 Right, the recording has started now, Penny. Very good. Thank you, Seal. I see someone did ask the group chat and private chats are kept. I don't know if there's a difference between those two, but they'll probably let us know a little bit later. Thank you for that introduction. I'm very excited to be able to talk with you about midwifery learning exchanges. Actually, right now, we are all participating in a midwifery learning exchange. I'm going to make this a little bit more specific to possibly midwifery programs arranging some learning exchanges. I hope that you paid close attention to Seal's introductory slides because I did not create a poll with the conference, which I think I may want to do that for another time, but I'm going to ask you to raise your hand. And we're going to start out with just two questions on the first two slides. And then I'm going to tell you about my thoughts and experiences about midwifery learning exchanges. And then at the very end, I hope to hear from you. And I hope that's why a lot of you are here at the presentation in my abstract. I did say that we would have some time for those of you who are interested to perhaps make some connections for your own learning exchanges. I've put my name and my email at the bottom of each slide. I know sometimes it's hard to keep all of our programs and papers together. So I do encourage you, if you have an interest in some type of learning exchange, you can certainly send me an email at any time. So let's go ahead and get started. The first part, I would like to just ask the group that is here, the audience, to please raise your hand, use that raise your hand feature. The little man at the top might be a little midwife at the top, I'm not sure. But that little white person raising their hand, if you click on that, and if you have been out of your country to visit a midwifery educational program or practice, select agree. And I believe I know that by the check marks that are, and I believe everyone sees that too, for our roster to the left of our screen, we can see people are checking if they've been out of their country to visit a midwifery educational program or a practice, perhaps. Okay, so some of you have, and that's very good. One more question then to find out about. Please use the raise your hand feature, that little figure at the very top of your screen. If you click on the down arrow and you could select agree. If you've participated in another virtual learning exchange besides virtual International Day of the Midwife of the IDM conference such as this. Okay, so that's very good. That's more. More of you have participated perhaps in some type of a learning exchange using some type of technology. So that's very good. And you can all just kind of see that and get an idea. But I would say for about half of the group, really, it's not been either. You've not participated other than this wonderful conference in perhaps a one-on-one program or actually leaving your country and going to see another country's program, midwifery program or practice. Thank you. And I believe perhaps you'll clear, I don't know as far as the checks and things, but those are the last of my questions. And that's helpful to get an idea of your interest and what your experiences have been a little bit in the past. So you'll see this has a lot of information on this particular slide and I will spend a fair amount of time on this slide. It's always fun to start out with the pictures that I've chosen and you can probably kind of guess. Types of learning exchanges and specifically talking about midwifery learning exchanges are a study abroad or a virtual learning. And so if you look at the fish bowls, that would be me jumping into someone else's entire environment and I may be a fish out of water for a little bit there, but I'm going to really immerse myself in a study abroad versus a virtual learning, which I think is what we're all really participating in with this conference is our fish bowls are kind of meeting in the middle. So it was wonderful, the opening presentation that gave me a little bit of a cultural idea. That was part of it, but it was probably more topic focus. So that's what my two pictures really represent there with the fish bowls is really who we are in this learning exchange. So I'd like to talk about the study abroad, the learner focus, and really that is the cultural immersion. And so it's more of a learner focus. The cultural immersion is probably one of your key priorities or what is going to happen with that. There will be development of intercultural understanding throughout that because there's a longer time period. The topic kind of comes after that and the topic exploration when I actually go to see your practice or go out of country will be through observation, in-person discussions, and these can be longer than just a 30 minute or one hour seminar. Could also include my participation in your practice or in a simulation, say in a program, could include some direct care. And that usually gets in more with a service type of service learning or service type of project. There are limits with the amount of direct care that can be done in a midwifery learning exchange due to liability issues, different restrictions for practice and qualifications, certifications, licensure, all those kind of things. But certainly observation, in-person discussions, participation with simulation can usually all be agreed upon for that. The entire time I am in country, the learner, I am comparing and contrasting with what my life experience has been up to this point. So it's really, I am totally immersed in this. I'm out of my environment and I'm soaking in really all that there is to offer. I certainly learn about topics and there probably will be an itinerary of topics for me to learn, but it's really more of this cultural immersion that I will probably take along with me and can really have a lifelong change within me. Then I'd like to talk, when we go to the fishbowl where we are kind of connecting in the middle and that's what