Yesterday morning, between 9am and 12.30pm local time, I and around 90 other midwives (I think) sat the exam.
The discussion at the university online forum and the fb site Graduate Diploma of Midwifery has been focused on relief. The analogy to a difficult labour has, understandably, been made.
The exam consisted of 18 questions, randomly allocated by computer for each student from a bank of questions. There were multiple choice; true/false; short answer; and 'discuss the statement' questions. I would have liked more time to complete the work - I spent more time than I should have on the early questions. There were questions on pharmacokinetics, the absorption, distribution, metabolism and excretion of a drug; the therapeutic range for a drug; the changes in pregnancy when a drug is used, and what happens to the developing fetus. There were questions that brought up polypharmacy, drug-drug interactions, genetic variances in enzyme activity, and social attitudes towards medication use in pregnancy.
I have nothing to compare this exam with, as it's the first of its kind, but I felt it was a reasonable test of the knowledge that should have been acquired over the past 5 months.
As I have journalled my student experience since July 18 I have sought to look at the course, and my personal response to the challenges that it presented me with, objectively. I put these things into writing as much for my own record as anyone else's.
On the positive side of the ledger I have enjoyed learning the basics of pharmacology, and the application of pharmacology to midwifery practice. I have appreciated the challenge to work on concepts that did not come easily to my ageing brain. Visualising the microscopic processes which project molecules of drugs through the blood stream, across cell walls, and to target tissue is fascinating. Remembering and revising basic science that I studied more than 40 years ago, understanding the constant movement of ionic charge from particle to particle, considering the anatomic function of the various body organs - this has all been good. I have enjoyed it. My friend Julie who I play tennis with most Thursdays is a high school science teacher, and she helped me revise the science of water solubility.
The less than positive side of what I want to record here is the lack of teaching by the university. One tutor responded to calls for help, and presented helpful tutorials using the online webinar facility of the university. With the wisdom of hindsight, I would encourage the faculty to offer a revision course for any students who are not up to date with current undergraduate midwifery knowledge in basic pharmacology - this applies to most of those for whom the course has been offered. I think a series of lectures in the first month or so, using the webinar, would assist those students who have not studied at university in the past decade. I have spoken in person about this to the head of the faculty for this course.
The ability to prescribe is still a little way off. There is a further topic in the Graduate Diploma of Midwifery, Diagnostics and Investigations, which I will undertake in the first semester of 2013. After that I will be able to apply for endorsement as a midwife prescriber.
I am thankful to the Commonwealth of Australia for the scholarship assistance that I have received.
Thankyou for your comments
Showing posts with label drugs. Show all posts
Showing posts with label drugs. Show all posts
Friday, November 23, 2012
Wednesday, October 3, 2012
Journal: back to pharmacology
The last two weeks were the mid-term break for the university, and I was happy to take a break from study. However, it wasn't a restful time for me, as several babies needed to make their entry into this world of ours, and they all needed me to be on the job through the night. The early postnatal days are very demanding for the new mother, even after an uncomplicated birth, and the midwife needs to stay focused as we watch and support and at times guide.
We are now in Week 9 of the pharmacology course. The focus is on writing prescriptions, and working on the second case study.
Today I have listened to the recording of an online tutorial of a session that one of the tutors has put up for students to access. This is the first 'live' opportunity that any of the students have had to interact with the faculty. Unfortunately it was attended by only 3 students, who were able to put questions and discussion.
The tutor gave information about the course expectations for the assignments. I found the tutor's comments useful - would have preferred having this prior to submission of the first case study. The tutor stressed the importance of referencing scholarly articles, and going into depth about the pharmacology of the medications that are being discussed. This is the field that I would like more teaching on. I have read the articles, but find there is a lot of new knowledge to acquire, and I think it's a good learning strategy to hear and discuss a topic as well as to read about it.
For example, when considering the pharmacology of metoclopramide, used to treat nausea, we need to discuss the general pharmacokinetic and pharmacodynamic actions of the drug, together with the changes that occur as a result of pregnancy. In addition to the physiological changes in a pregnant woman's digestive system, metoclopramide has an effect on the dopamine receptors in the GI tract, inhibiting some receptors, and activating cholinergic effects leading to increased motility of the GI tract, in addition to the effect of metoclopramide on the central nervous system. Reference to scholarly papers is needed for each point made.
Much of this language is new to me, and to the midwifery profession as I know it. I recognise the importance of a strong foundation when establishing a new body of knowledge. I have written to the tutor requesting more opportunities for live teaching as well as discussion, so that I can hear as well as read and discuss these aspects of the course.
Thankyou for your comments
We are now in Week 9 of the pharmacology course. The focus is on writing prescriptions, and working on the second case study.
Today I have listened to the recording of an online tutorial of a session that one of the tutors has put up for students to access. This is the first 'live' opportunity that any of the students have had to interact with the faculty. Unfortunately it was attended by only 3 students, who were able to put questions and discussion.
