Role of practical medical training in the provision of respectful intrapartum care: insights from two large public teaching hospitals in Southern India
Bibliographic record
Abstract
BACKGROUND: For over a decade, the maternal health discourse has focused on a phenomenon that is alternatively termed "obstetric violence," "disrespect and abuse" (D&A) or the "mistreatment of women" in institutional obstetric care. The search for what drives D&A includes questions around the role of medical education in shaping not just what doctors know, but how they learn to treat women as well. However, medical education as an additional pathway to D&A is under-studied. We explore how one aspect of medical education- practical medical training during internships and residencies- operate in labour rooms in public teaching hospitals. METHODOLOGY: We conducted 37 semi-structured in-depth interviews with a cross-section of obstetric care providers representing all cadres of two large public teaching hospitals in a south Indian city. We coded the interview transcripts thematically, examined themes related to teaching and learning, and considered their implications for Respectful Maternity Care (RMC). RESULTS: We identified four pathways through which practical medical training had implications for RMC: (a) professional hierarchies and social hierarchies; (b) institutional and educational prioritization of clinical outcomes over respectful care; (c) limited presence and supervision by senior providers in labour rooms; and (d) teaching responsibilities primarily falling on inexperienced and overworked peers. The results suggest that ad-hoc teaching adaptations prompted students to rely on informal learning, which fostered an obstetric practice which runs counter to the principles of RMC. CONCLUSION: Reforms in practical medical training, particularly with regard to intrapartum care in resource-constrained public hospital settings, can help in the realization of RMC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.013 | 0.011 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.003 | 0.007 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".