Wednesday, January 14, 2015

What I Wish I Had Known....11 Tips for Starting the Clinical Program

This post is courtesy of new graduate Liz Stika-a few tips for students in the clinical program!

Paperwork

1.       Make binders
About a year and half into my preceptorship I saw another student’s paperwork that she was preparing for NARM.  It had all of her clinical numbers, her NARM application, and clinical feedback paperwork neatly in plastic sleeves.  It was organized with dividers and color coded, and a far cry from the water and coffee stained stack of miscellaneous papers I had in a pile at home.  That beautiful and durable binder was perfect for carrying with me to births and was worth the extra effort to put together.
Along with the binder for official paperwork, make a binder for your Practical Skills Guide.  The spiral binding does not last, and the pages start to get pretty stained if your guide comes along to births too.  Luckily, I got the advice to pull out the spiral binding and three-hole punch the pages for a binder.  This way, my skills guide was ready for signatures in the moment.  I started keeping the signature pages in plastic sleeves as well for organization and protection. 
2.       Carry the binders with you
My pile of clinical paperwork was not organized and it was a mess.  Finding the right papers took me a long time, and I was embarrassed at my lack of organization.  Not to mention the risk to the paperwork of getting wet and messy.  So I didn’t consistently bring them with me to births or to clinical days and that just got me more behind.  Once you have your binders set up, keep them handy in a birth bag, or in their own file bag (Craft stores carry great bags for organizing papers for reasonable prices.  They’re always on sale).  That way, you can grab them and always have them on hand when you have the opportunity to get a signature. 

Photo courtesy of Brian Smith on Flickr (CC)
3.       Get signatures in the moment. 
Sometimes it seems like it just breaks the beautiful midwife flow, or sometimes it’s 7 AM after 24 hours at a birth and all you want is to go home.  But if you take 60 seconds to pull out your binder, fill in the information and get your signatures you avoid many hours of headache trying to repair the damage of charts that are incomplete or out of order.
4.       Use pencil
I am embarrassed to admit how many times had to rewrite my logs.  So, moral of the story- use
pencil, double check, go over with pen, then have your preceptor sign- in the moment.  It will only take a minute a more. 
5.       Keep a master client list
One thing that saved my paperwork was my master client list.  I worked with several midwives and I kept this list without fail for every homebirth midwife client I spent time with.  I included the client’s name, my personal code, the midwife I worked with. Somehow, I kept up with this list and it saved me when my official paperwork was subpar and I needed to track down a particular client. 

Plan Ahead and Prepare

6.       Communicate about skills
When you start your preceptorship, be clear with your preceptor about expectations for skills.  How will you practice?  What do you know and what do you need to work on?  When will you sign them off?  Will you have skill days, or discuss your goals before a birth?  The clearer you are together from the beginning the easier it will be to establish good habits.  My experience in several instances was the longer I waited to establish expectations the more awkward it got to start.  Even though this is easier emotionally in the short run, it leads to assumptions and private contentions that can get in the way of a healthy working preceptor relationship.  By going over your skills requirements with your preceptor from the beginning, you can map out a course for your apprenticeship that will be satisfying and beneficial for you both.
7.       Review
Make time to review cases.  Ask questions about what you could have done differently.  Research complications and learn from every situation you can.  Be honest about your choices and mistakes.  One mistake often leaves me feeling like a failure, or that I am on the wrong path trying to become a midwife.  But as an apprentice, and even as we join the sisterhood of midwives it is important to remember we are learners and that mistakes are steps to deeper understanding. 
8.       Start the NARM application…now
Read the NARM Candidate Information Book (CIB) and print out the appropriate application pages now so you know what you will need in the end.  This will give you a framework for your experience and help you avoid unnecessary effort.  I was so focused on finishing clinical numbers, I didn’t even look at the NARM application until I was ready to fill it out.  I had to clean up a few things, and get extra signatures from midwives I no longer worked with in order to finish the application.  It was awkward, unprofessional and unnecessary. 

(A note from the Clinical Dean: MCU students can find their forms at: http://narm.org/testing/graduate-of-a-meac-accredited-program/)

Midwives are People too

9.       Protect and Honor Vulnerability
Midwives take on students for many reasons, and I can’t speak for them all, but it seems to me that bringing on a student takes a lot of courage and humility.  More than hiring an assistant the presence of a student opens the midwife to constant scrutiny.  I didn’t really think about this until I was reaching the end of my clinical time and thinking about being a preceptor myself.  Students are in the process of becoming midwives and so every decision the midwife makes is mentally weighed against what the student has learned or how the student would have done differently.  It’s a very vulnerable space for a midwife to be in and as students I think it’s our responsibility to protect and honor that vulnerability by maintaining confidentiality, treating our preceptors the way we would wish to be treated when we are in their shoes, and by handling disagreements professionally
10.   Practice Reciprocity
As an apprentice I often felt I had little to offer.  The burden of responsibility for a client ultimately lies with the midwife, and it took a while before I felt I could truly be helpful.  The principle of reciprocity implies mutual benefit; giving and receiving.  Just like I mentioned above, it took me a while to really appreciate how hard my preceptors were working for me. Even though I couldn’t always offer equal professional help, I tried to show appreciation in other ways.  Helping with charts, organization, a gift or a heartfelt note can provide balance and that element of mutual benefit. 

Move Foreward

11.   Have Faith
Everyone’s circumstances are different, but I have found in my own experience that generally people want to help you succeed, and when you are open, opportunities present themselves.  Opportunities often come with sacrifice and a whole lot of work, but they will come.  There is a light at the end of the tunnel and every experience provides the backdrop for your future practice.  I asked around, sometimes several times, to work with several local midwives, saved up to work at a local birth center and even found my own clients for the last few primaries. It took about 3 years with a break for my own baby in the middle.  It took perseverance, faith, creativity and a lot of support.  Good luck! Your talents are needed and the work will be worth it  


Visit Liz's new practice on Facebook
Thanks for the tips, Liz, and best wishes as you graduate and start your own practice!

Monday, January 5, 2015

Clinical Update: January 5, 2015

Welcome back!
It's snowy and cold here in Utah, but this morning I heard the birds singing. Winter is here!

We had a record number of graduates in 2014--31! Congratulations to each of them! My hope is to have at least as many graduates in 2015, so if you are preparing to graduate and take the NARM exam in 2015, send me a quick message! I can advise you on the process and offer a lot of help to make sure you are ready to go.

Clinical orientation live sessions are available, if you'd like a refresher on the clinical program and requirements. Check your upcoming events page for details and registration information.

Other clinical live sessions will be scheduled based on who needs them. If you're interested in
Starting Your Clinical Placement: sign up here
Preparing for Primary Births: sign up here
or Applying for the NARM Exam: sign up here
Make sure you mark the session you need by January 15th!

We will be scheduling Clinical Rounds--if you'd like to present, please send me a message with your case topic and when you'd like to give your presentation. I will respond with a couple options of dates and times and we'll get it on the calendar!

Best of luck as you start your classes this semester and I look forward to working with you during the term!
Sarah Carter