Interprofessional Education Between Midwifery Students and Obstetrics and Gynecology Residents: An American College of Nurse‐Midwives and American College of Obstetricians and Gynecologists Collaboration
Journal of Midwifery &Women’s Health www.jmwh.org
Innovations from the Field
Interprofessional Education Between Midwifery Students and
Obstetrics and Gynecology Residents: An American College of
Nurse-Midwives and American College of Obstetricians and
Gynecologists Collaboration
Melissa D. Avery1, CNM, PhD , John C. Jennings2, MD, Elaine Germano3, CNM, DrPH, Tia Andrighetti4, CNM,
DNP, Amy M. Autry5, MD, Kim Q. Dau6, CNM, MS, Susan Agard Krause7, CNM, MSN, Owen C. Montgomery8, MD,
Tonya B. Nicholson4, CNM, DNP, WHNP-BC, Audrey Pe
y4, CNM, DNP, Phillip N. Rauk9, MD, Heather Z. Sankey10,
MD, MS, Mark B. Woodland11, MD, MS
Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of
health care providers exists. The American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists (ACOG)
partnered to obtain funding to develop interprofessional educationmodules and other learning activities formidwifery students and obstetrics and
gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team-
Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and
teams and teamwork developed by the Interprofessional EducationCollaborativewere used to guide thework. Sevenmodules have been developed
including guiding principles, patient-centered care, role clarification, collaborative practice, history and culture, care transition, and difficult
conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as
well as ba
iers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website
for use by programs interested in implementing an interprofessional cu
iculum. Ongoing formal evaluation including pilot testing of a program
evaluation method is described.
J Midwifery Womens Health 2020;65:257–264 c© 2020 The Authors. Journal of Midwifery &Women’s Health published by Wiley Periodicals,
Inc. on behalf of American College of Nurse-Midwives (ACNM).
Keywords: interprofessional education, midwifery education, obstetrics and gynecology residency
1University of Minnesota School of Nursing, Minneapolis,
Minnesota
2Texas Tech University Health Sciences Center, Permian Basin,
Texas
3Women’s Health/MCH Consultant, Santa Fe, New Mexico
4Department of Midwifery and Women’s Health, Frontie
Nursing University, Hyden, Kentucky
5Department of Obstetrics, Gynecology, and Reproductive
Sciences, University of California San Francisco School of
Medicine, San Francisco, California
6Department of Family Health Care Nursing, University of
California San Francisco School of Nursing, San Francisco,
California
7University of Massachusetts-Baystate, Springfield,
Massachusetts
8Drexel University College of Medicine, Philadelphia,
Pennsylvania. Dr. Montgomery is now with Thomas Jefferson
University, Philadelphia, Pennsylvania
9University of Minnesota School of Medicine, Minneapolis,
Minnesota
10Department of Obstetrics and Gynecology, University of
Massachusetts-Baystate, Springfield, Massachusetts
11Drexel University College of Medicine, OBGYN Reading
Health System, Reading, Pennsylvania
Co
espondence
Melissa Avery
Email: XXXXXXXXXX
ORCID
Melissa D. Avery https:
orcid.org/ XXXXXXXXXX
INTRODUCTION
The importance of interprofessional health care teams, col-
laborative practice, and interprofessional education (IPE) has
een acknowledged since the 1970s.1–3 More effective, com-
prehensive, and efficient care is provided when health care
professionals work together in cohesive teams focused on
patient-centered care. In addition, enhanced communica-
tion and teamwork have been shown to improve health care
outcomes.4–7 Team members must have trusting relation-
ships and understand each other’s educational backgrounds,
professional philosophy, and scope of practice.8 Developing
interprofessional teams beginning early in the health care
provider’s education program increases the likelihood of fu-
ture effective collaborative practice.9
The American College of Nurse-Midwives (ACNM) and
the American College of Obstetricians and Gynecologists
(ACOG) have had joint statements addressing collaborative
practice between midwives and obstetrician-gynecologists
since 1971 and explicitly recognize the importance of team-
work and interdependent practice. The cu
ent version of
this statement highlights IPE to promote future collabora-
tive practice patterns.10 In 2014, a small task force was con-
vened with representatives from both organizations to ex-
plore IPE for graduate midwifery students and obstetrics and
gynecology residents. The group determined that external
funding would be required to develop a meaningful project,
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c© 2020 The Authors. Journal of Midwifery &Women’s Health published by Wiley Periodicals, Inc. on behalf of American College of Nurse-Midwives (ACNM)
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited and is not used for commercial purposes.
https:
orcid.org/ XXXXXXXXXX
mailto: XXXXXXXXXX
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orcid.org/ XXXXXXXXXX
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✦ Interprofessional education is necessary to prepare clinicians to participate in team-based care that is more efficient and
effective.
✦ Educating midwifery students and obstetrics and gynecology residents together prepares these learners to work togethe
effectively in the future to improve US perinatal care and address workforce deficits.
✦ Midwives and obstetrician-gynecologists have partnered to develop interprofessional education learning activities that can
e adopted by other programs with the goal of increasing collaborative care models and ultimately improving perinatal
care.
and funding was obtained. This article describes the ACNM-
ACOG IPE project goals, focusing on the development of in-
terprofessional educational resources and the implementation
of interprofessional activities in 4 demonstration sites. The
outcome evaluation plan for this project and opportunities fo
other midwifery and obstetrics and gynecology programs to
use the IPE cu
icula, building on the resources developed in
this project, are presented.
