PROBLEM

1. APPLICATION OF KOLB EXPERIENTIAL THEORY TO PROMOTE EFFECTIVE TEACHING OF SHOULDER DYSTOCIA MANAGEMENT TO MIDWIFERY STUDENTS Basak Ardalani, BSc.RM. Instructor: Dr. Abbas Ghavam-Rassoul MD MHSc CCFP FCFP MScCH, Health Practitioner Teacher Education GOALS 1.Enhanced competency of midwifes in managing shoulder dystocia 2. Improved health outcome for mother and newborn RECOMMENDATIONS 1. Utilizing Kolb Experiential Theory in simulations   2. Implementing five step method to improve initial training  3. Keeping logs for simulations and bed side encounter of shoulder dystocia, documenting feedback and self- reflection  4. Incorporating the BID model in bedside teaching. 5. Offering teaching courses to current preceptors   6. Teaching course for final year midwifery students  IMPLEMENTATION AND SWOT ANALYSIS • Content will be discussed with the Midwifery Education Program & Association of Ontario Midwives for appropriatenessand implementation. • Midwifery Faculty & AOM can assist implementation by informing preceptors and providing necessary budget and resources. Discussion: Strength - Improves initial & ongoing training - Improves student’s confidence - Improves public safety Weakness - Implementation is time and resource consuming • - Addition of a new course to a full program • Opportunity • Can be utilized to manage other obstetrical emergencies - Can be adopted by other health professionals -Utilizing simulation labs at university centers - Arranging multi/Inter-professional simulations • Cost sharing with other disciplines • Threats • Resource limitations • Funding approval • REFERENCES • Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott TJ. Management of shoulder dystocia: Skill retention 6 and 12 months after training. Obstet Gynecol. 2007;110(5):1069-1074. • Crofts JF, Fox R, Ellis D, Winter C, Hinshaw K, Draycott TJ. Observations from 450 shoulder dystocia simulations: Lessons for skills training. Obstet Gynecol. 2008;112(4):906-912. • Kolb, D. A. Experiential learning: Experience as the source of learning and development. Engkewood Cliffs, N.J; Prentice-Hall;1984. • George JH , Doto FX. A Simple step Method for Teaching Clinical Skills. Fam Med 2001;33(8):577-8. • Miller KK, Riley W, Davis S, Hansen HE. In situ simulation: a method of experiential learning to promote safety and team behavior. J Perinat Neonatal Nurs 2008 Apr-Jun;22(2):105-113. • Understanding medical education : evidence, theory and practice. In: Swanwick T, Association for the Study of Medical Education., editors. . 1st ed. ed. Chichester, West Sussex: Wiley-Blackwell; 2010.p.164-180. • Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004 Oct;79(10 Suppl):S70-81. • Roberts NK, Williams RG, Kim MJ, Dunnington GL. The Briefing, Intraoperative Teaching, Debriefing Model for Teaching in the Operating Room. J Am CollSurg 2009 200902;208(2):299-303 • PROBLEM • Many midwifery students do not encounter shoulder dystocia during their academic studies and clinical placement and consequently do not feel confident to manage it effectively. • SHOUDLER DYSTOCIA [1,2] Shoulder dystocia is an uncommon, highly unpredictable and largely unpreventable obstetric emergency with potentially serious consequences for mother and neonate if managed inappropriately. KOLB EXPERIENTIAL LEARNING CYCLE[3] APPLICATION OF KOLB [3,5] “Learning is the process whereby knowledge is created through the transformation of Experience” Concrete Experience: Observing / practicing the management of shoulder dystocia on a low fidelity mannequin at initial training and/or clinical placement. Reflective Observation: Self-reflection, logs and feedback from preceptor and peers regarding the management. Abstract Conceptualization : Further knowledge by reading & e-learning videos. Analyze and plan for the next encounter with shoulder dystocia. Active Experimentation: More simulations provide opportunities to apply improved knowledge and skills. FIVE-STEP METHOD AT INITIAL TRAINIING [1,4] 1. Instructor motivates  the leaner by explaining the reason why maneuvers are needed and how it  is used.  2. Instructor demonstrates the maneuvers in full at the normal speed but without discussion.  3. Instructor performs the maneuvers while explaining the details of each.  4. Involves demonstration of all the maneuvers by the instructor with narration by the student.   5. The learner performs the procedure while being observed by the instructor and coached if necessary until reaching desired level of proficiency. • IN SITU SIMULATION [5,6] • BID • MODEL FOR BEDSIDE TEACHING [7,8] • Briefing: • Students and preceptor will begin by agreeing to focus on performing one or two maneuvers to relieve the impaction of the shoulder if an emergency arises. • Intraoperative teaching: • Preceptor will coach and guide the learner through the dis-impaction of the shoulder (if the maneuver set as the learning objective was not successful, the experienced preceptor could take over to prevent any undue delay of delivery and harm to the patient). • Debriefing: • Consists of four elements: reflection, rules, reinforcement, and correction. Preceptor asking the student to reflect on his or her performance and attainment of stated objective. Conclusion