Competition is growing among students for clinical experience in the birth suite
Clinical exposure to obstetrics is becoming harder to deliver as competition for places in the birth suite grows
Medical students have increasingly become bystanders in the birth suite owing to swelling numbers and competition from trainee midwives, leaving many graduates without essential obstetric experience.
New research from James Cook University showed a decline since 2008 in the number of medical schools that have mandated requirements for clinical exposure to obstetrics and gynaecology, and among those that do, many are struggling to meet them.
“There are a lot more medical students, and a lot more things for them to learn, so there’s a shorter time they are exposed to obstetrics and gynaecology,” study co-author and obstetrician, Professor Caroline de Costa, told The Medical Republic.
“When I was a student, we had to deliver 20 babies. That amount is probably not necessary. But now we have 18 medical schools, and in 10 of them there is no set number of deliveries,” Professor de Costa, who teaches at JCU, said.
In 2006, 1632 medical students graduated from Australian medical schools, compared with 3700 expected to graduate in 2016.
In surveys conducted by JCU researchers in 2015, medical schools acknowledged community expectations that doctors should be able to supervise the delivery of a baby and said they gave students as much exposure as they could.
“But there is no doubt it is becoming more difficult for medical students to get experience, particularly hands-on experience, and there is definitely more competition from midwifery students,” Professor de Costa said.
The barriers are spelled out in comments from medical schools in a JCU paper in the July edition of the Australian and New Zealand Journal of Obstetrics and Gynaecology.
“Until last year, we required all students to participate as an accoucheur for one vaginal birth, but have found the practical difficulties insurmountable,” a response from the University of Adelaide said.
“Many medical students do not get any ‘hands-on’ birthing experience. Labour wards are largely controlled by midwives who have variable attitudes towards medical student training but reliably prioritise midwifery student experience …” (University of Melbourne)
“Not all students achieve required delivery, competition from midwifery students … midwives do not allow medical students in the birth suite during the day so birth suite experience is limited to nights and weekends.” (University of Sydney)
The two schools that rotated students overseas – Monash to Malaysia and JCU to Fiji – said those students received “considerably more” experience than others.
Further, there was a strong belief among clinicians that childbirth simulators were a poor substitute for hands-on experience.
In response to the decline in women’s health as a core component of some medical schools’ curricula, the Royal College of Obstetricians and Gynaecologists is introducing compulsory extra training in obstetrics for trainee doctors as of December 1 so they can make up lost ground.
Professor de Costa said there could also be ramifications for GP registrar training, but as yet the issue has not come before the RACGP training committee, The Medical Republic has confirmed.
On a positive note, the JCU researcher found that medical schools employing midwife coordinators reported better obstetric training opportunities for medical students.
They also found women were more than happy to have medical students attend the birth suite.
A survey of 55 women who agreed to have a medical student present at their delivery at Cairns Hospital, found 20 were “unconcerned” and 32 were “happy” about the presence of a medical student. All but one thought it was important for students to have the exposure.