 All right, so without further ado, it gives me great pleasure to introduce this talk this evening on implementing the midwifery model of care. I'm delighted to introduce Dr Michelle Telfer, who is an assistant professor at Yale School of Nursing, where she teaches and practices full scope midwifery. Dr Telfer's research includes reducing unnecessary caesarean sections, supporting physiologic birth, exercise in pregnancy, and global maternal and newborn health. Her recent work includes establishing a partnership with Yale, Macarena University in Uganda, and Mother Health International that includes a National Institute for Health grant funding for collaborative learning research and clinical practice. Speaking with Dr Telfer as her co-presenter is Dr Joan Komalik. She's an experienced clinical midwife, currently employed as an advanced women's health research fellow in the VA Veterans Health Administration in the United States. She also holds a joint appointment as assistant clinical faculty at Yale School of Nursing. Her academic training includes a PhD and MPH from New York University. Her MSN, CNN was granted by Yale University and she has worked in full scope midwifery practice since completing her clinical training. Her research focuses on maternal outcomes, the midwifery model of care, and developing reproductive health services for women with mental health, comorbidities, and exposure to trauma. We're so very glad to welcome you here and I'm going to share the microphone with Dr Telfer. Great, thank you so much Jane for the lovely introductions and we're so excited to be here tonight and it's amazing to see people from all over the globe. I'm really looking forward to sharing the work that we've been doing and hearing, and most interested in really hearing your responses at the end of this. I hope you have lots of questions and feedback to offer us. So I wanted to start by giving a few thanks, because we could not have done this alone and first and foremost, this is Dr. Holly Kennedy, who is our kind of lead on this research and our mentor. And so I want to give her for that. Thanks to Yale School of Nursing and the Goldsmith Foundation that provided some funding for us. And we've also had support in the course that Joan is going to be talking about from the Yale University Porbu Center for Teaching and Learning. And that course also features videos from the Global Health Media Project. So before we get to the larger course that Joan's going to talk about, I wanted to give a little bit of historical perspective for how this course even came about. And it's been about three years that I was invited to develop a collaboration and a bidirectional partnership between Macquarie University, their Department of Nursing and Yale University's School of Nursing. And we were really building on kind of a more than 10-year relationship that Macquarie and Yale had developed through the School of Medicine. And they had had such good success with their partnership that they invited the School of Nursing to join in. And so we began that partnership. And through that we started to look around at what sort of these like a really good quality midwifery model of care would be, whether it's here in the U.S. or in Uganda. And we came across through some connections of colleagues, a model in northern Uganda in a town called Atyak. And it's from, it was developed by Dr. Rachel Zaslow through Mother Health International. And it's called that Nwa Mi Pooch Birth Center, and that means the house of birth and peace. And there are models there. I want to spend just a moment to talk about it. Dr. Zaslow, that's really her research and work. But what we found was it's a really well integrated birth center with a community of traditional midwives as partners in the birth center. And they're part of the care team, which is led by Uganda Nurse Midwives. They're partnering with the community and respecting the knowledge of not only the community and traditional midwives, but also respecting the knowledge of the women within the community and what their unique culturally specific needs may be. The birth center really has become a trusted community resource, and it's partly community owned. And it's really a beautiful midwifery model of care that addresses the three delays that many of you may be familiar with. And their outcomes are phenomenal, and it really shows that this model of care that it works. They've had no maternal deaths in over 12 years and over 10,000 births, and their neonatal mortality rate is better, not only than the rest of Uganda, but better than for a black woman giving birth in New York City here in the U.S. So their outcomes kind of speak for themselves. But we were able to forge a partnership with Macrary and Mother Health International. And part of that we'll talk about now. So this is an image. This is Dr. Rachel Dasso on the left. Dr. Rose Navarier, who is at the time the Dean of the School of Health Sciences at Macrary, and she's also a midwife. Holly Kennedy and myself. And so part of the aims of our collaboration were to establish collaborative midwifery educational and research. And to develop a collaborative curriculum that involves our students as well as Macrary midwifery students at the birth center. And we've actually started to expand that into our obstetrician residents and obstetric faculty as well. And then to develop sort of a wide reaching online educational course that would disseminate the midwifery model of care based on the Lancet series on midwifery and the model that we saw at the birth center. So to kind of talk a little bit about what that looks like for learning for students, and I know