As time moves on, there is a tendency to look back, with perhaps mixed emotions, on days past. These moments can bring unexpected insights that help us to value what we have and what we have become.
These thoughts crowd my mind after a demanding but enjoyable weekend teaching an enthusiastic group of midwives and doctors as part of an Advance Life Support in Obstetrics (ALSO-UK) course, a programme designed to develop health professionals' knowledge and skills to manage the emergencies that may arise in maternity care (American Academy of Family Physicians (AAFP), 2017).
The two-day course is packed with challenges, but is a great opportunity for delegates to reflect on their knowledge and skills, and gauge potential for dealing with life-threating complications.
While ALSO attempts to reflect the complexity, risks and realities tof obstetric emergencies; simulation is perhaps a poor replication of the dynamics and dangers that real life situations may provide. It does, however, provide an environment in which candidates can safely explore such events and develop their awareness as to what is expected of them.
This said, some seem fearful that their lack of experience or understanding may be exposed, making them feel threatened. But this is what education and learning is all about: understanding the unknown in order to learn, develop and succeed. In a supportive environment, with good mentors at hand, candidates willingly share their insights and experiences that not only facilitate team working, but also allay the anxiety and fears of those who doubt their ability to do well.
Each candidate has to be prepared, so pre-course reading is a prerequisite. Over the two days, there are only two lectures, but five case discussions that focus on the management and care of high risk events during pregnancy and childbirth. These enable an exchange of ideas and practice priorities that encourage group discussion. Inter-professional learning also takes place, and this promotes shared values and mutual respect of professional differences.
Assessment of the candidate is by a multiple-choice exam, as well as an obligatory objective structured clinical examination (OSCE). This requires the candidate to respond to a number of linked scenarios involving maternity emergencies; whereby they demonstrate decision-making and carry out the necessary actions.
Not surprisingly, these assessments may give rise to concerns about the possibility of failure. Yet interestingly, candidates appear to discount the fact that they may be required to safely manage any one of these given scenarios within the clinical environment in which they work.
There is an expectation that clinicians should be able to effectively respond to every obstetric emergency, whether this is interpreting a complex adverse CTG trace, making a decision to expedite a birth, or resuscitating a newborn infant. The public would expect no less.
There are many appropriate ways of managing emergencies and each clinician must exercise his or her own professional judgment in deciding on the appropriate action to take in emergency situations (AAFP, 2017). Nevertheless, having taught the ALSO approach throughout the duration of the course, each candidate is assessed accordingly.
What is of significant value and causes me to look back with pride at ALSO's work and achievements, is that this small charity has taught more than 20 000 midwives, obstetricians and other clinicians involved in maternity services. Candidates come from all over the country and from abroad, bringing their own cultural perspectives, all wanting to improve the care of mothers and babies. It is a tough course, but the majority learn important lessons about working together to deliver high quality maternity care.
Unlike many similar organisations, ALSO requires both theory-and practice-based assessments of all its candidates. The instructors know how hard it can be, but they have also experienced the elation and sense of achievement when the course is completed successfully.
This course was not that different from the hundreds of others I have attended over the years. It had knowledgeable and capable practitioners, who wanted to develop their career in obstetrics. I witnessed individuals providing emotional and educational support to those who were uncertain, reaching out across professional boundaries, sharing ideas and developing friendships. Seeing candidates developing their learning and capacity for caring made me wish that I could be starting out as a midwife again. I am proud to have had the friendship of many dedicated colleagues, who in spite of the challenges of society, continue to work hard for others.
It was a privilege to teach those attending the course and I am heartened to know that the women in their care will be safer and our respective professions stronger because of them.