Labor and delivery nurses: A survey of attitudes toward third-year medical students and their education

doi:10.1016/j.ajog.2004.07.063

American Journal of Obstetrics and Gynecology

Volume 191, Issue 5, November 2004, Pages 1828-1833

https://doi.org/10.1016/j.ajog.2004.07.063 Get rights and content

Objective

Forty-six percent of third-year medical students at the University of Alberta rated labor and delivery nurses as a negative influence on their obstetrics and gynecology rotation. We hypothesized that the nurses would have mostly negative opinions toward students and their education.

Study design

Labor and delivery nurses were surveyed with regard to their views on the following: (1) student learning objectives, (2) factors causing a patient to reject or accept a student, and (3) the role of the nurse in medical student education.

Results

Eighty-nine nurses ranked student tasks (objectives) as very appropriate, appropriate, neutral, inappropriate, and very inappropriate. History and physical examination, witnessing deliveries, assisting at deliveries, and following up women in labor were rated very appropriate or appropriate by more than 96% of nurses; 85% approved of students doing supervised deliveries. Nursing staff were equally divided in approving or disapproving of pelvic exams in labour and outpatient assessment by students. Artificial rupture of membranes, fetal scalp electrode application, and episiotomy repair were not approved of by more than 70% of nurses. The most important factors causing a patient to reject or accept a student were felt to be bedside manner and previous experience with a student, with least important being attractiveness, gender, and the nurse's opinion. Eighty-seven percent of nurses declared that one of their roles is to help students gain experience, but 71% said they would protect women from students with whom they were not comfortable.

Conclusion

Labor and delivery nurses generally have a more positive attitude toward students and their learning than review of evaluations by the students would suggest. However, nurses have reservations about students performing technical procedures in the labor and delivery room. Creation of guidelines (objectives) with nursing input and better briefing of students with regard to nursing expectations may improve the student's experience.

Section snippets

Material and methods

A questionnaire with suggestions for content provided by interested medical students, residents, and an L&D nurse manager was developed. The study received approval from the Health Research Ethics Board of the University of Alberta and the 3 hospital administrations. The precise number of nurses working in L&D was difficult to determine because some worked in more than 1 unit as casual staff. Staff working in more than 1 site were asked to answer based on the site worked at most often.

Statistics usage

Descriptive statistics were calculated using SPSS (Statistical Package for the Social Sciences, Chicago, Ill).

Results

Eighty-seven of 150 questionnaires were completed and returned by L&D nurses, giving a 58% response rate. There was only a 2-week opportunity in the summer for completion of the survey. The majority of respondents had significant experience in L&D, with 58 (67%) working 10 or more years in the labour and delivery suite. Ages reflect this, with 49 (56%) indicating they were over 40 years of age. Only 10 (12.2%) of those responding reported being trained midwives.

Forty-one percent of nurses

Comment

The response rate (58%) might have been better if the survey had been offered twice, avoiding the summer holiday time. The case room managers indicated there was considerable interest in the survey, and much discussion was generated by the questions among nurses, residents, students, and medical staff. Many of the surveys were completed with carefully considered comments, some more than 2 pages.

The finding of this survey that would not surprise most medical students is the fairly high number of

References (2)

Medical School Graduation Questionnaire; 1978-2004
(2002)
Canadian Medical School Graduation Questionnaire
(2003)

Cited by (7)

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The labor and delivery floor is a unique learning environment that poses challenges to teaching medical students, with a potentially detrimental effect on their evaluations of the obstetrics and gynecology clerkship. This article, from the “To the Point” series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, offers specific suggestions for improving undergraduate medical education in obstetrics with attention to student preparation, faculty development, nonphysician staff involvement, and patient education. Optimizing the learning environment in labor and delivery would improve student experiences and perceptions of our specialty.
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Citation Excerpt :
A similar situation may occur when a care provider limits student access to a patient because he or she believes they are protecting a patient from multiple exams. Seventy-one percent of nurses said they would protect patients from a student with whom they were not comfortable.20 Because of the high-intensity environment in the operating room, students may not be instructed on their role, or not understand their role, and thus feel expectations regarding their behavior are unclear or that they are being neglected.
This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is an overview of issues to consider regarding learner mistreatment and its effects on the undergraduate medical education learning environment in the United States. National data from the American Association of Medical Colleges Graduate Questionnaire and local data regarding learner mistreatment provide evidence that the learning environment at most medical schools needs to be improved. The American Association of Medical Colleges’ definition of learner mistreatment focuses on active mistreatment, but data on passive mistreatment also contribute to a negative learning environment. The lack of tolerance for active mistreatment issues such as public humiliation and sexual and racial harassment need to be made transparent through institutional and departmental policies. Additionally, reporting mechanisms at both levels need to be created and acted upon. Passive mistreatment issues such as unclear expectations and neglect can also be addressed at institutional and departmental levels through training modules and appropriate communication loops to address these concerns. To fully confront and solve this challenging issue regarding learner mistreatment at the undergraduate medical education level, solutions to need to be implemented for faculty, residents, and students in the institutional, departmental, and clerkship settings.
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Similar to the study that reported comparisons between peri-natal nurses and other nurses (Matsumura et al., 2004), the peri-natal nurses in the current study, while slightly positive about their perceptions of students were less positive than other settings. Capstick and Harley (2004) reported that peri-natal nurses reveal wariness and disapproval of medical students by endorsing the need to protect their patients from students and encouraging patients to choose if students may be involved in their care. Four of the ten items with which peri-natal nurses were less likely to agree reflect less belief that students contribute to the professional growth and development of staff nurses.
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: Presented at the 2004 CREOG and APGO Annual Meeting, Lake Buena Vista, Fla, March 3-6, 2004.

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Selected Manuscripts from the 2004 CREOG and APGO Annual MeetingLabor and delivery nurses: A survey of attitudes toward third-year medical students and their education

Objective

Study design

Results

Conclusion

Section snippets

Material and methods

Statistics usage

Results

Comment

Medical School Graduation Questionnaire; 1978-2004

Canadian Medical School Graduation Questionnaire

Selected Manuscripts from the 2004 CREOG and APGO Annual Meeting
Labor and delivery nurses: A survey of attitudes toward third-year medical students and their education