we have some students on here, which is wonderful because I think it's really hard as a student to go out into practice and to practice that you may not have actually had firsthand knowledge of. Many of us get experience in very high level, very busy tertiary care facilities, and we don't always get to see this model in real life. And so we wanted to see what it would be like for our students and Macrary students to be able to see this. So we had some of our students went last summer and they were prepared by a 14 weeks seminar that kind of gave them training in cultural humility, ethics, tropical medicine, things that they don't usually get in the training here in the US, which is the way of helping babies breathe and helping mothers survive for each birth. And so they were essentially there, they were there for six weeks and learning from the Ugandan midwives and the traditional midwives under some supervision with myself and another faculty member, and the director of the birth center, so that we were making sure we weren't causing an undue burden to the health system there or displacing students in Uganda as well. So I see this model in work. And one of the things we're working on is trying to see through research whether we can make this model transferable to other settings. And even here in the US we're working to sort of develop a similar kind of community engaged model within our larger health system. So for the online course that we was a pilot course, we developed this with the mockery faculty and with Mother Health International and it was really to disseminate information and evidence that was supporting the midwifery model of care to provide a no cost or low cost access to comprehensive evidence based research and to foster global connections and conversation between midwives and other women's health providers. We foster interdisciplinary community between the midwives, obstetricians and student learners, and to provide tools to advocate for and implement change in their own settings. And at the end of the course, it was at the end of the 14 week course was the Yale certification as a specialty credential. As I said, we've developed this with Macquarie and Mother Health International, and it was built around the Lancet series, and it was 14 weeks long. And this actually piloted in September of last year. And this is a picture of actually most of the faculty here, and some of the students, we all happened to meet up at the International Confederation and Midwives meeting in Namibia last fall, just as the course was getting started. So that was really nice to actually meet in person. It was hosted on the Canvas platform, and that's what Yale uses. And there were weekly readings, sort of from the latest evidence based practice, and based on the Lancet series, as well as other kind of formative landmark studies. The assignments were designed for the learners to apply the readings, kind of in their own settings. So not just taking the readings and getting the information, but actually applying it within the healthcare setting that they were either working in or as students were being precepted in. And there were discussion board postings, and that helped to foster collaborative learning and processing. And then there were five synchronous learning sessions, and we had six faculty in the first course, and there were about 18 students initially. So it was a high faculty to student ratio, but for the pilot we really wanted to have. And Ugandan faculty paired with one of our faculty so that we could sort of learn and collaborate as well. And it was a past failed course. And some of the challenges that we encountered with this initial course was really kind of learning this new platform. And there were challenges really for connectivity and for access to data from our colleagues that were in Uganda. And some of the students were master students that had been through Macquarie, and we're back in Lewanda where they work as midwives. So they had some challenges in just being able to connect. And then we had also challenges with navigating the time differences around geographies, the different time zones, and also people's work schedules, right? Because we're all still midwives or student midwives and everybody had different days of different shifts. Another challenge we found was only being able to use open access publications. And this is because many journals really charge an exorbitant fee to be able to share the articles. And while Yale faculty had access to those articles, it wasn't as easy for other students to be able to get those and to download them. And then cost and sustainability. So some of the things that we did learn that were very positive from this was that active discussion board postings. And this is where the students really engaged with one another as well as faculty and could really learn across the different settings between the US, Uganda and Rwanda. The synchronous learning was challenging, but it was also really lovely to be able to see people's faces and to talk and to see people in their work settings over Zoom, which I think a lot of us are getting a lot of experience more than we ever probably wanted with these days of being in lockdown. And the new knowledge that was gained around the midwifery model of care and best practices was another highlight. And really for everybody feeling connected and feeling empowered, which I think is something we're all getting from this virtual International Day of the Midwife. So just briefly some of the outcomes. It helped. This is from the students and faculty. The course helped me think about enacting change in my own work and studying and 