The tutor gave information about the course expectations for the assignments. I found the tutor's comments useful - would have preferred having this prior to submission of the first case study. The tutor stressed the importance of referencing scholarly articles, and going into depth about the pharmacology of the medications that are being discussed. This is the field that I would like more teaching on. I have read the articles, but find there is a lot of new knowledge to acquire, and I think it's a good learning strategy to hear and discuss a topic as well as to read about it.
For example, when considering the pharmacology of metoclopramide, used to treat nausea, we need to discuss the general pharmacokinetic and pharmacodynamic actions of the drug, together with the changes that occur as a result of pregnancy. In addition to the physiological changes in a pregnant woman's digestive system, metoclopramide has an effect on the dopamine receptors in the GI tract, inhibiting some receptors, and activating cholinergic effects leading to increased motility of the GI tract, in addition to the effect of metoclopramide on the central nervous system. Reference to scholarly papers is needed for each point made.
Much of this language is new to me, and to the midwifery profession as I know it. I recognise the importance of a strong foundation when establishing a new body of knowledge. I have written to the tutor requesting more opportunities for live teaching as well as discussion, so that I can hear as well as read and discuss these aspects of the course.
Thankyou for your comments
Saturday, September 1, 2012
Journal: writing prescriptions
Thismorning I have gone through the process of online submission of the first Case Study, which I wrote about in my most recent posting. I found that I needed to restrict myself, as the word count was 2000-3000 words. The additional material that I decided needed to be cut from the case study has mostly been pasted into my portfolio.
Today's task is to learn how to write prescriptions. The list of medicines that are given for students to practice includes some drugs that I carry at present (such as lignocaine for perineal repair, and syntocinon to treat postpartum haemorrhage, and paediatric vitamin K), as well as narcotics oxycodone and panadeine forte, that I would seek to avoid. Antibiotics such as Amoxil and flucloxacillin may occasionally be useful.
My response to this assignment is complex, on several different levels. While I am happy to upskill and have authorisation to prescribe medicines that are within my scope of practice, I feel conflicted as I am concerned that many midwives will prescribe just because they can.
One restriction that independent midwives have lived and worked under for as long as I can remember is that we have very little reliance on drugs. Antibiotics, such as penicillin, are prescribed in many hospitals for any labouring woman who has tested positive to group B streptococcus (GBS). In my practice, I do not swab for GBS, and I do not use antibiotics as a prophylaxis. This is a safe practice, as long as there is no artificial rupture of the membranes, and as long as there are no internal examinations in early labour with ruptured membranes. This practice is also safe because there is the stated intention to treat with antibiotics if symptoms of infection arise, particularly an unstable maternal temperature, with fetal tachycardia.
While every care plan focuses on avoidance of harm from the potentially catastrophic GBS infection, the plan to treat prophylactically is not without risk. The use of antibiotics can lead to adverse effects in mother and baby, and long term morbidity.
As an elder of the midwifery profession, I do not expect that my practice will change much, even when I have the right to prescribe from whatever formulary is available to midwives. The PBS list is different from the NMBA list, which is different from the Victorian government's list (which has not yet been approved).
I do hope younger midwives who move up in the ranks will hold to the basic knowledge of working in harmony with healthy natural processes in normal birth. The principles of promoting, protecting, and supporting normal physiological processes are in the interests of mothers and babies, and are at the core of normal midwifery practice.
Thankyou for your comments
Today's task is to learn how to write prescriptions. The list of medicines that are given for students to practice includes some drugs that I carry at present (such as lignocaine for perineal repair, and syntocinon to treat postpartum haemorrhage, and paediatric vitamin K), as well as narcotics oxycodone and panadeine forte, that I would seek to avoid. Antibiotics such as Amoxil and flucloxacillin may occasionally be useful.
My response to this assignment is complex, on several different levels. While I am happy to upskill and have authorisation to prescribe medicines that are within my scope of practice, I feel conflicted as I am concerned that many midwives will prescribe just because they can.
One restriction that independent midwives have lived and worked under for as long as I can remember is that we have very little reliance on drugs. Antibiotics, such as penicillin, are prescribed in many hospitals for any labouring woman who has tested positive to group B streptococcus (GBS). In my practice, I do not swab for GBS, and I do not use antibiotics as a prophylaxis. This is a safe practice, as long as there is no artificial rupture of the membranes, and as long as there are no internal examinations in early labour with ruptured membranes. This practice is also safe because there is the stated intention to treat with antibiotics if symptoms of infection arise, particularly an unstable maternal temperature, with fetal tachycardia.
While every care plan focuses on avoidance of harm from the potentially catastrophic GBS infection, the plan to treat prophylactically is not without risk. The use of antibiotics can lead to adverse effects in mother and baby, and long term morbidity.
As an elder of the midwifery profession, I do not expect that my practice will change much, even when I have the right to prescribe from whatever formulary is available to midwives. The PBS list is different from the NMBA list, which is different from the Victorian government's list (which has not yet been approved).
I do hope younger midwives who move up in the ranks will hold to the basic knowledge of working in harmony with healthy natural processes in normal birth. The principles of promoting, protecting, and supporting normal physiological processes are in the interests of mothers and babies, and are at the core of normal midwifery practice.
Thankyou for your comments
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