we're all engaged in right now, would be more of a virtual learning and that would be more topic focused. So you see that I still have the same premise of some cultural presence. I'm developing some intercultural understanding just from perhaps the language, looking at the slides, pictures, inflection of voice, those types of things, maybe even choice of the topic. But the topic exploration, it's really going to be topic focused. So that's going to be with audio visual content like we have right now and audio discussion, which I hope to have at the end of this. And the content is really planned. We're not going to have too much spontaneous types of exchanges in our particular topic focused virtual learning that we're having now. And as technology increases and improves, I certainly think that we can get to more perhaps video inclusion or maybe real time, like some of us have used Skype and things like that. But for right now, as we look, if we're really looking at a global setting, those can be really a challenge. So that's why for right now it is usually focused on more of audio and visual content so that we're not all waiting on our servers and our internet to catch up with us. So those are the two main types of learning exchanges that I've identified. Really, main considerations for those two types of learning exchanges, the main considerations need to be looked at very closely and need to be determined to support the feasibility and the success of what you're really wanting to do and kind of your purpose and your objectives so that you are accomplishing and really having some exchange and some quality exchange happen. So if we look at some of these considerations, we'll start with if a student is going to have a full immersion and if they're going to participate in a study abroad. This requires many considerations. So again, that study abroad is that learner focus where a student is going to another country. You may have students coming to your country also, but it is still really a learner focus for them. They may provide some presentations when they come to your program or practice, but because they're immersed in your culture and your practices, it still really has that learner focus. And of course when we have the number one is always cost. And sometimes that the cost is just prohibitive right from the beginning, no matter our desire or intent or our purpose. But sometimes there is funding available to support those costs. And depending on what country that people are coming from, sometimes there is government sponsored support for those costs because this is really valued by the country to have this type of a learning exchange. But cost is usually always the number one priority. Second is access. So for you to go to another country or another practice, another program, midwifery program, there usually is some type of passport involved. There may even be some type of visa that is required. I just mentioned a couple of different types of visas, J-1 student visas, J-1 scholar visas. Those have many requirements, limitations, documentation, some cost involved in that, time involved in that, or perhaps a visitor visa between some countries that works out very well. But these are all the considerations that are needed to do these in-country exchanges. In-country exchanges can be faculty led, which is what I'm most familiar with here at Ohio State University. All of our study abroad are required to be faculty led, which means I develop a course. I teach that course for those students who are going to go to another country, and then I go with them to that country. And so we have very planned out objective assignments and working with the other country to see what some of their needs would be, what some things they may want to share with us would be. So it can be faculty led, or another type that can be very common is a student exchange. And student exchanges usually involve a longer time period, perhaps a semester, where students from one program will be exchanged with another program. And it can be a direct exchange. They're earning credits from that other institution. They are living in the living quarters. They are attending classes as those other students do. And as you can imagine, because of the variation, sometimes in definition of midwifery, as well as the different scopes of practice, not so much scopes of practice somewhat, but legal regulations and oversight and certifications direct student exchanges in midwifery are very difficult to come by. I wouldn't say impossible, but that could be a goal and something that we would look or work toward. I think it could be very beneficial. But because of those restraints of the practice issue and the liability issue, those can be more difficult. So that is another decision. If a study abroad is looked at, will this be faculty led? Or even if the student wouldn't be practicing or signing up for courses, will the students just be sent? And then perhaps the home program will say, yes, we will take two of your students also and plan their whole stay in itinerary for that. So it can really go either way with that. Time in country usually corresponds very much to cost. Certainly a week never really seems enough with any type of distant travel and time zone change. Two weeks seems just about right. Three weeks sometimes becomes cost prohibitive for all the considerations and coordination that needs to be made for that in-country stay. And so speaking to some of this coordination, of course we would think of flights, housing, meals, local transportation, identification and approval, and itinerary. And I give you this list because in starting to plan this without having a fairly detailed list, these are things that need to be discussed right up front. And your host country or program can really give you some good ideas on how to negotiate this for most efficient coordination of time and most economical. I'll speak to a little bit to identification and approval. Aside from perhaps the passport or visa being able to enter a different