67% strongly agreed with that. They felt connected to a broader community of midwives and other professionals involved in maternal and newborn care. Again, 67% strongly agreed. And again, 67% agreed that the course gave practical tools to help make changes in their own work or educational environment. And everybody felt that administrators and policymakers would be interested in such a course. And that really kind of leads up to Jones Talk, which will be coming right up. Just to give you some of the quotes from some of the learners. They learned what is right for one woman is not right for the other. And staff shortages should not compromise maternity care that women should receive. Women have the right to make decisions about the maternity care they receive. The course broadened my understanding of maternal and child health indicators, reading and interpretation of data. In addition, it enlightened me about how maternal and child health can be improved. It gave me good insight into team building and collaborative care, which is key to the attainment of goals and objectives of an organization. And above all, the course reminded me of the need to strengthen respectful maternity care in every facility globally in order to foster a change of attitudes among midwives and to improve the experiences of women while seeking maternity services. So without further ado, I'll let Jane come in and tell you about the course that has kind of grown out of this that we hope to offer by the end of the year to everybody. Thank you. Hey, thanks, Michelle. So my name is Joan come back and I want to have a special shout out to our attendant who's from the state of Iowa because that's where I'm from so hello to you and I'm glad that to see. It's really exciting to be here I had no idea there would be so many people from all over the world, very exciting. So that's exactly the sort of I think enthusiasm and audience that we wanted to capture with this course after we had the pilot which was intensive and deep and kind of a more traditional didactic style. We had the opportunity to to broaden it and the challenge really to widen the audience to something that, of course that was designed primarily for for clinicians to something that could reach policymakers and administrators activists and consumers. So, we decided to construct this massive online open course if everybody knows that that acronym MOOC and working with the Coursera platform which is through resources at Yale collaboration between Yale and Coursera many of you might be familiar with the Coursera platform. We, we rolled out a pretty similar course to review the evidence for the midwifery model of care, and combine with that advocacy and experience and action for for local national and regional level work. And to really bring forth the evidence for the role of midwifery and health system strengthening, especially now it's actually very topical the course has been delayed it was supposed to be out by this time but it was delayed by the coronavirus. There are some complications that we've encountered but that's exactly one of the points that we were hoping to make that in this time of climate change and changing disease patterns and massive human migration that health system strengthening, especially in maternity care is really really more vital and important than ever, especially if we hope to accelerate progress toward the SDG goals. So this time really bringing forward evidence about the foundational parts of midwifery practice of preserving and protecting normal physiologic processes and being grounded and respectful and patient centered care. The the course underdeveloped right now under development right now is an eight module course one of the exciting aspects about Coursera is that it's free and open access for anyone in any setting. It's easy to connect to and it can be completely free. The participant wants to gain a Yale Coursera certificate it costs $49 which also is not an exorbitant fee so it feels exciting to be involved in providing that really open access kind of opportunity for people who are interested in this field. One of the most exciting elements of the course right now is that it's not just me and Michelle who are teaching it. We have I think 14 different collaborators who are leading experts in the field. They're leading clinicians contributors to the Lancet series they work in different environments and low middle and high income countries. It really has turned into an opportunity to bring together all these really outstanding thinkers and movers in the field of maternal and newborn care. And it's really designed around the structure that was presented in 2014 by ran through at all the quality maternal and newborn care framework. And so this is sort of the outline. I'm sorry I apologize the numbering system is off here but so eight modules altogether the first grounds us in the status of maternal mortality and newborn survival and still birth kind of the state of the world today. And the second module really goes deeper into what's a midwife what's a midwifery model of care and kind of introducing the need for in the process of developing the quality and maternal and newborn care framework. Then the next five modules go further into those five components of the QMNC framework practice categories organization of care values philosophy and care providers. And the final module is really hearing from people activists and people working in policy and advocacy for the midwifery model of care. And I just wanted to show a little bit larger blown up view here of the QMNC framework this is a kind of novel application of the QMNC framework to structure this