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.

"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.

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.

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.

Procedure-specific Risks of Thrombosis and Bleeding in Urological Cancer Surgery: Systematic Review and Meta-analysis.

CONTEXT: Pharmacological thromboprophylaxis involves balancing a lower risk of venous thromboembolism (VTE) against a higher risk of bleeding, a trade-off that critically depends on the risks of VTE and bleeding in the absence of prophylaxis (baseline risk). OBJECTIVE: To provide estimates of the baseline risk of symptomatic VTE and bleeding requiring reoperation in urological cancer surgery. EVIDENCE ACQUISITION: We identified contemporary observational studies reporting symptomatic VTE or bleeding after urological procedures. We used studies with the lowest risk of bias and accounted for use of thromboprophylaxis and length of follow-up to derive best estimates of the baseline risks within 4 wk of surgery. We used the GRADE approach to assess the quality of the evidence. EVIDENCE SYNTHESIS: We included 71 studies reporting on 14 urological cancer procedures. The quality of the evidence was generally moderate for prostatectomy and cystectomy, and low or very low for other procedures. The duration of thromboprophylaxis was highly variable. The risk of VTE in cystectomies was high (2.6-11.6% across risk groups) whereas the risk of bleeding was low (0.3%). The risk of VTE in prostatectomies varied by procedure, from 0.2-0.9% in robotic prostatectomy without pelvic lymph node dissection (PLND) to 3.9-15.7% in open prostatectomy with extended PLND. The risk of bleeding was 0.1-1.0%. The risk of VTE following renal procedures was 0.7-2.9% for low-risk patients and 2.6-11.6% for high-risk patients; the risk of bleeding was 0.1-2.0%. CONCLUSIONS: Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without PLND in low-risk patients). For "close call" procedures, decisions will depend on values and preferences with regard to VTE and bleeding. PATIENT SUMMARY: Clinicians often give blood thinners to patients to prevent blood clots after surgery for urological cancer. Unfortunately, blood thinners also increase bleeding. This study provides information on the risk of clots and bleeding that is crucial in deciding for or against giving blood thinners.

Pregnancy as a risk factor for severe outcomes from influenza virus infection: A systematic review and meta-analysis of observational studies.

BACKGROUND: Pregnancy is considered to be an important risk factor for severe complications following influenza virus infection. As a consequence, WHO recommendations prioritize pregnant women over other risk groups for influenza vaccination. However, the risk associated with pregnancy has not been systematically quantified. PURPOSE: Systematic review and meta-analysis of observational studies that reported on pregnancy as a risk factor for severe outcomes from influenza virus infection. DATA SOURCE: MEDLINE, EMBASE, CINAHL, and CENTRAL up to April 2014. DATA SELECTION: Studies reporting on outcomes in pregnant women with influenza in comparison to non-pregnant patients with influenza. Outcomes included community-acquired pneumonia, hospitalization, admission to intensive care units (ICU), ventilatory support, and death. DATA EXTRACTION: Two reviewers conducted independent screening and data extraction. A random effects model was used to obtain risk estimates. Ecological studies were summarized descriptively. DATA SYNTHESIS: A total of 142 non-ecological and 10 ecological studies were included. The majority of studies (n=136, 95.8%) were conducted during the 2009 influenza A (pH1N1) pandemic. There was a higher risk for hospitalization in pregnant versus non-pregnant patients infected with influenza (odds ratio [OR] 2.44, 95% CI 1.22-4.87), but no significant difference in mortality (OR 1.04, 95% CI 0.81-1.33) or other outcomes. Ecologic studies confirmed the association between hospitalization risk and pregnancy and 4 of 7 studies reported higher mortality rates in pregnant women. LIMITATIONS: No studies were identified in which follow-up began prior to contact with the healthcare system and lack of adjustment for confounding factors. CONCLUSIONS: We found that influenza during pregnancy resulted in a higher risk of hospital admission than influenza infection in non-pregnant individuals, but that the risk of mortality following influenza was similar in both pregnant and non-pregnant individuals.