Frontier Clinical Bound

Selke · Jun 30, 2008

... As i said before this would never be accepted in medical schools or schools with more men. Men would not agree to practice catheters or prostate exams on each other. If you can't speak up for yourself on issues like this then how can you ever advocate for your patients who are extremely vulnerable. ... .

You have an excellent point here. Medicine has more prestige because it is male-dominated, and midwifery, which is classified as advanced practice nursing in the USA, has less prestige being a female-dominated profession, and associated closely with nursing. I was a gyne teaching associate a long time ago and taught med students how to do pelvics on me (before I went into health care). The female med students might have practiced on each other -- I never heard of it. Probably not but maybe they do sometimes, to improve their technique. If so, it is voluntary and private, not mandated by the school.

I think most midwifery schools do hire gyne teaching associates. They certainly teach much more thoroughly than what we got at Frontier. They are able to critique your technique as you perform an exam on them. This doesn't happen with two students practicing on each other.

The only reason why I can guess Frontier does not hire them is because they don't want to spend the money, or possibly they can't find any to travel to Hyden, KY.

I did not like the fact that at least one faculty member saw my body without clothes. I wouldn't mind practicing with students so much, but the faculty watching crossed too many boundaries for me. Thankfully it was over in one afternoon, and I did volunteer more than once, despite my feelings.

I think any of us with sensitivity and compassion can advocate for our pts and help those with traumatic histories, just as you don't have to have had a baby to be a midwife or OB, or have had a chronic illness or surgery or tragedy to empathize with those who suffer. But those women who have been sexually traumatized can tell the rest of us what helps and what hinders performing such exams, and how can we do them in such a way to cause as little trauma as possible?

Penny Simkins has a book out about caring for women in childbirth with a history of sexual abuse. Have you read that? There are articles about it, too, although they are no with me right now so I can't give you information. Maybe you could offer to give a short talk at clinic bound at Frontier about how to approach a woman with a history of trauma, instead of letting someone examine you.

MidwifeMom · Jun 30, 2008

Selke thanks for your post. I am glad at least one person can understand my feelings. I just don't think it is acceptable for midwifery schools to require this. Sure we can all get through this, but it is really necessary. Gynecological Teaching Assistants seem so much more effective because these women are trained like you said to teach the skill effectively and critique students. I can't see how much could be learned on the opposite spectrum when both students practicing in front of an instructor are already embarressed and uncomfortable. It's not ok for Frontier not to use GTA's just because they don't want to spend the money. Students pay a lot for tuition.

I will have to read the book you suggested. It seems very informative for those of us study to become midwives. Something like 1 in 3 women have suffered sexual abuse so this would be very helpful.

Journey_On, BSN, RN · Jun 30, 2008

It has been interesting to read both sides of this issue - both are very logical.

I found the book by Penny Simkins. It is called When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women. Thank you for mentioning it, Selke. I think it is an important thing to consider when working with women, considering the statistics.

midwyf · Jul 1, 2008

Yes Jamie, at Frontier anyone has the right to refuse to have a pelvic done on them. There are students with issues and everyone is told at the beginning that if they object and do not want to participate, they should tell the instructor.

Dr. Tammy, FNP/GNP-C · Jul 10, 2008

I think most midwife students go through with this because they are too afraid to stand up for themselves. In my opinion this practice is outdated and completely unethical. We pay enough for school that they should be able to hire "models" or gynecological teaching assistants.
If you don't go into midwifery with a compassionate attitude to begin with than you shouldn't be in the profession. No one can make you compassionate and caring to patients if you are not compassionate and caring:angryfire.

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KYCFNP · Nov 16, 2008

I just returned from clinical bound, and I know this topic was from a few months ago, but if anyone is still reading and considering Frontier, this may help you out. The pelvic exam portion is completely non-confrontational, there is a video playing, the lights are dimmed, there are exam rooms, part of the class is practicing pap smears on a model, part is practicing the pelvic exam on a model. By the time the course is over, no one knows who has had a pelvic done on them, and who has done one; this makes it almost completely anonymous except for you and your partner. I chose not to have the pelvic done on me, yet I had a classmate that offered to let me do one on her. Take my advice as someone who has been a victim of sexual abuse, it is a completely stress free environment. You are not made to say "I don't want to do this," there is no singling out.

CNM2B · Nov 16, 2008

I just returned from clinical bound, and I know this topic was from a few months ago, but if anyone is still reading and considering Frontier, this may help you out. The pelvic exam portion is completely non-confrontational, there is a video playing, the lights are dimmed, there are exam rooms, part of the class is practicing pap smears on a model, part is practicing the pelvic exam on a model. By the time the course is over, no one knows who has had a pelvic done on them, and who has done one; this makes it almost completely anonymous except for you and your partner. I chose not to have the pelvic done on me, yet I had a classmate that offered to let me do one on her. Take my advice as someone who has been a victim of sexual abuse, it is a completely stress free environment. You are not made to say "I don't want to do this," there is no singling out.