course around this but I think it really speaks to the strength and the applicability of the framework to use this comprehensive comprehensive view that the framework has developed. So student expectations for the courses. If if people are interested in getting the certificate they need to pass short quizzes they are asked to post commentary. Coursera actually has the capacity to sort of have interactive engagement if there's a enough participants in the course. You can post things and get responses so you can actually develop into a more real time dialogue, even though everyone is doing self study at their own pace. And so that pace could be probably a person could get through it in a week of more intensive study or they can take their time and do it in eight weeks, you know, or any amount of time that they want in order to finish it. But baseline is they need to show that they have understanding of the material covered and have is have engaged with it. And in terms of distribution. The strength of the Coursera platform is that they have over 30 million discrete users. Michelle and I are really hoping that there are 30 million people out there who are massively interested in the midwifery model of care but we'll be happy to get a smaller number. We are also advertising through professional organizations and the networks of the amazing contributors that we have as well as Yale we rely on several Yale faculty from the School of Business actually the School of Public Health and the School of Nursing. From the School of Medicine as well so there's a fair number of Yale faculty involved, and we will also provide continuing education credits I think it could be used even for a course at various university courses as a special global maternal and newborn care course. And we have the opportunity then to do as value evaluation as well not just enroll the number of people who enroll and the course ratings but really I think even more interesting or who are the people taking the course and what are they interested in is this useful to them. What is their preferred content and what other content would would be of interest to them. So that we can continue to refine the course as we go along and be responsive to that or also as a guide to developing other course material. So some of the challenges, however, and it has been a bit challenging. It's very labor and cost intensive for the initial development of a course like this. And it was a pretty steep learning curve for Michelle and for me, given that online learning the research around online learning shows that women shows that people actually learn in a different way than they do in a classroom environment so it tends to be, you know, shorter videos with really condensed information and then a moment to take a quiz or have a reflection or do a reading and then another seven to 10 minute video from, you know, another perspective or another short lesson. So it's been a steep learning curve to organize all of that. It would have been very, very difficult without the technical assistance from the poor who center for teaching and learning at Yale. They've provided all that we need to film people to make sure that the audio is okay to do the editing to let us know the capacity of the Coursera platform. So it's been an exciting challenge to work on that. And some of the highlights it's really been, you know, supported and exciting vision from the Dean and from the School of Nursing at Yale and supported with key funding support. Like I said, University resources were really important to support this development. And then the great thing is that once we get this up and running, actually the continued faculty investment or the continued investment in the course is very low because Coursera takes over on maintaining the student enrollment and, you know, sending out certificates and all of that. Actually it becomes really self sustaining after the initial development. We have the opportunity as I said to update it as needed or every few years it will be updated. And we can be responsive to learner needs and change it as it goes forward even. So our future plans around the course are just to try to evaluate the impact longitudinally we'd really like to see not just as I said like who's using this but how does it affect their care and their practice and have they been able to implement change in their local environments. We hope that this can be an exciting opportunity for developing other courses with a global perspective. I think that we have such power when we can communicate to each other with each other and I think as Michelle said we're overnight kind of getting a lot better about that so it feels like just all part of that same flow right now. And we hope you know ultimately to really foster a more global dialogue around quality maternal and newborn care. I just want to make reference briefly to another initiative of Holly Kennedy who was taking the lead on this on many of these initiatives. She has just recently posted and launched the quality maternal and newborn care website at www.qmnc.org. This will be an ongoing portal for midwifery education at Yale, but and it will also be a portal for this course. It is also a meeting place for researchers who are interested in quality maternal and newborn care. And I think in the first week of launching the program I think or the website I think it's now in its second or third week in the first week over 200 researchers and people who are interested in information registered at the site. And so it will really be a place where people can meet up and can collaborate and get up to date information. So it's a very exciting new element