Could a decision support tool be the key to supporting choice for women regarding place of birth?

OBJECTIVE: To assess the effectiveness of using an innovative decision aid, MyBirthplace, to facilitate shared decision-making regarding place of birth. DESIGN: A quasi-experimental study comparing pre-test and post-test responses from participants who had access to the intervention. SETTING: A large urban hospital in the south of England. PARTICIPANTS: All pregnant women who accessed maternity care between April and December 2016. INTERVENTION: A decision aid (MyBirthplace) designed to provide information and support regarding place of birth. The digital tool (available in both an app and web-based version) was used to facilitate discuss between the women and her midwife at the booking visit. MEASUREMENTS: Women's stage of decision making as measured by the Stage of Decision Making Scale. A questionnaire was administered before and after using MyBirthplace at booking, and again at 28 weeks gestation. FINDINGS: Nearly half the women (42.1%) had already decided where they wanted to give birth before the booking appointment, but a third (34.3%) had not yet begun to think about their choices. The introduction of the decision aid during the booking visit was associated with a significant increase in the stage of decision making suggesting that women had greater certainty in their decision P< 0.0001 [SD 1.077]. Women who accessed MyBirthplace had lower decisional conflict after the booking appointment than those women that did not access the decision aid (35.5% compared with 22.0%) but this difference was not statistically significant. KEY CONCLUSIONS: Decision aids, as a standard part of practice, have the potential to ensure women are informed of their options and encourage shared decision making about place of birth. Women were more confident with their decision following the booking appointment and by 28 weeks; however, further research is needed to identify the role that the decision aid played in building this confidence. IMPLICATIONS FOR PRACTICE: The introduction of a decision aid, Mybirthplace, within the hospital impacted early discussions between the woman and the midwife and appeared to benefit women's decision making regarding place of birth. Further studies of midwives' use of innovative technologies and their implementation are required.

Student performance in medical biochemistry and genetics: comparing campus-based versus zoom-based lecture delivery.

BACKGROUND: We appraised the effectiveness of online (Zoom) delivery versus live campus-based delivery of lectures in biochemistry and genetics courses and assessed the security of remote versus campus-administered exams. METHODS: Participants were 601 students entering Michigan State University College of Osteopathic Medicine in 2019 or 2020. The former cohort completed courses and exams on campus, while the latter completed courses online due to the COVID-19 pandemic. For the biochemistry and genetics courses, the same lecturers delivered the same content and used identical exam questions for assessments in 2019 and 2020. The investigators compared percent correct for each question in 2019 and 2020. RESULTS: This study found 84 of 126 (67%) of the questions yielded little difference (3% or less in % correct) between live delivery and Zoom delivery. For questions whose % correct index differed by 4% or more, Zoom delivery yielded a better performance for 16 questions (13%), while 19 questions (15%) showed live lectures performed better. Seven of the questions (6%) had an identical mode of delivery in 2019 and 2020 (e.g., self-study exercise). These served as "control questions" for which equivalent student performance was expected. The 126 questions analyzed spanned a wide range in the % correct index, from 60% correct to > 90% correct. CONCLUSIONS: The results suggest that Zoom and on-campus delivery of the content in biochemistry and genetics yielded similar achievement of course objectives. The high concordance, between 2019 and 2020, of the % correct for individual questions also speaks to exam security including online proctoring.

Understanding Student Characteristics in the Development of Active Learning Strategies.

Student evaluations after non-lecture, active learning sessions at Michigan State University, College of Osteopathic Medicine, have yielded bipartite responses with one group responding favorably and the other group negatively. The purpose of this study was to understand the characteristics, motivation, and learning strategies of medical students that find value in, appreciate, and perceive active learning sessions to be beneficial and those of students that do not. We generated a survey, based on the Motivated Strategies for Learning Questionnaire (MSLQ), that included questions regarding overall student motivations for learning, learning strategies that students employed throughout medical school, and their perceptions of active learning. Following an active learning session on hyperammonemia, we administered the modified MSLQ survey. Using the results of this survey, we validated the modified MSLQ and identified correlations between student characteristics and their perception of the active learning session. We found that, in general, students with high task value, intrinsic goal orientation, self-efficacy for learning and performance, and control of learning beliefs felt more positively about their experience in the active learning session. Understanding the characteristics, motivations, and learning strategies that help students find value in active learning sessions will help medical educators develop future curricular material so that these exercises will better engage and be more effective with a greater number of learners. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01550-9.

Infant feeding attitudes of women in the United Kingdom during pregnancy and after birth.

BACKGROUND: To address the recognized low rates of breastfeeding in the United Kingdom (UK), a change in fundamental attitudes toward infant feeding might be required. This paper reports an exploration of women's attitudes toward breastfeeding at different time points in the perinatal period, undertaken as part of a larger breastfeeding evaluation study. OBJECTIVES: To measure women's infant feeding attitudes at 3 stages during the perinatal period to see whether, on average, they differed over time. METHODS: Using the 17-item Iowa Infant Feeding Attitudes Scale (IIFAS), this cross-sectional study measured the infant feeding attitudes of 866 UK women at 3 perinatal stages (20 and 35 weeks antenatally and 6 weeks postpartum). RESULTS: Mean IIFAS scores were very similar, which shows that discrete groups of women at different time points in pregnancy and postpartum appear to have the same attitudes toward infant feeding. The predominance of scores lay in the mid-range at each of the time points, which may indicate women's indecision or ambivalent feelings about infant feeding during pregnancy and the postpartum period. CONCLUSIONS: Action must be undertaken to target the majority of women with mid-range scores whose ambivalence may respond positively to intervention programs. The challenge is to understand what would be appropriate and acceptable to this vulnerable group of women.

A qualitative study exploring the support needs of first-time mothers on their journey towards intuitive parenting.

OBJECTIVE: to gain an understanding of the experiences of first-time mothers in the early weeks of motherhood in order to elicit what areas of support these women find empowering in easing their adjustment. DESIGN: a grounded theory approach was used. Data were collected through individual in-depth interviews. SETTING: an area in the South of England with maternity services provided by a consultant obstetric unit and four midwife-led centres. PARTICIPANTS: eight primiparous women aged 20-39 years, who had given birth normally at term to a healthy baby. FINDINGS: five categories 'expert to novice', 'losing touch', 'perceiving expertise', 'restoring balance' and 'falling into place' revealed a journey women travelled as they left behind their comfortable, controlled lives in which they were 'experts' and faced the unknown world of motherhood. Eventually, practice, support and knowledge shared with peers facilitated proficiency and intuitive mothering. Throughout this transition, the overriding concern of the mothers was to develop confidence and skills to give optimal care to their baby. 'Doing it right' emerged as the core category. IMPLICATIONS FOR PRACTICE: an understanding of the factors women considered to be supportive or inhibitive in easing their adjustment to motherhood might enable midwives to move beyond more traditional forms of postnatal care to explore innovative ways of providing and facilitating access to supportive resources.