Distance Learning Success Stories

Here is a nice story sent in by a friend:

I attend the Nurse Midwifery program at East Carolina University in Greenville, North Carolina. It is the only one in our state. They have been graduating midwives from the program for 10 years now. Non-nurse midwifery is illegal here and treated poorly in much of the state, although Asheville, in the Western mountains, seems to be very friendly to much alternative health type of stuff. North Carolina also has the "supervise" clause in the practice act that makes practicing midwifery a challenge if they want the autonomy. I found out recently that ECU was able to get the midwifery program when it did because of a grant. North Carolina was 50th in the nation in infant morbidity and mortality (47th now) and the state granted a bunch of money for the program because midwives have such a good record of better health statistics in poor and underserved communities.

ECU had some courses online for a few years but as of the class that began fall 2003 they have moved the courses completely online. I have had face time for the first day of each semester for planning and trying to get to know the others in the program. I don't believe it is "mandatory" but it is pretty useful. I do already have a bachelors in nursing, and I am not 100% certain that they have an RN completion program here to go with. Through a grant all of the Midwifery students have received brand new Dell Axim pocket PCs for our use over the remainder of the program. I think it is very cool. I am trying to find a way to get every last bit of data I could possibly need packed into it before the clinicals start so I am not filling up my pockets.

One of the CPMs in my state started the program at SUNY Stonybrook at the same time I started ECU. It is also distance ed. She had to go for 1-2 week intensive and I am not sure if she has to go back any more.  My nurse manager when I was on the Navajo Res did the Frontier program, and she had to come to Kentucky for intensive hands on time too. The biggest setback of Frontier was that it is totally your responsibility to find your preceptor, and if it the same person all the time I think that can be a disadvantage because you are only ever seeing one way to do things. I actually live in Greenville, there is only one classmate that also lives here. Everyone else is disbursed throughout the state. Last semester I chose to attend the 1st day of the semester, and was glad I did. There was alot of useful information. In addition I had to physically be present on campus for 3 days. They were all for physical assessment....you cannot do a physical on the computer...The first day was essentially "practice", the second was Genitalia lab (paps and prostates) and the third was the midterm exam.  While we were there she told us if we were happy with our midterm grade we could keep it for the final. I was not ecstatic, however, I did not care to repeat it and my grade was so solid that I ended with an A.

The major benefit to me of distance ed is that I can study when and where I want, dressed as I want, and that my 4 year old does not have to attend daycare while I do "class work". That said, this has been way more work than I expected. Part of it is that it is graduate school, part because it is distance ed, and part because I am a different student than I was 10 years ago. Last semester I got notice we needed to move out of the house we were renting from the church for 2 years (they finally got a pastor) a week after school started. I had just tapped out everything I had in tuition, books and a new computer. I then had 20 days to find a place to live, to pack, and to move.  We managed it, and I kept up on 3 of my classes really well, however I never did really recover with Reproductive Physiology. I felt behind the entire semester. After we moved, as if tension was not high enough, my husband called me the day of my midterm exam to tell me he had just quit his job, and I needed to come pick him up from work.  I am not sure I fully processed it. I did decide I would go on strike, and I have been living in a pigsty since. So much for his theory of what a clean person he is. ;)  Anyway, I theorized, school was my job and he didn't have one so he could be the housewife. I would have rather he was earning an income, but to be honest I am not totally sure how I would have made it through the semester if he had been. I was waking up at 8am almost every day and going directly to the computer and working all day coming up for air just for potty breaks and with him bringing me food occasionally. I was then heading back to bed between 1 and 3 am. But I did it. YEAH!!

So I even managed to get myself a job and started immediately after school got out. I worked full time all through the vacation, but cut back to 2 12s after school started. It feels like there is never enough time. I get sidetracked with things that are school related, but not the actual homework.  I would prefer not to work.  I could use the 2 additional days to work on stuff during the week. This is really stressful. My first check came the day tuition was due, and I had $4 left over. Malpractice insurance kept getting pushed back, thankfully, and is due Monday ($840) After almost 4 months dh is now 'sick of being at the house' and might actually start a job in the next week or so.  I feel guilty because I am really not able to provide the kind of parenting I would like. When dh goes back to work it won't be much fun for dd, or me. I will be doing alot more of the late night stuff, and trying to prevent the distraction.