of the Yale midwifery world and also a portal as I said to this course. And again just the mission of the website is fostering research information and community. So just to sum it up. We're looking forward I think to your feedback whether this is a course that you would be interested in whether you have done similar work, whether you've had similar experiences and reaching out to midwives or or workers in that field globally and what your experience is. We had structured this course I think to to meet everybody's need whether you're a person out there asking what's a midwife. You're sort of at that level or you're a person who's deeply into advocating for midwifery and the midwifery model of care we hope to provide the evidence needed to support your, your action and the information that you need. So that's all that we have for now and we'd love to hear your questions and feedback. So there's a question from Emily, the pilot included a six week in country immersion will this be available for those engaging in the MOOC. Yeah, that won't be for those in the MOOC. That was sort of a part of a pilot I mean it eventually that somewhat of a dream of ours to be able to reproduce that birth center setting. I don't know if it's such an individualized thing to replicate and we're not even sure we're able to do that yet, but we had the McLeary students did go up this spring to the birth center so they did start to learn in that model. But that got cut short due to Corona, but for this online course it's just going to be instructional only kind of an online learning it's not a clinical course. And Dacey, thanks for your question. The name will be quality maternal and newborn care. Well, I'm sorry global quality maternal and newborn care. Yeah, we were hoping to have the course launched by now but unfortunately with Corona hits and the team that usually helped us make those had to take a break to help the university put all their classes online. So it's a little bit delayed we're hoping maybe by the end of the summer. I would love to share your links on all our channels too. Wonderful. Does any I'm just interested in if anyone in the audience has had any similar sort of experience with class designed to reach a global audience. Well, I hope it'll be unique and exciting in that case. I hope we'll draw you all in. And really, you know, I want to emphasize the contributors who have participated are really outstanding so tune in to hear from the experts and leaders in the field. They're available in English. And if there's, if there's interest, Yale has the capacity to provide we do have a one Spanish speaking contributor I believe. But Yale does have the capacity to provide a translation down the road if that becomes something that people are interested in. We agree. I mean, connectivity and bandwidth was really a challenge. I think that Coursera is an easier platform to for people to engage with. I think one of the benefits of Coursera is that you're able to, if you do have connectivity, you can download all the modules, kind of at one time and work offline and then re upload once you get back into connect to a connection. So it's a little bit easier than the platform we were working on. I think as Michelle mentioned, we were all dearly attached to the synchronous learning learning sessions that we had with all of our students in the US and Rwanda and Uganda, especially the initial session had everyone in the course altogether including the six faculty and the 16 students and it was really exciting to see people's faces but the synchronous learning sessions were very, very challenging and there were several times when not everyone could connect. Interested in BlueJeans app. I haven't heard that. Does it work well? Yeah, it's very good for low bandwidth settings and this is Jane again, the facilitator. You'll probably realize now why none of us use webcams in this platform because we can't connect so many people if we're all in the West with the high resource countries using up all the bandwidth then our partners and other countries can't even get on the platform. Yeah, I think it in response to your comment about using in a midwifery program. I hope that you will check it out and see if it's appropriate for your needs. We found in our master's prepared students as well as those in Uganda and Rwanda that it was content that they felt they hadn't gotten and a kind of bigger theoretical perspective and that was reinforced by research that they hadn't gotten previously so we're hoping that it will kind of fill a particular niche that isn't a standard part of the midwifery curriculum. And I think we're hoping with this course to really reach people that aren't midwives and maybe it's physicians or maybe it's policymakers or someone in government to really get this model out there because even though it's midwifery model of care it's so applicable in so many settings and we know that this evidence works and to reach the SDGs we need to get this implemented and so we're hoping that this kind of more of a broader application of it will kind of get community activists and other people that maybe aren't midwives to really kind of see what this model is and why it works. Well, I think we're all so inspired with your presentation. I think we're all really looking forward to the course in Coursera. So, thank you again, Dr Telfer and Dr Comilik. We really enjoyed your presentation. Thank you for bringing all this information and we'll make sure when we get your links that we push out on our channels as well because it's really, really an important concept. And oh, sorry, here's your references. Sorry, I forgot you had references here.