country, identification certainly needs to be done as we all know from our precepted experiences or even out in our own communities. Often some form of identification needs to be done with that student for background check with approval, identification of where they are able to go while they are there, if they're able to make say home visits, if they're able to go within the hospitals, what part of the hospitals if they're able to review any electronic medical records or any type of charting. So those different types of identification need all need to be set up ahead of time to really make the experience very full for once people are getting there and getting to the country. The itinerary then is very key to making a very worthwhile experience for your host as well as for those that travel. And when we get to my next slide, which talks a little bit, why are we even making all this effort to travel and to come together and hear each other, I'll go into a little bit of how that itinerary can be set based on what our purposes are. So you can see if we're deciding on a study abroad learner focus type of midwifery learning exchange, there are really a number of considerations that we have to address. If we say on the other hand, and I would also suggest that for any study abroad where you're going there, you would want to start out with some virtual learning even to set up your study abroad. But if we're looking at the other part, the virtual learning with having topic focus, that is really based on still some access, but internet access and capability. I've provided a website link for you here, the Freedom House report, which provides globally some information on the capabilities of countries and also kind of on the Freedom 4 exchange over their internet. And so with the green, you can see that those pretty much have full capability. The yellow is more limited, the blue is little to no access in those areas of the world. So I think that that's something that needs to be considered, and I think even within this wonderful conference we're attending now, we can see who's able to come into this conference, and that might follow a little bit of this map too. So for those of you that are thinking maybe I could reach out and find some of these different countries, this would be one consideration if you're thinking of reaching out and finding out if there's interest. And then the schedule for virtual learning or topic focus, that is really faculty determined if we're talking about between programs. Now there's certainly nothing that prohibits practices exchanging information. I think that we think of it more in a perhaps in a learning setting in a midwifery program setting where we're really starting out with new midwives and wanting them to be able to expand their idea of midwifery. And so that's kind of the focus for here would be for that new midwife, the learning midwife in a program, and then that faculty really needs to determine less than an hour is probably a great idea, kind of like we're scheduled here. We have a little bit of time in between conferences and really our talking time is about 45 to 50 minutes. Regular intervals could be considered or at the beginning of a term and at the end of a term. Again, it depends on your purpose and what you're thinking about. It could be decided that the cohort, if you have cohorts of students, that they might determine what topics they would be interested in, who they might want to talk with globally if that could be a match. Sometimes the topic would really determine also how often you might meet to meet the objectives. Really looking for some relationship building over the years, too. So the relationship building more than likely will come between faculty, that relationship building, because our students, we are hoping they will certainly matriculate and graduate and do all those wonderful things that they need to do. But some of that relationship building would be with faculty over the years to build stronger and stronger and improve upon your learning exchanges. So getting started, how exactly are you going to get started? You've heard some of the different needs that go into this, and I guess I would say there has to be an interest. I would say that we have the interest, though. Midwifery is universal. It is global. We all need to educate our midwives, and education usually corresponds, right, with new ideas. So I would say the interest is more than likely there. The need, I identify the need of developing professional behaviors for cultural understanding. And yes, we have all different cultures, especially in the United States. We have different cultures that are coming to us, and we do meet those needs, or we do teach about those needs and ask students to reflect on that. But I think sometimes those shifts in feelings and ideas do not happen until we are really faced with a global difference. And what midwifery means, very similar mothers, babies, families, the health of the mother's babies and families, and their well-being. But when we see it globally then, I think that that also does transpose to what we're trying to do here with perhaps various cultures that we take care of on a day-to-day basis. So the interest is there. The need is there. Desire does have to be there. We just thought traveling is not easy. It takes time. There's a lot of work in planning, money, logistics. Virtual can seem a little bit easier, but there can be technical frustrations and logistics. And it's certainly quite the same experience. It really has different purposes and different outcomes. So those have to be in place. That desire does have to be in place. So looking then at purpose and the outcomes for why you're really doing this, you need to be very clear on that. And so these would be very specific to the faculty plan. So faculty interest would come there first for wanting to have perhaps this need of developing these professional behaviors and professional kind of developments for cultural understanding. And then looking at what would these outcomes be? What