Use of a Centering Pregnancy© approach to teach obstetric care in a longitudinal integrated clerkship model
Objective: To assess the utility of a Centering model of obstetric care for teaching in a longitudinal integrated clerkship year and compare with traditional students’ experiences. Background: In 2010, Duke University School of Medicine offered a longitudinal integrated clerkship (Primary Care Leadership Track, PCLT) experience to three selected students. These three medical students did the majority of their required clinical training in longitudinal outpatient placements that met on a weekly to monthly basis for most of the year. The students’ obstetric experience arose from their participation in a Centering Pregnancy group run by the CNM service. Centering provides health care assessment, education, and support in a group setting facilitated by a credentialed health provider and a co-facilitator. The group approach gives patients an opportunity to learn together and from each other. Students’ roles in delivering care included educating patients about their pregnancy in the group setting, counseling patients one-on-one, performing belly checks, ordering appropriate tests, and documenting in the electronic medical record. Students established continuity with a group of obstetric patients from 20 weeks until the patients’ postpartum visit. The Centering model meets the philosophical model of the PCLT by introducing interdisciplinary care as well as group care and learning. Methods: Comparisons between PCLT and traditional students were made between NBME shelf scores, in-house “practical” exam scores, and number of vaginal deliveries in which the students directly participated. Comments on the educational quality of the obstetrical experiences were solicited from both groups. Results: 3 students were on the PCLT track and they were compared to the traditional students who took the shelf and “practical” exam within 2 weeks of the PCLT group. Shelf scores were comparable: PCLT 73+5.6 (range 68-79), traditional 75.1+8.6 (range 61-94). Practical scores: PCLT 9.3+0.3 (range 9-9.6), traditional 9.6+0.3 (range 9-10). PCLT students participated in 4-6 deliveries, traditional 0-4. PCLT comments were consistently positive. One student commented, “My patients really appreciated my being present during their prenatal care and delivery. For example, one of my patients wanted me to help her with positioning during labor and was comfortable with me delivering her child, with the CNM in the room. As a student, I do not feel I could have established such rapport and gotten such hands-on experience with a patient I had just met the day they came to the L&D floor. This was my favorite part of second year; I wish my peers could experience something similar”. Conclusion: On shelf exam and in-house exams, PCLT students performed academically similarly to their traditional peers. The centering obstetric experience was consistently identified by PCLT students as an exceptional experience.
