1. Kriebs, Jan M. MSN, CNM, FACNM

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As I come toward the end of my career as a midwife, I have been thinking about the best teachers I have had-the ones who encouraged me to be better than I thought I could be, who pushed me beyond my comfort zone. This has led me to consider what the components of exemplary teaching are, and how to give every student the experience of at least one exemplary teacher.


Students are present in many of our clinical workplaces-students of nursing, midwifery, or medicine. We might frame the questions this way: What are they learning from us, and what should we be teaching? Can we form a chain of teaching goals to help us raise exemplary future caregivers? And can we, as we do this, build healthy relationships across the various cultures that exist within an obstetric unit? Let us consider this in the context of a birthing suite.


The obvious first link in the educational chain is that students are learning the tasks and skills of a chosen profession. Whether these are simple or complex, clinical education is where the theoretical meets reality. A fetal monitoring strip can be read in isolation for changes in variability or pattern. Decisions about the progress of labor or the safety of vaginal birth can theoretically be divined from that piece of paper or monitor screen. But add reality-how advanced is the mother's labor, how soon will the baby come, or what interventions can affect fetal well-being short of expediting delivery? Each profession's learning overlaps far more than it differs at this point. Only which task comes next changes with the professional role.


For example, nurses need no order to help a woman to a position better for placental perfusion, increase intravenous fluid flow, or provide short-term oxygen for an abnormal pattern, although an order to change fluid rates or supplement oxygen generally requires a written order. A midwife or physician might go to the room to perform a cervical examination, evaluate labor progress, and verify that the standard nursing interventions have been taken. Both will be assessing the results. At this point, we should be committed to helping a student develop knowledge, rather than criticizing what he or she has not yet learned.


The next link, or lack thereof, can be seen in how students are taught their individual roles and how they learn to understand the roles others play. This can be taught most easily in locations where more than 1 group learns but can be achieved anywhere the clinical teachers want to take the time and have interest. If we are all teaching effectively, our students will learn which things can be performed independently and which need a call for collaboration from a provider with different skills. How and when to communicate are skills that can help break down the traditional silos of hospital-based care. Teamwork can be built by problem-based discussions that cross professional lines. When there is an adverse outcome, debriefing will be easier if other cross-cultural conversations have been held.


This leads to the third link in our chain. That link is professionalism, shown by mutual respect and civility toward others. How do the members of the team address each other-both in front of patients and in a conference room? When teaching, do we make disparaging comments about our colleagues or do we emphasize how a team can work together? For that matter, how do we speak of our patients? Is this laboring woman interrupting us by asking for labor support? Do we look up from the computer to encourage her? Or, are we finding ways to meet our workplace requirements that are not to the detriment of a strong bond with the woman we are supporting and providing care for? This can be challenging. Not all colleagues are congenial; some are disrespectful or rude. Not all women are making the choices we would make, and yet they also deserve our care and attention.


So, if we are teaching effectively, we have taught not only the skills needed to complete a professional degree but also the need for interdisciplinary care and for professional behavior toward our colleagues and our patients. I would like to suggest a final link to our chain, one that can serve metaphorically to extend our impact as teachers. That link is making the extra effort to mentor students-to help them make good choices for themselves about their careers. In the context of clinical education, it is a limited role because most of us will have students cycle through our workplaces and beyond. It is still a necessary one to achieve a high-performing future.


Modeling high-quality care and professional behavior and demonstrating evidence-based care are all components of this, but mentoring goes a step further. A mentor is a trusted advisor. A mentor values students, acts as though he or she cares what happens, and pushes the student to demonstrate maturity as well as expertise. Mentoring asks-how can I help this person to achieve his or her goals to grow beyond simple competence to be the best that he or she can be? There are ways to do this in the context of clinical teaching. I would argue that by teaching skills in the context of evidence-based care, professional behavior, and interdisciplinary collegiality, we lay the groundwork for a mentoring relationship.


So, here is a challenge to all of us who teach: can we help our students bridge the gap between learning about their future role and owning it for themselves? My career was the gift of those who helped me look beyond what I thought I wanted to what was possible. Every student deserves that belief in his or her future.


-Jan M. Kriebs, MSN, CNM, FACNM


Adjunct Professor


Midwifery Institute at Jefferson


Philadelphia, Pennsylvania