are we looking for? And that would really help determine if you want to develop a study abroad program or have virtual learning. So that's kind of the decision behind that. I do suggest though that when faculty to faculty are getting together in the plan, that is really the first step to your virtual learning. And really for faculty, that is cultural learning too. Faculty do things differently from program to program in country, very differently program to program globally. That begins that cultural kind of change and broadening of our ideas even in the virtual learning or the virtual meetings to set up either a virtual exchange or to set up a study abroad. So I would take the kind of the directives that we had for our presentations for this conference to start simple, kind of to recreate almost what you're a part of here, reaching out to someone who's maybe not as familiar to you that you would have an interest in or that might be attending this conference. I think that that would be a great way to get started and to get the discussion started. And for another thing, for getting started in the, I do have it on the slide here, for faculty to faculty planning, setting a regular brief time to meet is very important. Every time you end, you need to have the next time planned when you're going to meet and those times do need to be brief, perhaps at 20 minutes. If we all have Adobe Connect here, and that is usually often the easiest way, you don't need to do video, but the easiest way to communicate. Bring up some of your documents right there. So you're not emailing back and forth and actually having a conversation is probably the most efficient way to move along your goal of study abroad or virtual learning. So let's look now, I did prepare a slide on what some of these topics might be. So topics for virtual learning exchanges, and I chose virtual learning exchange because I think that's something that is realistic. It takes off out that big cost factor, the big travel factor, some of the access and things like that, and as a starting point. And if you develop the relationships and the program moves along, that can turn into a study abroad, which could be very rewarding for both programs. And so I do think that it's important, especially in involving students, that we look to ICM, Essential Competencies for Basic Midwifery Practice, that kind of pulls all of us together and has set global standards for midwifery. And looking to those, I have just pulled out three. I mean, there are many, many more in that document, and I've listed that reference at the bottom of this slide. But I've pulled out three. And if you just think to yourself, as I mentioned these, like how you could picture what that learning exchange could look like with this particular objective or goal that you would set, and could this be covered in an hour, three hours, to give an international perspective, a different cultural perspective to the topic. So looking at these ICM Essential Competencies that also familiarizes the students with a global organization. And I do think that that is very important, and that it's something that we do want our students to be aware of. And this is topic-driven. We've pulled this out, and it is topic-driven, so it would lend itself to a virtual learning exchange. So you can look at these topics that the students might prepare these topics. Each, from each program, the students could prepare these in a 15 or 20-minute presentation, that then they come together, again, that fishbowl coming together in the middle to each present, how they partner with women to promote self-care. That could be a very early-on in the program type of presentation that they could prepare. It raises their self-awareness that they need to have self-care if they're going to be midwives and care for themselves as they care for others. And then to learn how a different culture, a different group, someone out of country would do that. Advocacy for normal physiologic labor and birth. The advocacy part is very interesting. That could raise some very interesting discussions within the exchange. So that could be a discussion that could also be a case presentation where each side would present a case, a great example, perhaps an example that needed some help or some intervention for what we might do at a different time. And not only advocacy, but what is normal physiologic labor and birth? And so what does that mean? And we would be very surprised in very developed countries if we're able to have some of our countries that normal physiological labor and birth is what they have to have and they're looking at a different part of the birthing process where they want to intervene. They will come up with very different problems or prioritizations that they have for labor and birth. And that can be very eye-opening to both participants in the exchange. And then the last one that I just brought out, I think can be very helpful, is one of the key midwifery concepts. Key scope of practice that ICM identifies is a midwife may practice in any setting, including the home, community, hospitals, clinics, or health units. So really getting an idea from each participant where are those practice sites. And so that gets into one part that I wanted to definitely mention would be pictures. And I think pictures can be very, very helpful to explain what a home, community, hospital, clinic, or health unit does look like and have some comparison and contrasting even within your own program and practice settings. Permissions often need to be sought. Definitely if there are any clients that are there, mothers, infants, families, other staff that are in the picture. Even if there are just pictures of rooms or units or different settings, permissions may need to be sought from the organization that that is okay to use. And then there are certainly some copyright things and those approvals that I mentioned. But that can be a very powerful way of explaining the different practice settings that we were in. So I really think that a virtual learning exchange