Original Article

Out-of-Hospital Birth in Medical Education: A Thematic Analysis of Question Banks for Medical Licensing Examinations in the United States

Authors: Magdalene R. Lederer, DO, Daniel J. Hurst, PhD, ThM

Abstract

Objectives: This study assessed the content of US Medical Licensing Examination question banks with regard to out-of-hospital births and whether the questions aligned with current evidence.

Methods: Three question banks were searched for key words regarding out-of-hospital births. A thematic analysis was then utilized to analyze the results.

Results: Forty-seven questions were identified, and of these, 55% indicated a lack of inadequate, limited, or irregular prenatal care in the question stem.

Conclusions: Systematic studies comparing prenatal care in out-of-hospital births versus hospital births are nonexistent, leading to the potential for bias and adverse outcomes. Adjustments to question stems that accurately portray current evidence are recommended.
Posted in: Obstetrics and Gynecology72 Pregnancy31

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Karpicke JD, Roediger HL. Repeated retrieval during learning is the key to long-term retention. J Mem Lang 2007;57:151–162.
 
2. Sabin JA. Tackling implicit bias in health care. N Engl J Med 2022;387: 105–107.
 
3. Ripp K, Braun L. Race/ethnicity in medical education: an analysis of a question bank for Step 1 of the United States Medical Licensing Examination. Teach Learn Med 2017;29:115–122.
 
4. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach 2020;42:846–854.
 
5. Gingrey JP. Maternal mortality: a US public health crisis. Am J Public Health 2020;110:462–464.
 
6. Korb D, Goffinet F, Seco A, et al. Risk of severe maternal morbidity associated with cesarean delivery and the role of maternal age: a population-based propensity score analysis. CMAJ 2019;191:E352–E360.
 
7. MacDorman MF, Declercq E. Trends and state variations in out-of-hospital births in the United States, 2004-2017. Birth 2019;46:279–288.
 
8. Souter V, Nethery E, Kopas ML, et al. Comparison of midwifery and obstetric care in low-risk hospital births. Obstet Gynecol 2019;134:1056–1065.
 
9. Sandall J, Soltani H, Gates S, et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016;4:CD004667.
 
10. American College of Obstetricians and Gynecologists. Planned home birth. Committee Opinion No. 697. Obstet Gynecol 2017;129:e117–e122.
 
11. Cheyney M, Everson C, Burcher P. Homebirth transfers in the United States: narratives of risk, fear, and mutual accommodation. Qual Health Res 2014; 24:443–456.
 
12. Merelli A. Why doesn’t the U.S. have more Black midwives? https://www.statnews.com/2023/09/18/midwife-training-expand-racial-diversity-maternal-health/. Published September 18, 2023. Accessed March 25, 2024.