P.U.R.E. (purposeful, unambiguous, respectful, and effective) Conversations and electronic fetal monitoring: gaining consensus and collaboration

The "6 A's": A risk manager's guide to emergency cesarean delivery

The allegation of delay in performing an emergency cesarean delivery is common in litigation involving neurological injury to newborns. Analyzing the actual performance of an emergency cesarean involves multiple steps, individuals, and systemic processes that need coordination for appropriate action when necessary. This article gives risk managers a systematic way to evaluate a given perinatal unit's approach to the ability to perform an emergency cesarean through evaluating the 6 "A"s: Assess, Alert, Align, Assemble, Act, and Analyze. Each of these elements is discussed based on current evidence. A checklist that may be useful in the evaluation of the elements of performance of emergency cesarean delivery is provided.

The conundrum of vanishing early decelerations in British obstetrics, a step backwards? Detailed appraisal of British and American classifications of fetal heart rate decelerations - fallacies of emphasis on waveform and putative aetiology

A recent opinion survey of British Obstetricians revealed 'early' fetal heart rate (FHR) decelerations as the commonest type in their practice. This contrasts with the guidelines by the National Institute for Health and Clinical Excellence, UK (NICE 2007) that 'true uniform early decelerations are rare and most decelerations are variable'. This analytical review suggests that the emphasis on putative aetiology and 'waveform' of decelerations by NICE and other national guidelines leads to fundamental inconsistencies. 'Uniform shape' is misinterpretation of the description by Hon and Quilligan (1968). Truly 'uniform' (identical)) decelerations do not occur and no examples can be found. Gradual ('bell') or rapid shape has no correlation to putative causation or fetal condition. Obstetricians and midwives should seek clarification of these fallacies. The previous British practice of classifying decelerations based solely on time relationship to contractions seems most scientifically robust leading to more consistent interpretation and better discrimination of fetal status.

P.U.R.E. Communication: A Strategy to Improve Care-Coordination for High Risk Birth

High-risk birth can be an emotionally-charged and sometimes emergent event that requires a cohesive multidisciplinary team. Communication breakdowns in perinatal emergencies are known to contribute to errors and adverse patient outcomes. One approach to breaching these barriers is the Purposeful, Unambiguous, Respectful, and Effective, P.U.R.E. process. P.U.R.E. is a method of communication that emphasizes coordination and recognizes the contributions of each member of the team. The purpose of this article is to describe how the P.U.R.E. process works and how teamwork strategies, group skills training, and structured communication techniques complement it.

The curriculum for the doctor of the future: messages from the clinician's perspective

BACKGROUND

Medical curricula should focus on the future of health care. Contemporary competency frameworks for curriculum design such as Canadian Medical Education Directions for Specialists (CanMEDS), ACGME and Tomorrow's Doctors share this vision by stressing generic competencies.

AIM

The objective of this study was to investigate how well a contemporary competency framework fits in with clinicians' perspectives on future health care.

METHODS

Using a strategic planning approach, a semi-structured open-ended questionnaire on the future of their profession was sent to 102 Dutch gynecologists. Through inductive analysis, a future perspective and its needed competencies were identified and compared to the CanMEDS framework.

RESULTS

The 62 responses showed content validity for the CanMEDS roles. Additionally, two roles were identified: advanced technology user and entrepreneur. Within the role Communicator, the focus will change through more active patient participation. The roles Collaborator and Manager are predicted to change in focus because of an increase of complex interdisciplinary teamwork and leadership roles.

CONCLUSION

By studying the Dutch gynecologists' perspective of the future in a strategic planning approach, two additional roles and focus areas within a contemporary competency framework were identified. The perspective of clinicians on future health care provides valuable messages on how to design future-proof curricula.