can be used prior to or after a study abroad also to really enrich that and to continue the relationships. Virtual learning exchange will definitely be used to plan a study abroad, at least the technology behind that. So that is the most efficient way to be able to move along your objectives and really talk out some of what you hope to get from this. And it probably is more likely, if we really do want to provide a global sense to our students, it's probably more realistic to be able to incorporate a virtual learning exchange within our midwifery programs due to some of the barriers or some of the extensive planning that needs to be done for the study abroad types of things. So I'm going to move to my next slide and tell you a little bit about my experience. And then I would be more than happy. I think we probably have maybe, oh, 10 minutes or so or even a little bit longer, to have anybody who would like to, if you want to, put your microphone through the testing and things, because I think it is great to hear from you and we would like to hear from you, especially, you know, from around the world. I think that's a very exciting part of this. So go ahead and it's a little bit different the first time you do it, but once you get through the microphone testing, it's actually quite fun. And I know Seal can help turn the microphones on and off. My experience in visiting and providing actually midwifery coverage or midwifery care was not outside of the continental United States, but it was what is considered a different nation within the United States, the Navajo Indian Reservation in Chinley, Arizona. And so that I was immersed there and put right in like land. And tonight you'll be taking care of women, their families, delivering their babies and really helping them through that. And so that was a wonderful experience that I was able to participate in. I am involved in the planning of a somewhat of an exchange, but not for credit hours and not for an extensive period of time, but with UK midwifery students are planning to come here to Ohio and the United States, to Ohio State University. And they were planning to come here probably this fall. And then I've created, which is required by my university, a course to be able to take some of our students over to UK to a setting where these midwives have trained. And so we're working all of that out and all of the logistics out, which are very, very detailed. And that's a little bit different too because they are midwifery students and their education is at the baccalaureate level. And here at the Ohio State University, we have nurse midwifery students at the master's level. So they are nurses and midwives. But it is very helpful to look at this and look at some of the ICM commonalities. And that's what some of the students are going to explore to be able to see where we measure up on that and how we are meeting some of those goals too. And being able to see what their preparation is and also what their healthcare is and their outcomes and be able to really take some very good things that they're doing and be able to incorporate that. So my goal with this presentation, and I'm so very excited I was accepted to talk with you this evening, is to help provide a forum that you might identify a match with another program. If any of you have an interest in Ohio State University, the United States, I'm certainly happy to talk with you also. And then to perhaps be able to have this even expand further if we have some of these learning exchanges, the virtual international day of the midwifery conference and just the idea out there expanding that further. And then looking to see what relationships might grow from this. And if this is something that can be kind of a jumpstart to be able to make some of those matches. So I think I'm okay on time, Zeal. I think some people have a microphone if you want to put them on. My microphone is back. What you didn't realize, Penny, is that I lost connection. I came in and out on a totally new computer. Thank you to Lorraine. Oh, no. Kate Best had a question and I had enabled her microphone. It looks like it's off again. Kate, if you- Sorry, I'm here. There it's on now. Yes. Hi, Kate. To listen to what Penny had to say. Can you hear me? Yes. Yes. Okay. So my name is Kate Best, I'm actually a student midwife in Ontario in Canada. And I'm in the process of planning placements for the rest of my degree. And something that I've been kind of struggling with and I don't know if this is part of your program at Ohio State. I think exchanges are a really good way of dealing with this question. Kind of coping with the people who have access to a lot of these international exchanges tend to be often times people who come from a lot of privilege. So whether it be economic privilege or we all speak English or whiteness or being Western or whatever the privilege is that we cope with. And kind of figuring out how to accept that and still take advantage of the learning opportunities that are available to us. For example, I'm in a francophone program and I would love to do an exchange to Haiti or to Senegal. But I'm just kind of grappling with what that would mean for- Again, I think exchanges is a great opportunity but not taking advantage of my privilege and instead using it for good. And I don't know if that's part of your preparation for your students' exchanges or if you could speak to that. I certainly can speak to that. And I think several of the points that you raised are fact. I don't think that they really have any judgment to them at all. I think that explains probably the demographics and some of the history of exchanges. So I think that that is very true. I think that that is something that I am hoping to introduce to students and it would depend on where we might make some of these matches, where they can be matched. So I know one of the other faculty that's at Ohio State University, she, at the same time that I will take some students to UK, she will be going to Honduras. And that's much more of a service and a