Journal: exam finished

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

Journal: Preparation for exam

This week I am trying to spend some good time in revision of the core concepts that I will need, not just to achieve a pass mark in the pharmacology topic, but to consolidate the learning.

One of the main criticisms that I and other students have had as we approach the end of the course is that there has been a lack of teaching of the basics of pharmacology.  We are reading text books and academic papers, and for me the words and concepts of the science are often a confused jumble.

To address this deficit I have been watching a set of  lectures on Youtube

One of the faculty tutors hosted a webinar on Tuesday evening, and went through the practice exam that had been provided.  I found this very helpful.  A couple of points that were identified, at which I might improve my performance in the exam are:

• understanding how points are awarded: a question that is worth 2 marks towards the total score requires the student to make 4 statements (ie .5 each) that are relevant to the question.
• In multiple choice or true/false questions, a student will be awarded marks for each correct statement, whether it applies to the correct answer, or making the argument as to why a statement is incorrect or false.
• Clinical questions, such as discuss a pregnant woman who has a headache and wonders if she can take paracetamol, require discussion of the pharmacology of the drug in pregnancy, as well as the basic midwifery investigations, such as check the blood pressure, and question the cause of the headache.
• Polypharmacy is defined as the concurrent use of 5 or more medicines, which can include prescriptions, over the counter, and complementary.  For example, a woman who is receiving one prescribed medicine, such as oral antibiotics (1) for a chest infection in late pregnancy, may also take an antacid (2) for heartburn, raspberry leaf herbal tea (3) to achieve good uterine tone, an iron supplement (4) for anaemia, and pyridoxine (5) to treat mild fluid retention.  These substances will likely pass easily across the placenta to the fetal compartment.  What are the possible drug interactions with this group of apparently innocuous medicines?

Your comments are welcome.