Anyway, the major disadvantages to distance ed are: you really do not have an opportunity to build a relationship with your classmates. There is just not enough contact. I also find I need to spend alot more time on the material than I would have in a classroom setting.  Now keep in mind when I was working on my BSN I had 2 jobs and worked 60 hours a week on top of full time school and clinicals. I fell asleep in class alot, and think most learning occurred through osmosis. I got very solid Bs all the time, which was fine by me. I wonder how I survived. I rarely studied, never crammed, and made enemies all along the way as a result. It is more important to me to do better than that now. I don't want to be a B student. I want to be an A student, and I don't want to skate by, I want to fundamentally understand EVERYTHING I an doing. So now this semester I am up between 8 and 9 and up to 3-4. I am comatose on Saturday nights between my two shifts. I am really worried about clinicals, they start next week. I will be at the health department 830-5p every Thursday through the rest of the semester.  Our program has tried really hard to find good clinical placements. Alot of the girls are traveling 1-2 hours from their home. They say it is much harder to place for GYN than anything else. I am lucky to be right in Greenville. Classes also run over the summer. The schedule is grueling. 12 cr hours each 1st year fall and spring (9 is considered full time in grad school) and 6 over the summer. the 2nd year fall and spring are only 9 credits each however the clinical time becomes more demanding.

This semester is Well Woman, Issues in Nursing, Research, and Pharmacology. Pharmacology has insanely long power point presentations (about 100 slides each week) with streaming audio lecture. We will have asynchronous chat every week. (meaning we type back and forth on the discussion board). There are two exams. They are 'open book'. Her philosophy is that we won't be practicing in the real world without references, why test without them.  Research also has weekly discussion board asynchronous chat and we will be doing a written research proposal. Doesn't sound like much I know, but you would be surprised. Issues also has weekly discussions on the board. She has 2 papers, a power point presentation and then we have to critique each others work and effort. All three classes weigh the discussions heavily. To get an A you need to present your own view and respond to classmates each and every week. That can be difficult to do when classmates wait until the last minute to post there own comments.  Well woman has not got as much structure as I would like. Learning is very self paced.  All the midwifery core coursed use the "module" method like many other programs. We received the module, which is about 100 pages outlining exactly what we are responsible for learning in the course. The midterm will test on the first 4 objectives and the final will be comprehensive. At least none of the exams this semester are Essay!! For those who are far away exams are proctored. Of course clinical will also effect our grade. All the instructors have been adamant about evidence based medicine, and all input needs to be heavily referenced. That means a whole lot of time looking for articles to support statements.

The research part has been fairly decent. The library has a ton of search databases. They also have a ton of electronic journal subscriptions (even midwifery today, believe it or not). Last semester they were doing a study and all distance graduate students had access to ordering articles for free....meaning I had access to anything I needed. The health science library is attached to the hospital, so much more convenient for parking than the school is. If I had to get an article on campus it was rare. Mostly I was a bum and got what was available online or ordered articles if the school did not have them.  Not so lucky this semester, and ordering articles can be expensive, so I am likely to rely more heavily on what is available electronically...however I tell you that sure includes most of what I have needed. 

I had gotten the feeling that the program is very 'medical model' minded, although I am beginning to think it is more my fellow classmates than the instructors and philosophy of the school. I had to do some interviewing of CNMs in practice for my first Issues paper.  The thing I heard most from every single person I talked to is that there is not nearly enough GYN in school to prepare you for how much of it you will do in practice. That has been totally banged into my head. That it is near impossible to support oneself only on the OB portion of services. There is also a lot of ethical stuff to consider. Things you may do in school (even if you choose never to do so again) How do you feel about performing circumcisions? abortions? emergency contraception? abortifacient forms of contraception? how strong a breastfeeding advocate can you be? Even if you never cut another episiotomy in your life you better do every possible one that comes your way in school, because you need the suturing experience.  Anyway, this are all things that I have had on my mind this week.

Back to distance ed...it takes a whole lot of discipline.  The best thing to do is check out each school if you are unsure...everyone has different plans, and alot depends on where their enrollment is for that semester. If I could have started the previous fall ECU would have loved me. There were only 5 midwifery students. Right now there are 12 in our class and 3 part timers. Anyway...good luck in the decision process. I will try not to take quite so long to respond next time. 
Take care all!.
Chantel
tlcms@earthlink.net