mission program. And that's not what they, an educational program, but that's to actually provide service in somewhere where there's been long-standing need for that. So I think those type of education abroad programs, that is really a different purpose. And so I would just, I think that's a very good point and I would challenge you to look for the right, the correct match that we would have. I think if that's talked about and stated, that some of those with privilege identify how to reach out to others. And whether that may be eventually in providing some with the technology to be able to communicate in a virtual type of exchange or if that's actually setting up a program where service or training can be done. I think that that is our, that helps to open our eyes more than shelter us. That's the way I view these exchanges. What I think I heard you say is if you take part in exchange that costs a lot and does seem like the only reason you could go to it is because you have that money or you, you know, you are able to have that. I understand that kind of internal struggle that you're having and you would need to really look at what that program is and how you might move forward or what that purpose of that program would be. So I'd like to hear back from you. I don't know if that helped at all or if you would like to have a follow-up comment. I think you spoke to it well. I think you only have reiterated what I already think I know internally, which is like, it's not a yes or no question. You know, it's something that we all have to grapple with and it's privileged even among all populations. For example, the placement penny or the exchange penny was talking about. There's privilege, a privilege on disbalance or unbalance that exists in that exchange as well. But recognizing that everybody has some, like, I think exchange is a really good answer to that and maybe finding more opportunities for exchange where like a one-to-one, one student comes here and we go there and that can feel like more of a balanced exchange rather than just like, you know, kind of tourism almost like... Exactly, exactly. And that, yes, and we are now particularly looking at, there is a tourism aspect to it, but we're looking at a cultural identification and a cultural growth, a cultural development to happen. And so that's where I see that even if whatever that culture might be is that then a student, as I know myself, came back with a broader approach to patients that I see every day because I would see different cultures right here without going anywhere. So thank you, Kate. Time-wise I don't know how we are, but I wondered if anyone else had a microphone on or would you like to say if you would like to match or identify anyone here. I think I saw some different countries when we introduced ourselves and that would be fantastic even to see what people are doing. Hello, Teni. Hi, Teni. So I'm Susanna. I'm just very curious about what kind of work are you going to do in Honduras because as far as I know there is no registered midwives there. So are you planning to work with traditional birth attendants or nurses? Right. That program is not a program to program. So it's not an educational program to educational program, but that is done through a longstanding with their health ministry. And so that is to go down there and actually provide care within some of their clinics. So that is not a midwifery educational program to midwifery educational program, but it is through their health ministry there. Thank you, Teni. So the next presenter actually, he's actually going into, well, we can discuss this later, but there's some program that is going to be made in Honduras. And as a midwife, I think it would be a good idea to work all together into actually make this process a united work where actually midwives can work with it, too. Yes. I don't think I understood exactly your comment. You said that they are developing a midwifery program in Honduras. It's going to work that it's going to be done in terms of maternal mortality. And there has been an effort in terms of working with midwiking Honduras, but there was no midwifery program there. Ah, okay. And yes, so that would be, you know, that's a different, really different type of learning exchange that, you know, if someone did reach out, that would be take on a little bit different direction for those countries that may not have that but are interested in that. And I could see that very much in a policy direction. We do have, and I'm becoming more involved in it, we have a national organization, American College of Nurse Midwives, and I do know that they have a global division that they do try to, you know, work and look for that. And, you know, not go in and put themselves in there but certainly work with countries that are looking to move that forward. So yes, I do agree that if that would be the moment to begin that, especially if a government who perhaps controls resources and, you know, access for care and those types of things is looking for a solution in midwifery, that would be wonderful to be able to reach out and assist on that. That would be really pretty beyond the types of exchanges I'm talking about here. But that's what happens when you start talking and broaden your horizons. There's many different ideas that can spark from that and connections that can be made. Thank you, Penny. I think we have time for one more quick question if anybody has anything quick for Penny. All right, I'm going to move on to my housekeeping slides. Penny can be contacted through the Midwifery Program at Ohio State. If some of you think about connections that you might make later on, I would also second what she just said. Some of our professional organizations have international divisions that can be a good resource for us as we look to do international work. They may have already done some work with midwives in that country and can give us kind of a springboard into our own experiences. Thank you so much, Penny. You're very welcome. Thank you, Phil. Turn off the recording.