Learning the Skill of Antenatal Consultation at the Threshold of Viability: A Framework for Trainees - Abstract
Background: An objective of Neonatal-Perinatal Medicine (NPM) training is learning skills for antenatal consultation at the threshold of viability (<26 weeks’ gestation) (ACTV). However, there is no suggested educational curriculum.
Objectives: To evaluate: 1) antenatal consultation at the threshold of viability (ACTV) training in Canada; 2) parental needs and expectations, and physician considerations for ACTV.
Study Design: Mixed methods study. Qualitative methods informed by grounded theory traditions. Data collection included: a survey of Canadian Neonatal-Perinatal Medicine (NPM) Program Directors; a questionnaire for physicians in the Neonatal Intensive Care Unit (NICU) at British Columbia Women’s Hospital; and transcripts of focus groups (NICU physicians and parents of extremely premature babies).
Results: Training in ACTV is insufficient, focusing on medical information rather than communication. One-third of Canadian NPM programs have formal training, employing: role modeling, direct observation and supervisor feedback. ACTV may be urgent (Labour and Delivery Room); semi-urgent (Antepartum Wards); or nonurgent (Outpatient); each with different goals. Consultations consisting of preparation, interaction and decision-making phases are best provided in two or more sessions,
tailored to parents’ self-identified needs. The discussion respects parents’ religious and cultural background, appreciates their emotional turmoil and provides them with support.
Conclusion: ACTV training, particularly in communication skills, is inadequate across Canada. This proposed framework could serve as a basis for building an educational curriculum for ACTV.