 23 Australian/New Zealand medical schools responded to the request for more information. All confirmed, beyond their University's general student leave policies, they had no additional pregnancy and parental leave policy. Analysis of each school's processes identified the following themes: lack of school specific pregnancy and/or parental leave policies; lack of public statements of support for medical students who are pregnant and/or with current parental responsibilities; and lack of attention to the specific needs of medical students who are pregnant and/or with current parental responsibilities, including those with pregnant partners or are a birth support person. CONCLUSION: There was a lack of documentation and formalized processes related to the support of this group of students. By creating easily accessible information on pregnancy and parental leave which is nuanced to the challenges of medical school and clinical placements, medical schools and medical education accreditation bodies in Australia/New Zealand can address the needs of medical students who are pregnant and/or with current parental responsibilities and normalize pregnancy and parental status within entry-to-practice medical courses.

Childbearing women's experiences of the maternity care system in Australia during the first wave of the COVID-19 pandemic.

BACKGROUND: Substantial changes occurred in Australian healthcare provision during the COVID-19 pandemic to reduce the risk of infection transmission. Little is known about the impact of these changes on childbearing women. AIM: To explore and describe childbearing women's experiences of receiving maternity care during the COVID-19 pandemic in Australia. METHODS: A qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. Twenty-seven interviews were conducted with women from across Australia. Data was analysed thematically. FINDINGS: Three primary themes and nine sub-themes emerged: 'navigating a changing health system' (coping with constant change, altered access to care, dealing with physical distancing restrictions, and missing care), 'desiring choice and control' (experiencing poor communication, making hard decisions, and considering alternate models of care), and 'experiencing infection prevention measures' (minimising the risk of exposure and changing care plans to minimise infection risk). DISCUSSION: The substantial changes in care delivery for pregnant and postpartum women during the pandemic appear to have reduced woman-centred care. In most cases, care was perceived as impersonal and incomplete, resulting in a very different experience than expected; consequences included missing care. The presence of a known care provider improved women's sense of communication, choice, and control. CONCLUSION: This study provides unique insight into the experiences of childbearing women across Australia. The importance of respectful woman-centred care cannot be forgotten during a pandemic. The findings may inform future service planning during pandemics and disaster situations.

Midwives' experiences of providing maternity care during the COVID-19 pandemic in Australia.

PROBLEM: The COVID-19 pandemic has required rapid and radical changes to the way maternity care is provided in many nations across the world. BACKGROUND: Midwives provide care to childbearing women across the continuum and are key members of the maternity workforce in Australia. AIM: To explore and describe midwives' experiences of providing maternity care during the COVID-19 pandemic in Australia. METHODS: A two-phased cross-sectional descriptive study was conducted. Data were collected through an online survey and semi-structured interviews between May-June 2020. FINDINGS: Six hundred and twenty midwives responded to the online survey. Many reported a move to telehealth appointments. For labour care, 70% of midwives reported women had limited support; 77% indicated postnatal visiting was impacted. Five main themes were derived from the qualitative data including: coping with rapid and radical changes, challenges to woman-centred care, managing professional resilience, addressing personal and professional challenges, and looking ahead. DISCUSSION: Restrictions applied to women's choices, impacted midwives' ability to provide woman-centred care, which resulted in stress and anxiety for midwives. Professional resilience was supported through collaborative relationships and working in continuity models. Midwives revealed 'silver linings' experienced in providing care during the pandemic. CONCLUSION: Findings provide valuable evidence to understand the impact on midwives who have provided care during the COVID-19 pandemic. Knowledge will be useful for health leaders and policy makers as they consider ways to continue care during the pandemic and support the essential midwifery workforce. Recommendations are presented to improve preparedness for future pandemics.

Receiving maternity care during the COVID-19 pandemic: Experiences of women's partners and support persons.

BACKGROUND: In Australia, the provision of maternity care during the COVID-19 pandemic was significantly altered to limit transmission of the virus. Many hospitals limited face-to-face appointments to only the pregnant woman and restricted the number of support people present during labour, birth, and postnatal visits to one person. How these restrictions were experienced by partners and support persons of childbearing women are unknown. AIM: To explore the experiences of partners and support persons of women receiving maternity care during the COVID-19 pandemic. METHODS: A two-phased qualitative study including an online survey and interviews. Analysis was undertaken using content analysis. FINDINGS: Partners and support persons experienced a sense of 'missing out' from the pregnancy and maternity care experience because of changes in the provision of care during the pandemic. They reported feelings of isolation, psychological distress, and reduced bonding time with babies. Conflicting information and processes within and across maternity services contributed to feelings of uncertainty and a perceived reduction in the quality of care. Partners and support persons were negatively impacted by restrictions on maternity wards, however they also perceived these to be of benefit to women. DISCUSSION: Many partners and support persons were negatively impacted by restrictions in maternity services during the pandemic; strategies to ensure their active involvement in maternity care are needed. CONCLUSION: This study offers insights from the unique perspective of partners and support people of women receiving maternity care during the pandemic. Policies and processes that exclude partners and support persons need to be reconsidered.