An increase in maternal mortality and mo
idity in the
United States over the past 2 decades has drawn attention to
the system of antepartum, intrapartum, and postpartum care
with calls for improvements. The United States spends more
on perinatal care than any other nation yet has the highest
maternal mortality rate among developed countries.11 In
2018, the US Department of Health and Human Services,
Health Resources and Services Administration (HRSA)
hosted the HRSA Maternal Mortality Summit and
ought
experts from around the world together to develop strategies
to solve this crisis.12 Factors such as racial bias, maternal obe-
sity, mental health conditions, opioid use, and chronic health
conditions, as well as lack of access to care (both direct access
to high-quality perinatal services as well as access to insurance
coverage for services), and health care provider preparedness
in emergencies contribute to poor maternal outcomes.12
Although the HRSA report did not specifically address IPE,
team-based support for women was identified. The recently
published Blueprint for Advancing High-Value Maternity
Care through Physiologic Childbearing has identified IPE
for perinatal care professionals as one of 6 recommended
strategies to improving perinatal care in the United States.13
In 2010, ACOG and ACNM partnered as part of the
ACOG President’s Issue of the Year in a competitive call fo
papers describing examples of successful collaborative prac-
tice betweenACNMmembermidwives andACOGFellows.14
The initiative resulted in submission of 60manuscripts jointly
authored by midwives and obstetrician-gynecologists; the
papers were reviewed by a team of ACNM member mid-
wives and ACOG Fellows. Fourteen of the papers have since
een published in obstetrics and gynecology and midwifery
journals.14–27
A qualitative analysis of 12 of those published papers
found that the motivation for launching a collaborative prac-
tice was usually a desire to improve patient care.28 Several
themes identified in this analysis illustrate elements of suc-
cessful collaborative practice. These include excellent com-
munication, mutual consultations, functional financial struc-
tures, and a commitment to the success of the partnership
including mutual respect and trust.28 Also identified as con-
tributing to success were care integration centered upon
women’s needs, withmidwives and obstetrician-gynecologists
using a common approach to specific care situations, and ed-
ucation of health professionals in an interprofessional care
environment.28
In 2016, ACOGpublished amonograph entitledCollabo-
ation in Practice: Implementing Team-Based Care.29 This
monograph was the product of the work of the multidisci-
plinary task force convened in 2014 that was charged with ex-
ploring team-based practice as a health care delivery model.
Themonograph encourages a patient and family-centered ap-
proach in which health care providers partner with patients
and the health care team to provide high quality care. The task
force considered efficiency, quality, and value in implement-
ing team-based care rather than giving primary consideration
to cu
ent or proposed payment models. The authors noted
that emerging demands of health care delivery have priori-
tized the triple aim of 1) improving the care and experience
of individuals and families, 2) improving the health of popu-
lations, and 3) lowering health care costs.30 Representatives of
multiple professional organizations, includingACNM, partic-
ipated in creating the ACOG document. The monograph was
endorsed by 20 national health care organizations and sup-
ported by others.29
ACNM and ACOG believe that
inging both midwifery
and obstetrics and gynecology learners together is critical
to prepare for future collaborative practice improvements in
our evolving perinatal care system and to meet workforce
needs. Implementation and perpetuation of team-based care
equire the development of effective interprofessional educa-
tional tools that learners experience during their specialty ed-
ucational programs. This project represents a substantial step
in that direction.
ACNM-ACOG IPE PROJECT
The ACNM-ACOG project, ACNM-ACOG Maternity Care
Education and Practice Redesign was launched in Fe
uary
2017. The primary project goals include 1) developing and
implementing an IPE cu
iculum that promotes collaborative
practice between obstetrician-gynecologists and midwives
and includes core modules, skill-based activities, and inter-
professional practice opportunities; 2) aligning accreditation
equirements and educational competencies related to IPE
for midwifery and obstetrics and gynecology; 3) identifying
and resolving ba
iers to implementing IPE within midwifery
258 Volume 65, No. 2, March/April 2020
Table 1. Guiding Principles for Team-Based Care
The patient and families are central to and actively engaged as
members of the health care team
The team has a shared vision
Role clarity is essential to optimal team building and team
functioning
All team members are accountable for their own practice and to
the team
Effective communication is key to quality teams
Team leadership is situational and dynamic
Source: Collaboration in Practice: Implementing Team-Based Care.29
and obstetrics and gynecology programs; and 4) increasing
the number of midwifery graduates long term by exploring
ways to add midwifery students to obstetrics and gynecology
training locations.
Four demonstration sites serve as the educational settings
for this project. These include 2 traditional university settings
that have both a basic midwifery and an obstetrics and gy-
necology residency program, an independent academic med-
ical center that includes a basic midwifery and an obstetrics
and gynecology residency program, and a partnership site that
includes a distance midwifery program and 2 obstetrics and
gynecology residency programs. A midwife and an obstet-
ics and gynecology physician from each education program
colead the development and implementation of an IPE cur-
iculum that includes didacticmodules, laboratory simulation
opportunities, and clinical practice experiences for graduate
midwifery students and obstetrics and gynecology residents at
their locations. Learning materials are shared among demon-
stration sites, and our IPE cu
icular materials have been dis-
seminated for use by other institutions via