Group Prenatal Care and Group Facilitation Student Workshop

Group prenatal care (GPNC) provides prenatal care, interactive learning, and peer support to groups of 8 to 12 pregnant patients of similar gestational ages.1 GPNC achieves outcomes equivalent to or better than individual care while reducing racial health disparities. Patients receiving GPNC experience reductions in preterm birth and low birth weight,2 with larger effects in Black participants.3 They also have fewer emergency department visits,4 decreased risk of neonatal intensive care unit (NICU) admission,5 and improved experiences of care.6, 7 The American College of Nurse-Midwives (ACNM) Core Competencies for Basic Midwifery Practice are guidelines for US midwifery education programs. They include principles of group health education, person-centered care, patient empowerment, and continuity of care8—key elements of GPNC. Widespread adoption of GPNC9, 10 and its alignment with Core Competencies provide motivation for midwifery programs to educate students in the model. This article describes the development of a workshop to prepare midwifery and women's health nurse practitioner (WHNP) students to participate in GPNC as learners. The impetus for this workshop was the reintroduction of GPNC at a university hospital midwifery clinic, where midwives precept midwifery and WHNP students. Although one author (G.N.) had been teaching an overview of GPNC, faculty agreed to expand this to prepare students more fully to participate in GPNC in clinical practice. Finding no published data describing such a program in midwifery or WHNP education, the faculty supported the first author in creating a workshop and adding it to the curriculum in the second semester of the first year of the 2-year master's program, when students have had some prenatal care experience. The workshop was designed by the authors. G.N. is experienced in classroom and clinical teaching, simulation, and researching and providing GPNC. S.S.R. developed CenteringPregnancy GPNC and has designed and facilitated GPNC training programs for professionals. We consulted the school's in-house expert in educational design to refine our pedagogy and the Simulation Team, who suggested conducting the workshop in a home care simulation suite with a living room, enabling participants to sit in a circle as they do in GPNC. Simulated prenatal abdominal examinations were conducted in adjacent space. We conducted a pilot workshop with 23 second-year midwifery and WHNP students in fall 2024; half of the students attended on one day and half attended on another day. In spring 2025, the workshop was integrated into the curriculum for 27 first-year midwifery and WHNP students. Three guest faculty participated in the workshops as learners. The workshop goals are to (1) familiarize students with the GPNC model, (2) prepare students to participate in GPNC, (3) introduce students to group facilitation, and (4) identify challenges of implementing GPNC in health systems designed for individual care. Workshop methods include prework, facilitated discussion, a simulated group session, and multiple debriefs. Before the workshop, students read an article on GPNC1 and respond to this writing prompt: “Write a brief reflection on what you know about group prenatal care. Include actual experience, things you have heard, and what you think about the model. Please be honest. This can be just a few lines or paragraphs or longer if you wish.” Continuing education (CE) is available for this article. To obtain CE online, please visit http://www.jmwhce.org. A CE form that includes the test questions is available in the print edition of this issue. The 4-hour workshop contains 2 2-hour segments and a 15-minute break. Part 1, “What is Group Prenatal Care?” is an interactive discussion conducted in a circle to introduce students to group care. It opens with an icebreaker activity in which students are asked to discuss in pairs their vision of perfect health care, after which they introduce their partner and their partner's vision to the full group. Next, participants engage in faculty-facilitated discussion of the following topics: (1) GPNC model components, (2) GPNC history, (3) GPNC research evidence, and (4) dissemination of group care models. A few slides and videos help students conceptualize this often-unfamiliar model; however, slides are limited to encourage engagement. Part 2, “Mock Group,” is a simulated GPNC session, in which students take turns role playing as facilitators and patients. Central to this segment is demystifying facilitation by introducing the technique of acknowledge, refer, return (ARR). Acknowledge is validating a participant's comment, refer is referring to the group for discussion, and return is returning the issue to the original participant to see if their concern was addressed. Mock group activities are (1) demonstrate abbreviated prenatal examination, (2) debrief about examination experience, (3) convene GPNC session and introduce participants, (4) demonstrate ARR, (5) debrief about ARR demonstration, (6) practice ARR in 2 breakout rooms with faculty, (7) debrief about ARR practice experience, (8) discuss challenges in facilitation (eg, using restraint as facilitator to create space for participants, avoiding being didactic, managing dominating participants), and (9) wrap up with the prompt “One thing I wonder when I think about group care is…” A key feature of mock group is having faculty facilitators conduct debriefs after activities to actively process the challenges of an unfamiliar paradigm. In debriefs, faculty encourage learners to honestly share their experience of the preceding activity, including positive reactions, discomfort, and lingering questions. The workshop concludes with an activity in which participants state an affirmation about their ability to create change (eg, “I know care can be better,” “I'm reflecting on my part in creating change,” “I have the power to create change”). Student and faculty workshop participants completed anonymous evaluations. Participants expressed enthusiasm for learning about the model and evidence, mock group, debriefs, community-building exercises, and the ability to ask questions. Some participants recommended longer workshops with in-depth exploration of facilitation challenges and model implementation. S.S.R. and G.N. debriefed together after each session and modified the workshop based on participant evaluations and our assessments. Changes included spending less time on model history and dissemination to allow for more facilitation practice and adding breaks and interactive activities. After the spring 2025 workshop, which had 13 to 14 students each day, some participants said the group size was too large. Students who have participated in GPNC in their clinical sites after attending commented informally in person and in anonymous evaluation that the workshop prepared them for the workflow and processes of GPNC. Our workshop, although not designed to certify students as GPNC facilitators, provides learners with a robust introduction to GPNC, a midwifery-designed and led model of care. This workshop is novel and easily replicated. It models facilitative leadership, uses participatory activities, simulates GPNC, uses debriefs to encourage open discussion of concerns and discomfort, and promotes active ownership of learning. Finally, it encourages reflection on how care should be provided and how clinicians can implement system change. Student feedback indicates that the workshop offers tangible steps to gaining competence and confidence in participating in this innovative approach to care. The authors would like to thank the Yale Women Faculty Forum, whose Seed Grant supported the development of this workshop. The authors have no conflicts of interest to disclose.