Australian women's experiences of receiving maternity care during the COVID-19 pandemic: A cross-sectional national survey.

BACKGROUND: The COVID-19 pandemic has led to multiple changes in maternity services worldwide. Systems rapidly adapted to meet public health requirements aimed at preventing transmission of SARS-CoV-2, including quarantine procedures, travel restrictions, border closures, physical distancing and "stay-at-home" orders. Although these changes have impacted all stakeholders in maternity services, arguably the women at the center of this care have been most affected. This study aimed to explore women's experiences of receiving maternity care during the COVID-19 pandemic in Australia. METHODS: A national cross-sectional online survey, including fixed choice and open-ended questions, was conducted during the first wave of the COVID-19 pandemic in Australia; pregnant and postnatal women were recruited through social media networks. RESULTS: The survey was completed by 3364 women. Women felt distressed and alone due to rapid changes to their maternity care. Limited face-to-face contact with health practitioners and altered models of care often required women to accommodate significant changes and to coordinate their own care. Women felt that they were often "doing it alone," due to public health restrictions on support people and visitors, both within and outside health services. Women described some benefits of visitor restrictions, such as, more time for rest, breastfeeding establishment, and bonding with their baby. CONCLUSIONS: This large nationwide Australian study provides unique data on women's experiences of receiving maternity care during the COVID-19 pandemic. Lessons learned provide an opportunity to rebuild and reshape the maternity sector to best meet the needs of women and their families during current and future public health crises.

COVID-19 vaccination perceptions and intentions of maternity care consumers and providers in Australia.

INTRODUCTION: Vaccination against COVID-19 is a key global public health strategy. Health professionals including midwives and doctors support and influence vaccination uptake by childbearing women. There is currently no evidence regarding the COVID-19 vaccination perceptions and intentions of those who receive or provide maternity care in Australia. The aim of this study was to address this gap in knowledge and explore the perceptions and intentions regarding COVID-19 vaccination from consumers and providers of maternity care in Australia. METHODS: A national cross-sectional online study conducted in early 2021 in Australia, a country that has had a very low number of COVID-19 cases and deaths. Recruitment was undertaken through parenting and health professional social media sites and professional college distribution lists. A total of 853 completed responses, from women (n = 326), maternity care providers including doctors (n = 58), midwives (n = 391) and midwifery students (n = 78). FINDINGS: Personal intention to be vaccinated ranged from 48-89% with doctors most likely and women least likely. Doctors and midwifery students were significantly more likely to recommend the vaccine to pregnant women in their care than midwives (p<0.001). Fewer doctors (2%) felt that women should wait until breastfeeding had concluded before being vaccinated compared with 24% of midwives and 21% of midwifery students (p<0.001). More than half of the midwives (53%) had concerns about the COVID-19 vaccine for the women in their care compared with 35% of doctors and 46% of midwifery students. Despite national guidelines recommending vaccination of breastfeeding women, 54% of practitioners were unlikely to recommend vaccination for this group. CONCLUSION: This is the first study to explore the perceptions and intentions regarding COVID-19 vaccination from the perspective of those who receive and provide maternity care in Australia. Findings have utility to support targeted public health messaging for these and other cohorts.

Becoming a mother in the 'new' social world in Australia during the first wave of the COVID-19 pandemic.

BACKGROUND: Substantial public health measures occurred in Australian society during the COVID-19 pandemic to reduce the risk of community transmission. Little was known about the impact of these changes on childbearing women. AIM: To describe childbearing women's experiences of becoming a mother during the COVID-19 pandemic in Australia. METHODS: A qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. A total of 27 interviews were conducted with women across Australia. Data were analysed thematically. FINDINGS: The thematic analysis resulted in four primary themes and ten sub-themes. The themes were 'going it alone - having a baby was an isolating experience' ('receiving maternity care alone', 'dealing with government restrictions', and 'desiring social support'), 'advocating for self or others' ('seeking reliable information', 'valuing peersupport', and 'having to be resourceful'), 'finding a way through' ('a changed experience for all', 'managing stress and anxiety', 'requiring constant adjustments', and 'managing fear mongering'), and 'keeping safe'. CONCLUSION: Becoming a mother during the COVID-19 pandemic in Australia was a profound experience for the women. Following the public health initiatives which resulted in physical distancing restrictions, isolation, and the need to provide and receive social and peer support were common experiences. Whilst public health initiatives are implemented to keep people safe, the social and emotional toll on childbearing women should be considered by healthcare professionals. Childbearing women need to be safe but also require support and reassurance.