Thanks for your post! I am headed to Frontier Bound in 2 weeks and while this portion of the program is more than a year off for me, I have been a little nervous about it. I know that it is part of the "deal" and I will get over it, but it is still a little nervewracking. I do think, however, that maybe having a novice perform a pelvic on us will give us insight into what it feels like from someone who doesn't have a lot of experience, which will be the case for most of us. Thanks for the info--it sounds a bit better than what I expected!

Other than that, how was Clinical Bound? Did you learn a ton? Do you feel ready to start clinicals? Was it as fun (or more?) as Frontier Bound?

KYCFNP · Nov 16, 2008

Clinical Bound was wonderful! I'm so glad you asked because it still is so fresh to talk about. I think that the Frontier program is great for starters. Throughout the program I've worked 40 hours a week and been on call, and been in the program part time. Clinical Bound comes at the best time, it's a time when you're starting to feel maybe a little scared/nervous or feeling like "Oh my gosh I'm almost done, do I know enough?" Then all of a sudden you're there, surrounded by other people that feel the same way as you, and you're not alone. We did lots of case studies and scenarios, and you realize how much you've learned and that you actually can put it into practice. The skills are really helpful too, everything is really laid back. When you're at Frontier Bound there will be a larger group, you'll leave feeling so excited and ready to start, when you do CB, it's a smaller group, you leave feeling the same way, but you also are so empowered. You'll also feel so proud to be part of Frontier. I was proud of myself when I graduated with my BSN. But, just for me, not because of the school I went to or what it represented. When you are realizing that you're finishing at Frontier, you're a part of something much larger than yourself, and it's a really great feeling.

CNM2B · Nov 16, 2008

Thanks KYCFNP! I appreciate your insight! I have a question for you---I'm trying to get perspective from several people.

I am doing the CNEP program and have planned all along to go full-time. I cut back my hours at work to one-shift per week (I can always pick up extra if I have the time or between quarters). I also have a super supportive husband (who has a PhD, so he understands the need to study and the stress level). We have a 22-month old daughter who I take care of full-time, but I plan to study during nap times and in the evening when she is in bed. Plus, I will have the weekends when my husband is at home.

I have always done well in school and enjoy school, so I really want to do this full-time. Do you think that is a good plan? The faculty seems like they really push the part-time plan. Is it true that if you go full-time, you are not allowed to drop down to part-time?? Thanks for any advice you can offer!

KYCFNP · Nov 16, 2008

No I think it's definately do-able. I've taken 2 classes each term, and worked my 40 hours. My husband is in pharmacy school and works 1 day a week to pay for his gas money. We dont' have any children though, but from a stressful standpoint, I sort of get where you're coming from. I work M-F, so I get home around 3 o'clock, eat dinner, and usually read until I go to bed around 10 or 11. Now, on Wednesday nights, 80% of the time I have time to watch my favorite TV shows, or on Friday/Saturday go out and watch a movie or eat dinner. You can make time by staying on top of things and keeping up with the reading. I recommend a planner, the courses will be ready 4 weeks before they start, so you can get access to the syllabus and required readings beforehand. A week or so before class, I take a few hours and just write all my readings in my planner, as I get them done, I highlight them. This helps me to visually see how hard I've worked. If one week I see no pink highlighter and it's Thursday, I know that I better get my butt in gear for the weekend. There are times that I'll sort of slack during the day, and stay up late and night and work on things too. I think that working one day a week will be just fine for doing 3 courses. It might give you a nice break from the monotony also. There are times in doing an online program that it's just nice to bounce ideas off someone else or talk about what you're going through. That day will come in handy. I'm going to quit work for my clinical practicum, and do 32-40 hours a week for it. I just took out extra financial aid and I'm going to live off of it for about 5 months. It will all work out. After your first couple of classes, you'll get your own groove and sort of figure out how to juggle your classes. Try not to take any incompletes if you can. I took 2 in the program, and it sort of gets you off track. Keep thinking of questions and I'll answer all I can!

Belinda-wales, RN · Nov 17, 2008

It is completely do able I work full time nights in a leadership position so extra meetings and work at home have three children two grade level one pre school - a very supportive husband who has a busy job. I am full time at frontier half way through my first term and keeping on task - my grades are good not top of the class but comfortable well so far. Although for me some of the work is revision I still have to read and produce the papers and patho is patho never mind how many times you done it before reading it and retaining it for exam is another matter. So good luck and go for it!

jeepgirl, LPN, NP · Nov 17, 2008

I hear that students have to practice pelvic exams on each other in every program, not just Frontier.

**** - are you kidding? no way i wouldn't have done my NP program if they made us do that...

they hired people at our university to do our pelvic "experience". i heard they got paid like 250 bucks for the 2 hours it took... we did it after hours at a womens center at the university - each student completed a physical exam including pelvic and breast exam on one of the people who agreed to come in and do the project.