[Midwifery Clinical Practice] Why can't you write an initial diagnosis? Tips on the "way of thinking" taught by clinical instructors

"I don't know what to write for the initial diagnosis..." Isn't this the first wall many students hit during their midwifery clinical practice?

You gather basic information about the pregnant woman, the course of pregnancy, vaginal examination findings, CTG, and other data from the medical record, and work hard to fill out the assessment sheet.

Yet, when the clinical instructor asks,

"So, how do you think this woman's labor will progress?"

"Why did you think that?"

Have you ever had the experience of freezing up the moment you were asked these questions?

But that is not because you lack study.

You just haven't had enough practice in "connecting information and thinking about it."

While there are many opportunities to learn knowledge at school, there are surprisingly few opportunities to systematically learn "how to think."

I am currently involved in clinical instruction for midwifery students, but what I am looking for from students is not the "correct answer."

What I want to know is,the thought process of "how you arrived at your conclusion."

In this article, I will share the important way of thinking when writing an initial diagnosis from the perspective of a clinical instructor.

Not "what to write," but "how to think"

I hope this article will help alleviate your discomfort with initial diagnoses, even if just a little, and serve as a trigger for you to feel the "joy of thinking."

The purpose of an initial diagnosis is to "predict the future"

The primary purpose of performing an initial diagnosis is

to predict "what kind of labor this woman is likely to have from here on out."is.

In other words, it is to draw a future scenario based on the information currently available.

This purpose has three major meanings.

① To "connect and think" about information rather than just "copying it down"

An initial diagnosis is not the task of transcribing the contents of a medical record onto an assessment sheet.

For example,

Instead of just evaluating these pieces of information one by one and finishing, it is important to connect the dots by thinking,"Given this information, how might the labor progress?"and considering them together.

What is required of students is not to list knowledge, but to be able to explain in their own words,"This is why I made this prediction.".

② To decide what to observe next and what care to provide

A prediction does not end with just making the prediction. For example, if you think, "Labor seems likely to be prolonged,"

and so on, you will naturally see"what to observe next" and "what kind of midwifery care to provide."

The initial diagnosis is performed to connect the assessment to midwifery care.

③ To acquire the "ability to think"

The most important thing in an internship is not to get the prediction right. We midwives also cannot predict the future with 100% certainty.

That is why what clinical instructors are looking at is,not the "result," but the "process of thinking."

Being able to explain this in your own words is a major step toward growing as a midwife.

Let's acquire the thinking process to turn dots into a "line"

For example, suppose a pregnant woman with gestational diabetes (GDM) is admitted at 40 weeks and 3 days of gestation. The estimated fetal weight three days ago was 3,560g.

At this point, students often write in their assessment, "Because she has gestational diabetes, there is a risk of a macrosomic infant."

Of course, that line of thinking is not wrong.

But,it is a waste to let your thinking stop there.

In clinical practice, we think in the following way.

Once you think that way, you gather further necessary information.

For example,

In this way, from a single piece of information, you can see "what needs to be checked next."

Furthermore, if it is a macrosomic infant, you might ask, "Is there a risk of shoulder dystocia?"

"If it happens, what kind of response would be necessary?" This also becomes an opportunity to organize your knowledge by re-reading guidelines and textbooks.

And after the birth is over, you think, "I also need to be careful about neonatal hypoglycemia," and

Thinking in this way, you broaden your perspective to include the period after birth.

In clinical practice, it is very important to expand your questions one after another from a single piece of information and return to your textbooks to confirm your knowledge.

You learn not to memorize knowledge, but to understand the mother in front of you.

Through that repetition, scattered pieces of knowledge gradually connect, and "dots" turn into "lines." I believe that is the most important "way of thinking" for an initial diagnosis.

Assessment is only meaningful when it leads to "care"

I sometimes receive consultations from students saying, "I can write an assessment, but I can't think of any care."

That might be because you are only focusing on the progress of the labor.

For example,

By also looking at these daily activities, the "midwifery care you can provide now" will naturally become apparent. Assessment is not just for creating a plan.

It is something done to provide better care to the expectant mother in front of you.

What I want to convey from a clinical instructor to students

During practicums, I often tell students:

"An initial diagnosis is just a diagnosis at that moment, so it's okay if it's wrong."

An initial diagnosis is a 'hypothesis at that moment' based on limited information.

After that, if new information is obtained, you can just revise your assessment. Therefore, there is no need to try to come up with a perfect answer from the start.

What I value in practicums is not whether the prediction was correct, but

"What was the basis for that thinking?"

"How did you interpret the new information, and why did you revise the assessment?"

It is that thought process.

A practicum is not a place to show off your knowledge.

It is a place to acquire the ability to think based on information obtained from the expectant mother in front of you, and to connect it to better midwifery care while revising your thinking as necessary.

I would be happy if, through this article, you could feel that 'an initial diagnosis is not something to write the correct answer for, but a start for continuing to think.'