As I come into the final two weeks of my official training as a midwife, I’m having a lot of feelings, and reflecting a lot on my time as a student midwife. It’s a difficult place to be, as our medical system doesn’t support Nurse Practitioner education like it supports the training of physicians. Physicians receive four years of medical school (albeit in everything. They are trained as generalists before they pick a specialty), and then, depending on the specialty they choose, they get 3-8 years of supported educational practice as residents. I often talk to the Family Practice residents that work at the hospital I’m at, and they essentially do the same job I’m doing as first year residents. They consult with their fellows or their faculty for each exam, assessment, and plan. They do this for a year before they start taking solo call. Furthermore, this first year, where they do essentially the same work I do? Paid. Not a great salary, but they are paid for their valuable work.
Nurse Practitioners, on the other hand, have no system-wide support of residency across the board. There are a few residency programs that pop up here and there, but they are few and far between, and very highly sought after, and thus incredibly competitive.
Another huge difference? If you are seen at a teaching hospital, there isn’t really much of a choice that you will see a resident. I have some feelings about that, as I strongly believe in patient choice
Before every visit, or every birth, my preceptors, or the medical assistant if we’re in clinic, ask the patient if it’s alright if they see a student (i.e.: me). A vast majority of the time they say yes. I am so grateful for the patients that have allowed me to learn with them, and I have found it difficult to start to say goodbye to them, especially the women I have built relationships with over the course of their prenatal care, but I will never see again.
Sometimes, people say no. I try not to let it hurt my feelings, but let’s be honest, it kind of does. I completely understand the multitude of reasons that someone may not wish to see a student, and I respect that choice, and believe it should always be an option for the women that I see.
But, I’m going to tell you now, all the reasons that you should see a student midwife, or a student nurse practitioner, or a student doctor.
1) We are incredibly enthusiastic and happy to see you. We relish in using our problem solving skills, developing our clinical skill and knowledge with each and every visit. Every time I’m pulled into a room by one of the physicians I work with (when I’m not conducting routine visits) to do an exam or see a rare complication or variation, I always thank that patient for letting me learn with them. Our training is so short, that there is no way we will see everything before we are thrust into the world . I’m not grateful because I’m glad I got to see something weird/cool/out of the ordinary, I’m grateful because letting me do an exam just helped make me a better prepared midwife.
2) We come equipped with all the latest data and research. Medical research is an ongoing process and our recommendations and treatment guidelines are constantly changing. It’s a lot to keep up with as a student, and I’m sure even harder as a busy practitioner. But that’s where students come in! We are constantly studying, and I often look up a protocol or guideline before bringing it to my preceptor as a plan. Students are making sure you get the most appropriate, evidence-based treatment or screening that exists. For example, our screening guidelines for pap smears recently changed, and it is my absolute pleasure to inform women that they do not, in fact, need a pap smear this year, or maybe not even next year either!
3) We really really care how you feel. We’re fresh, we’re new, and we really really don’t want to hurt you. We have practiced our exam techniques over and over again, on fellow-students sometimes, to find out exactly how much pressure is enough to feel, but not enough to hurt. We are also really going to focus on your exam, and remember clearly that we need to tell you when and where we’re going to touch.
4) Related to the point above, you’re going to get the most thorough exam you’ve probably ever had. As students, we really want to get the exam right, want to be really sure in what we’re seeing, feeling, or listening to. We have a high suspicion for anything slightly outside the range of normal, and will always make sure a seasoned practitioner looks at anything we think is abnormal. We have not yet hit the point in our careers, for better or worse, where anything is routine for us. We approach every exam, every visit with a determination to make the right assessment, not just haphazardly look/feel/listen.
5) We really want to practice our counseling points. We really love talking to patients. Well, at least I do. We really want to talk to you about exercise, nutrition, preventative care, and emotional well-being. Similarly, as a midwife, it may be awkward, but I’m going to ask you if you’re enjoying the sex you’re having (if you’re having it). Most people go through their entire reproductive health care lives without ever being asked about their sex lives. There are many things we can suggest to help you and your partner (or just you on your own!) improve your sexual satisfaction. Because sexual health is IMPORTANT, and that encompasses feeling fulfilled sexually.
6) We’re going to spend more time with you. Our preceptors may see 15-20 patients in a day and not think twice, but for most students that’s too much to handle. That means that I’m not on a deadline. I have a schedule to keep up with, but it means I have the time to really explore what’s going on with you this visit, do a thorough exam, and do some really good teaching. We really want to make sure you understand what’s going on, and why we’re doing what we’re doing.
7) Lastly, by seeing a student you are contributing to building a stronger, more prepared, medical workforce. By participating in our education, you are teaching us something. I learn something from each and every patient I see in clinic and from each birth I attend that makes me a better midwife. By letting me see you, you’re contributing to the future of midwifery!