physician assistant for clinical midwifery · roles professional domain competencies expert...
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Rotterdam, the Netherlands
Irma van der Velden
Master course
Physician Assistant for Clinical Midwifery
The staff
Irma v.d. Velden
Medical Biologist
Evelien Cellissen
MPA midwifery
Eveline Wouters MD,PhD
Nicole Steemers MD
Gynaecologist
Rudy Riijke
MD,PhD
Menno Kiel
MD Yvonne Post MPA Midwifery
Els Grijseels
MD,PhD
Bernice Engeltjes
MPA Midwifery
the Netherlands:
some facts and figures
320 km
180 km
41,160 sq km
16,7 million inhabitants
Groningen
Amsterdam
Utrecht
Leiden
Rotterdam
Nijmegen
Maastricht
Average inhabitants per sq km in the Netherlands: 491
Highest population density per sq km: The Hague 5967 inhabitants
Last decades a decreasing number:
1989: 38 %
2009: 24 %
Number of home deliveries in the Netherlands traditionally high (compared to other W-European countries)
increased request for pain relief during labour
a relatively high perinatal mortality (compared to other European countries)
women get older before they get their first born, more risk
more chronicle diseases, more obese
Factors that contribute to this decrease
Number of midwives:
2500 (yr 2010)
750 clinical midwives
47 male
Annual number of baby deliveries: 184,000 (yr 2010)
low risk
midwife
home
delivery
high risk
obstetrician
hospital
delivery
Perinatal care in the Netherlands:
basic principle
Outlines of a Community Midwife
Takes care of patients with low-risk pregnancies and in many cases the
patient will deliver at home
Works autonomously, but abide by the rules of a national midwifery referral
manual
With help of this manual, a risk analysis can be made
Patients can be referred to an obstetrician during pregnancy and/or labour,
if there is any reason to suspect an increased obstetric or medical risk.
What happend the last 10 years:
Midwifes started to play a more important role in the obstetric departments of the hospital.
In many hospitals the community midwives started to run the labour ward under supervision of the obstetrician.
Due to the growing responsibilities:
The need:
1. Properly qualify the midwives for the function they were fulfilling
2. Give them the opportunity to expand their tasks.
The Master Physician Assistant Programme for Clinical Midwives was developed for them.
And introduced in 2005 in Rotterdam.
*Amsterdam MSc
Community midwife ~ Clinical midwife
Master courses*:
The Rotterdam MPA - KV
Four years Bachelor’s degree
Clinical
Midwife
Community
Midwife
2½ years ~ 150 ECTS*
The study is divided into:
first year (60 ECTS),
second year (60 ECTS)
third year (30 ECTS),
All years: including on-the-job training
* (ECTS= credit points,according to the European Credit Transfer System).
Characteristics of the programme
Duration:
Master Physician Assistant Midwifery
(MPA - Midwifery)
Characteristics of the programme
Title:
A Bachelor’s degree in Midwifery
Legal qualification in midwifery (according to the Dutch Individual Health
Care Professions Act) = Dutch BIG Act
Two years of relevant practical experience
A paid position for 32 hours per week
An obstetrician acts as a personal study counsellor / teacher on-the-job
Characteristics of the programme
Access requirements:
An expert in obstetric health care
An obstetrician/ gynaecologist
A rollmodel for the students
A supervisor on the job who evaluates the practical competencies
Characteristics of the programme
The personal study counsellor / teacher on-the-job:
School:
One day in the week to school
Follow 17 theoretical and practical
courses
Including a research programme and a
integrative masterthesis
Clinic:
Work at 3 or 4 days
Based on a task book
Being assessed by the trainer on the job
Characteristics of the programme
Structure:
Expert
Manager
Caregiver
Medical counselor
Teacher
Researcher
Professional
Characteristics of the programme
The Rotterdam Master Advanced Midwifery Practice
Program defines 7 professional roles:
Roles Professional domain Competencies
Expert
Clinical midwifery expert 1. Safeguardance and promotion
of physiology
2. Risk evaluation
Manager Coordination and management
of the health care proces
1. Coördination
2. Triage
Caregiver Support of the healthcare
process
1. Optimal communication
2. Provision of psychosocial care
Medical
counselor
Medical care 1. Diagnostic evaluation
2. Treatment
Teacher Expertise 1. Promotion of expertise
Researcher Practical research 1. Evidence based practice
2. Medical research
Professional Clinical midwife 1. Professionalisation
2. Quality control
o Learning skills
o Safeguarding physiology
o Clinical decision making
o Pathology
o Physical examination
o Triage
o Counseling
o Quality control o Psychosocial problems
o Teaching skills
o Ultrasonography
o Research skills
o Evidence based practice
o Literature review
o Master thesis
o Management skills
o Managing obstetric medical emergencies
Characteristics of the programme
17 training courses:
pe
rce
nta
ge
va
n d
e n
orm
ale
be
va
llin
gen
jaar
57%
Bewerking van: de Neef T, Franx A. Ned Tijdschr Obstet Gynaecol 2009;122:270.
Gegevens van de Stichting Perinatale Registratie Nederland, bewerkt met LVRinsight.
Result: the role of Clinical Midwives rises
Main conclusions, based on assessments Students:
undergo an important development, resulting in functioning at a master level
are more capable in dealing with complex clinical situations
take more initiative
show leadership qualities
are creative and innovative in multidisciplinary teams
Some opinions of medical specialists in the
obstetric units of the hospitals
“They work on a higher level in our department, function more independent,
show more initiative, show more overview in complex situations”
“They have more practical knowledge and skills in clinic (pathology,
gynecology, evidence-based practice)”
“They are more competent in discussions with physicians, and take
responsibility for the team”
First point of contact for the obstetric department
Making diagnoses and prescribe therapy
Responsible for writing and evaluation of protocols in the delivery rooms
Establish skill and drill in emergency training at the department
Providing perinatal audits and education
Conducting scientific research
First shelter for the home deliveries by suspecting an increased obstetric or
medical risk
New tasks:
Dutch tradition at the birth of a baby
Bisquit with anise sprinkles !
Rotterdam, the Netherlands
Thank you!
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