PEM: Action Learning Sets Group K by

Lacking confidence in performing VEs and explaining the findings

ellenjohnson4 — 2025-02-10 13:39:20 UTC

ellenjohnson4 — 2025-02-10 13:40:59 UTC

Lack of support from practice supervisors in facilitating opportunities

ellenjohnson4 — 2025-02-10 13:41:58 UTC

Women declining due to the need for the PS to repeat the VE

ellenjohnson4 — 2025-02-10 13:55:19 UTC

Working with different practice supervisors each shift means that they may not be aware of your learning needs or confidence levels

ellenjohnson4 — 2025-02-10 13:56:18 UTC

Concerned about making mistakes or misleading the women

ellenjohnson4 — 2025-02-10 13:57:08 UTC

Seek out intrapartum spokes to build confidence on intrapartum VEs

ellenjohnson4 — 2025-02-10 13:57:42 UTC

Expressing need to gain experience with VEs to your practice supervisor at the start of each shift

ellenjohnson4 — 2025-02-10 13:58:27 UTC

Being proactive in seeking opportunities for VE experience, asking the PS and the woman whether you can perform the VE when required

ellenjohnson4 — 2025-02-10 13:58:50 UTC

Seek opportunities to practice skills in clinical skills labs

ellenjohnson4 — 2025-02-10 13:59:25 UTC

Seek out experience when on the antenatal ward or community placements to build confidence and experience with antenatal VEs

ellenjohnson4 — 2025-02-10 14:07:13 UTC

This RCT found that student midwives' knowledge and accuracy of determining cervical dilation and cervical effacement and fetal descent was significantly after student midwives completed clinical simulation teaching.

2025-02-10 16:12:45 UTC

Roosevelt, Diebel and Zielinski (2018) book "Midwifery" addresses the difficulty STMW's have with gaining experience in performing VE's in practice and the long term repercussions this has on students e.g. stress that they will not feel competent with this skill before they qualify.

This book highlights the importance of students advocating for themselves in clinical practice, to gain this exposure.

For example, having good communication with their supervisor- that it is one of their learning needs so they are more likely to get exposure to this skill.

2025-02-10 16:16:16 UTC

seek out experiences of speaking to women regarding VE's for example what Vaginal Examination entails (explaining dilatation and effacement) and consent to perform VE's.

2025-02-10 16:22:52 UTC

ward activity- This can make you reluctant to ask midwives if you can perform a VE due to the work load that midwife has. This can make you feel like they may not have time to supervise you performing a VE followed by themselves repeating the examination.

laurengall — 2025-02-10 19:45:42 UTC

Confidence in ability as this is a new and developing skill- students may feel that asking is a burden to the woman and their supervisor and may feel that this is inappropriate for certain VE indications such as emergencies requiring delivery imminence assessment

laurengall — 2025-02-10 19:56:02 UTC

This literature review highlights how midwifery students may have improved confidence with VEs with proper training of how to gain informed consent for this procedure. This review also demonstrated how negative experiences of vaginal examination are linked with their overuse, and how positive experiences can be achieved with good communication skills and continuity of carer. This evidence therefore implicates a need for student midwives to have good knowledge of vaginal examinations through theory teaching, and be shown evidence-based ways of gaining informed consent. Student midwives may also greatly benefit from using their student caseload as an opportunity to perform VEs, as they are able to build a continuity of carer relationship.

https://www.nmc.org.uk/globalassets/sitedocuments/standards/2024/standards-of-proficiency-for-midwives.pdf

laurengall — 2025-02-10 20:00:10 UTC

6.34 undertake vaginal examination with the woman’s consent

from the standards of proficiency for midwives, which are outcomes midwives must possess at time of registration

laurengall — 2025-02-10 20:02:03 UTC

Use continuity of care caseload as an opportunity to do vaginal examinations, as having that longer term relationship with a woman may give the student more confidence to communicate and gain informed consent in this situation.

laurengall — 2025-02-10 20:04:36 UTC

negative experiences for example feeling put on the spot by supervisors with questions you are unsure about, concern that you are taking too long as vaginal examinations are often uncomfortable for the woman and therefore not fully completing the examination

laurengall — 2025-02-10 20:06:50 UTC

ensure that the woman has good counselling for the examination, including advice on using analgesia such as gas and air and asking your supervisor to coach the woman through the examination to support you to effectively use opportunities to complete vaginal examinations and gain communication skills.

https://www.nice.org.uk/guidance/ng235/chapter/Recommendations#care-throughout-labour-in-all-birth-settings

laurengall — 2025-02-10 20:14:39 UTC

1.8.9

When conducting a vaginal examination:

be sure that the examination is necessary and will add important information to the decision-making process
recognise that a vaginal examination can be very distressing for a woman, especially if she is already in pain, highly anxious and in an unfamiliar environment
explain the reason for the examination and what will be involved
ensure the woman's informed consent, privacy, dignity and comfort
explain sensitively the findings of the examination and any impact on the birth plan to the woman and her birth companion(s)
advise the woman that she can decline the examination before it starts, or ask to stop at any stage during the examination. [2014, amended 2023]

laurengall — 2025-02-10 20:24:19 UTC

concerns about difference of opinion with results, as the assessment may be varied due to different practitioners completing it.

Use of action learning

laurengall — 2025-02-10 20:32:23 UTC

first we established ground rules for our group
we then identified the problem of lacking confidence in performing VEs through group discussion, making sure to actively listen to eachother and not jump to giving advice
following this, we allocated different roles to each member of the group to allow reflection and questions to be asked around this problem
from these conversations, we developed an action plan to address confidence with performing and explaining vaginal examinations

lydiawashbourne — 2025-02-11 09:37:45 UTC

This study found that student midwives who performed a VE using the DOPS method led to students correctly identifying the findings of the VE. The DOPS method is as follows:

Observing the desired skill within the prescribed time (1 min for vaginal examination and giving feedback in 5 min (while reviewing the items in the evaluation)
Repeating the desired skill after 1 day and emphasizing the strengths and weaknesses of the student in that skill
Repeating the desired skill after at least 1 week and emphasizing the strengths and weaknesses of the student.

This demonstrates the importance of continuity of PS when improving VEs for students - it also gives time to complete feedback