Anne Drover, Amanda Pendergast – Memorial University of Newfoundland, St. John’s, Canada

This abstract was published and presented at the 2019 Academy of Breastfeeding Medicine Annual Meeting in the United Kingdom.

Background: Breastfeeding issues are very common. It is critically important that health care providers have adequate knowledge and skill to identify and assist in the management of these issues. The inability to manage breastfeeding issues can adversely affect breastfeeding duration. It is well documented that education in lactation is lacking in nursing and medical schools. Traditionally, clinical knowledge and technical skills were obtained by spending long hours observing and doing in a hospital setting. The philosophy was “learning by doing” in an apprenticeship model. In this new era of competency‐based education, we recognize that time does not equal competence and that deliberate practice is required. How much deliberate practice is needed for a particular skill is still under investigation. The International Board of Lactation Consultant Examiners (IBLCE) who license Lactation consultants around the world allow three Pathways to obtaining lactation specific clinical hours: with hours required ranging from 300 to 1000. The Liaison Committee on Medical Education states that no longer can we assume learners see and learn what we think they do just by simply being in the location of patient care. We now must set predetermined objectives and ensure the learning environment is appropriate. Learners must log encounters to ensure these encounters occur. It is not sufficient to rely on the possibility that every learner will be exposed to a wide variety of breastfeeding cases. It behooves lactation programs to find alternative ways for learners to gain knowledge, skill and leadership expertise to manage critical breastfeeding issues. To overcome the barriers of limited clinical exposure and the inordinate numbers of hours required for licensing; educators have the responsibility to create structured, repeatable educational interventions for their learners. In most other areas of clinical education, educators are now relying on simulation to ensure a standardized curriculum. The use of Human Patient Simulation allows the learner to be exposed to repeatable, standardized scenarios that mimic real life but in a safe and controlled way. Simulation allows safety for the patient and emotional safety for the learner. There is a growing literature on the use of simulation as a teaching and assessment tool in medical education. Overall, there seems to be an increasing acknowledgement of the benefits of this type of teaching and it has been shown to be highly accepted by the learner. It has also been shown to be effective in aiding learning and recall, particularly in skill development and assessment.

Objective(s): 1) To develop a breastfeeding education day that is highly interactive and innovative using various forms of simulation. 2) To utilize the LiquidGoldConcept Lactation Simulation Model, Gynecologic Teaching Associates and Recruited mother/baby pairs to enhance learning.

Materials/Methods: The whole clinical day course was developed with adult education principles in mind. The course development committee consisted of a pediatrician, a family doctor, and five lactation consultants representing NICU, Obstetrics, Community and La Leche League. We endeavored to develop a course that was as interactive and hands‐on as possible. An outline of the course is as follows: Workshop 1: Getting Started with Breastfeeding: Three Rotating Sessions: A: Breast/nipple assessment & exam using gynecologic teaching associates and 3D breast models. B: Ideal position and latch using real mother and newborn dyads. C: Breast and nipple issues using LiquidGold Concept Lactation simulation Model. Workshop 2: Overcoming Challenges in Breastfeeding: Three Rotating Sessions. A. Shallow Latch using two sets of mother infant pairs. B. Painful Latch using two sets of mother infant pairs. C. Baby won’t maintain latch using various videos. Concurrent Workshop 3: Tongue Tie/Lip Tie: assessment, imitators and management extensive use of pictures and videos. Concurrent Workshop 4: Overcoming Challenges in Breastfeeding: use of LiquidGold Concept Lactation simulation Model and demonstration of various pumps, and alternative feeding methods.

The innovative aspects of the curriculum are as follows: the use of Gynecologic Teaching Associates who are women trained and paid to serve as standardized patients for medical students in pelvic exam. We were able to utilize these women in breast and nipple assessment. We also were able to 3D print various breast models out of silicone that had varied nipple shapes and issues. These were very useful for assessment and discussion. Next, using the LiquidGoldConcept Lactation simulation Model and a standardized patient who wore it; we were able to role play various scenarios in breastfeeding management. Most importantly, we recruited and paid a large number of mother/infant pairs that had various breastfeeding issues and the Lactation consultants were able to demonstrate and have participants assess and manage these issues.

Participants completed evaluations of the course specifically with respect to interactivity and the opportunity to practice clinical skills. The participants also evaluated the usefulness of the LiquidGoldConcept Lactation Simulation Model, the use of the 3D breast models, the use of the Gynecologic Teaching Associates and the use of the real mothers and babies in enhancing the learning.

Results: Approximately 80 participants took part in the Breastfeeding Clinical Day workshop. The response to the highly interactive and hands‐on workshop was overwhelmingly positive. Respondents unanimously agreed that the LiquidGoldConcept Lactation Simulation Model, 3D breast models, Gynecologic Teaching Associates and Recruited mother/baby pairs greatly enhance learning. The participants appreciated the active nature of the workshop as that more accurately reflects the clinical setting rather than sitting in a lecture. The varied sessions and topics reinforced and complemented each breastfeeding issue. We were unable to evaluate knowledge and skill as this was the first offering for this workshop but that will be added to the next offering.

Conclusions: Breastfeeding education is crucial in order to properly support mothers in their breastfeeding journey. Lack of knowledge and skill can be a detriment to success. It is critical to create effective and efficient methods of teaching breastfeeding management. All areas of clinical care are moving to a competency based curriculum model. Lactation education must make use of new technologies and methodologies in order to ensure practitioners have all the skills required to assist mothers in the clinical setting. This innovative workshop made use of simulation based medical education techniques to ensure a high level of interactivity and hands‐on learning. Participants were overwhelmingly positive about the use of the LiquidGoldConcept Lactation Simulation Model, 3D breast models, Gynecologic Teaching Associates and Recruited mother/baby pairs to enhance learning. Next steps will be to use the simulation tools in assessment. This may allow for the development of more robust curriculum and assessment tools in the education of new lactation practitioners.