The Latent Phase: Maintaining Your License, and Building Collaborative Relationships!

My blogging over at the ACNM continues! Read below for my two latest posts, and check back later this week or early next week for a post focusing on students and new graduates at the Annual Meeting! See many of you in Denver!

Maintaining Your License: Crunching the Numbers

Understanding the specific requirements needed to maintain your midwifery license, including continuing education, is a numbers game. Here is how I have come to understand the system, and keep track of seemingly complex requirements in a clear fashion.Just when I thought I had all the numbers crunched in my list of certification, licensure, and maintenance requirements, I learned the true depths to which the numbers-game of maintenance goes: I encountered continuing education. Thank goodness the counting doesn’t start until after graduation! For those in clinical practice, here’s how it works (nota bene: 10 contact hours = 1.0 CEUs).National RequirementsFirst, let’s start with our certifying body. The American Midwifery Certification Board (AMCB) operates on a 5-year certification cycle. That means that if you initially pass the Boards this year (2014), you have until the end of 2019 to fulfill the cycle requirements, which are:1. Completion of 20 contact hours (2.0 CEUs), and2. Eithera. Testing in 3 certification maintenance modules; orb. Retaking the certification exam within the same 5 years.Upload your CEUs to the AMCB website via your individual profile to ensure completion. Once you have met the requirements, a green announcement will show up under the “Continuing Education” section on your profile page that reads “Congratulations. You have met the continuing education requirement for your current cycle.” Similar red/green announcements will appear under the “Modules” section to alert you about whether requirements have been met.There are also annual or cycle fees associated with maintaining certification. You can track your fee payments via your individual profile on AMCB’s website, too, as well as map your progress in modules. Visit their website for further details regarding these requirements.... Read the full post here for information on state requirements, free and low cost CEUs for all provider types!  

Building Collaborative Relationships

Perhaps one of the most tenuous aspects of working as a new graduate midwife is developing a collaborative relationship with physicians. In the physician-midwife, as well as physician-nurse practitioner or physician-physician assistant relationship, there are many factors at play: power differentials, scopes of practice, health and care provision belief systems, historical interactions of each provider with others in the same field, and experiences in prior collaborative relationships.When I first started midwifery practice, I worked at 2 different clinics, with 2 different collaborating physicians who had 2 very different styles of practice. I never worked simultaneously with either of them, so our communication was linked only through my referrals to them, or the rare text message for quick questions.I recently started at a new clinic within the same organization, and now have one collaborative provider. She and I work similar days, so we often overlap not only time in the clinic, but also office space, rooms, medical assistants, and patients. The difference in our relationship is palpable: she hears my discussions with patients in the hallways, my communication with the medical assistants for scheduling and testing, and my counseling to women and their families. A strong relationship will be needed to facilitate a group approach to our practice.I also work once per week at a hospital, where each day is different. Each shift, I have 2 collaborating physicians from a group of over ten 10 possible, including my current clinic collaborator. That’s a lot of collaborating relationships to develop. That’s a lot of personalities. That’s a lot of belief systems. That’s a lot of opportunity for hiccups – to put it mildly – in patient care if smooth communication and a positive collaborative relationship have not been established.I haven’t even come close yet to developing the perfect relationship with any of my collaborative providers. I am only just beginning this, and still have a lot of work to do. I plan to work carefully and patiently with my newest clinic collaborator to build a strong relationship and develop trust – on both sides. Already, we have had differing opinions on practice, and both disagreements and agreements over more casual topics. We each have room to improve, but I believe we can keep dialogue open and allow space for disagreements while maintaining respect for different approaches. So, I have been thinking about the collaborative relationship, and thinking hard because I want to get it right. As I make a list and check it twice, I share my thoughts about how I might develop a strong foundation:Find common ground. Get to know each other holistically, as you would get to know anyone else with whom you develop a relationship. What brought you to your current place in life? What do they love about their work? What are their struggles? What is their life outside of work? Do they have prior experiences with midwives? If not, start out with your individual approach to your work: your mantra, your midwife or prior work experience, and your goals for collaborative practice.Talk about the basics. We all know there are grey spaces in approaches to health care. Address them head on! Work toward creating a shared mental model of approaches: Where are you going to cut off the 1 hour glucola, or will you do the 2 hour? At what BMI might you do additional testing? What are the genetic screening options available and which do you each prefer? Are they open to your expanding your scope of practice and bringing those to the clinic or hospital, such as with colposcopy, biopsy, ultrasound, or surgical first assist? Clarify any grey areas in the collaborative agreement regarding which individuals would qualify for midwife-only care, collaborative care, or transferred care.... Read more here for additional suggestions on building collaborative relationships!