Counselling for induction at 41 weeks — shared decision-making station

Simulated-patient shared decision-making station: counselling a well-informed nulliparous woman about induction at 41 weeks versus expectant management to 42 weeks. Tests accurate quantified counselling from SWEPIS and the 41-versus-42-week meta-analysis, correcting a common misconception with data rather than authority, explaining what induction actually involves, and documenting a plan when the woman declines. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 34-year-old G1P0 attends the antenatal clinic at 40+6 weeks. Dating is certain from an 8-week scan. The pregnancy is uncomplicated, growth is normal, the fetus is cephatic and she reports normal movements. The unit's policy is to offer induction at 41+0 weeks. She has read that induction 'doubles your chance of a caesarean' and tells you she wants to wait until 42 weeks. She is well informed, calm and asks direct questions. You are the registrar.

Station brief

Format. Simulated-patient shared decision-making station, approximately 12 minutes. The simulated patient is briefed to be well informed, to quote things she has read online, and to become more receptive when you engage with her data rather than dismiss it. ^[1]

Candidate instruction. Counsel her about induction of labour at 41 weeks versus expectant management. Correct any misconception with information rather than authority, explain what induction would involve, and reach a documented plan that she agrees to — including a plan if she still declines. ^[1]^[3]

References7Show

[1]Alkmark M, Keulen JKJ, Kortekaas JC, et al. Induction of labour at 41 weeks or expectant management until 42 weeks: A systematic review and an individual participant data meta-analysis of randomised trials PLoS Med, 2020.PMID 33290410
[2]Wennerholm UB, Saltvedt S, Wessberg A, et al. Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial BMJ, 2019.PMID 31748223
[3]Grobman WA, Rice MM, Reddy UM, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women N Engl J Med, 2018.PMID 30089070
[4]Finucane EM, Murphy DJ, Biesty LM, et al. Membrane sweeping for induction of labour Cochrane Database Syst Rev, 2020.PMID 32103497
[5]de Vaan MD, Ten Eikelder ML, Jozwiak M, et al. Mechanical methods for induction of labour Cochrane Database Syst Rev, 2023.PMID 36996264
[6]Wheeler V, Hoffman A, Bybel M Cervical Ripening and Induction of Labor Am Fam Physician, 2022.PMID 35166491
[7]Kelly AJ, Alfirevic Z, Ghosh A Outpatient versus inpatient induction of labour for improving birth outcomes Cochrane Database Syst Rev, 2013.PMID 24222365

Counselling for induction at 41 weeks — shared decision-making station

Station brief

References7Show

[1]Alkmark M, Keulen JKJ, Kortekaas JC, et al. Induction of labour at 41 weeks or expectant management until 42 weeks: A systematic review and an individual participant data meta-analysis of randomised trials PLoS Med, 2020.PMID 33290410
[2]Wennerholm UB, Saltvedt S, Wessberg A, et al. Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial BMJ, 2019.PMID 31748223
[3]Grobman WA, Rice MM, Reddy UM, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women N Engl J Med, 2018.PMID 30089070
[4]Finucane EM, Murphy DJ, Biesty LM, et al. Membrane sweeping for induction of labour Cochrane Database Syst Rev, 2020.PMID 32103497
[5]de Vaan MD, Ten Eikelder ML, Jozwiak M, et al. Mechanical methods for induction of labour Cochrane Database Syst Rev, 2023.PMID 36996264
[6]Wheeler V, Hoffman A, Bybel M Cervical Ripening and Induction of Labor Am Fam Physician, 2022.PMID 35166491
[7]Kelly AJ, Alfirevic Z, Ghosh A Outpatient versus inpatient induction of labour for improving birth outcomes Cochrane Database Syst Rev, 2013.PMID 24222365