Defining competency for Royal Australian and New Zealand College of Obstetricians and Gynaecologists training: An exploratory study of Victorian Integrated Training Program coordinators' understanding of competency.

BACKGROUND: Competency-based medical education (CBME) is increasingly employed by postgraduate training programs worldwide, including obstetrics and gynaecology. Focusing on assessment of outcomes rather than time-in-training, and utilising a well-defined curricular framework, CBME aims to train doctors capable of meeting the needs of modern society. When this study was undertaken, in 2019, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) had a time-based curriculum and was due to undergo a curriculum review starting in 2020. AIMS: To explore Victorian RANZCOG Integrated Training Program (ITP) coordinators' understanding of the concept of competency and how it is taught and assessed within RANZCOG training. MATERIALS AND METHODS: A qualitative, grounded theory design using semi-structured interviews was employed. Victorian RANZCOG ITP coordinators from inner and outer metropolitan, and regional sites, were approached to participate. Transcripts were coded and analysed using thematic analysis. RESULTS: Themes identified were: Competence, Vision and Innovation, Structures, ITP Coordinator Role and Teaching and Learning. Competence was defined as a combination of independent practice and understanding of ones' own limits, in addition to required clinical skills and knowledge. Enablers and barriers to achieving competency were identified and associated with structures, human and logistical factors. Victorian ITP coordinators believed the current training program has positive elements but could be further improved. CONCLUSIONS: Several areas for future research were identified regarding understanding of competency, relevant if RANZCOG is to introduce a CBME framework. Replicating this research across all RANZCOG jurisdictions in Australia and New Zealand would be prudent to determine if the themes are universal.

Experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia: A five-cohort cross-sectional comparison.

INTRODUCTION: The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. METHODS: A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were recruited via social media and invited to participate in an online survey released between 13th May and 24th June 2020; a total of 3701 completed responses were received. FINDINGS: While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family's health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women's partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. CONCLUSION: This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders' experiences of the rapid changes to health services.

Covid-19 changes to maternity care: Experiences of Australian doctors.

BACKGROUND: The COVID-19 pandemic meant rapid changes to Australian maternity services. All maternity services have undertaken significant changes in relation to policies, service delivery and practices and increased use of personal protective equipment. AIMS: The aim of this study was to explore and describe doctors' experiences of providing maternity care during the COVID-19 pandemic in Australia. METHODS: A national online survey followed by semi-structured interviews with a cohort of participants was conducted during the first wave of the COVID-19 pandemic in Australia (May-June 2020). Participants were recruited through social media networks. Eighty-six doctors completed the survey, and eight were interviewed. RESULTS: Almost all doctors reported rapid development of new guidelines and major changes to health service delivery. Professional colleges were the main source of new information about COVID-19. Most (89%) doctors felt sufficiently informed to care for women with COVID-19. Less than half of doctors felt changes would be temporary. Doctors described workforce disruptions with associated personal and professional impacts. The ability to access and process up-to-date, evidence-based information was perceived as important. Doctors acknowledged that altered models of care had increased pregnant women's anxiety and uncertainty. All doctors described silver linings from sector changes. CONCLUSIONS: This study provides unique insights into doctors' experiences of providing maternity care during the COVID-19 pandemic in Australia. Findings have immediate relevance to the maternity sector now and into the future. Lessons learnt provide an opportunity to reshape the maternity sector to better prepare for future public health crises.

Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic.

The COVID-19 pandemic is impacting health systems worldwide. Maternity care providers must continue their core business in caring and supporting women, newborns and their families whilst also adapting to a rapidly changing health system environment. This article provides an overview of important considerations for supporting the emotional, mental and physical health needs of maternity care providers in the context of the unprecedented crisis that COVID-19 presents. Cooperation, planning ahead and adequate availability of PPE is critical. Thinking about the needs of maternity providers to prevent stress and burnout is essential. Emotional and psychological support needs to be available throughout the response. Prioritising food, rest and exercise are important. Healthcare workers are every country's most valuable resource and maternity providers need to be supported to provide the best quality care they can to women and newborns in exceptionally trying circumstances.

Twelve tips for facilitating and implementing clinical debriefing programmes.

Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.