Project partners have high enthusiasm for IPE and have worked hard to overcome identified challenges to putting these two groups of learners together:
Midwifery: graduate education programs with specific courses required each term with credit hours, tuition charges, specific allotment of clinical hours and the usual exams, papers, and related activities associated with a traditional credit bearing graduate program. Programs are 2-3 years, depending on terminal degree. Students pay the university.
Ob-gyn Residency: graduate education programs that are hospital based with a smaller portion of the program focused on didactic education, with majority of learner time based in clinical care. Programs are typically 4 years. Programs are hospital funded and provide a salary to residents.
Solution: With these differences, it has been necessary to focus on joint learning activities within each learning environment instead of a universal curriculum. Faculty have experimented with simulations involving learners at different stages, such as having new midwifery students consult with 2nd year residents who are learning how to be consultants while being observed by 3rd year residents. Differences in tuition/payment options are beyond the control of the project.
Midwifery: Incoming students typically begin in Fall or Spring semester. Some programs front load all didactic material before starting students in the clinical arena, others intersperse clinical experience along with didactic learning.
Ob-gyn Residency: New residents start annually at the end of June, beginning of July, and advance to the next level of their training at that time every year.
Solution: Both midwifery and residency program faculty have found ways to be flexible in order to bring the groups together for didactic, simulation and clinical experiences. In order to put the groups together for didactic and simulation activities, midwifery programs have changed their lecture days to coincide with residents’ didactic days, since changing the residents’ clinical times would involve too much disruption in patient scheduling.
Electronic Medical Records (EMR):
Midwifery: Midwifery faculty may sign orders and care notes but midwifery students may not.
Ob-gyn Residency: Residents may sign orders and care notes.
Solution: This problem exists for all midwifery education programs whether involved in IPE or not. Midwifery students are typically required to write orders and notes, but faculty must enter them into EMR, an inefficient duplication of effort that is beyond the control of this project.
Billing for Services:
Midwifery: Midwifery faculty cannot bill for services when they are teaching residents or midwifery students as supervisors of the learners, they can only bill if they performed the services themselves.
Ob-gyn Residency: Residents are able to bill for supervising students.
Solution: There are bills pending before Congress to change the rules that govern supervision of health care professional students.