MM-TI
Miscarriage Management
Training Initiative
Training Outline:
Introduction to Products of Conception
This exercise is designed to increase staff’s comfort and confidence in talking about products of conception (POC). It is
highly interactive and provides many opportunities to model patient-centered language. It is important to create a safe
environment prior to starting the training and to acknowledge that there are often many teachable moments
throughout the exercise: i.e. opportunities to learn from each other. The facilitator should be very comfortable in
talking about products of conception and be willing to be supportive of a wide range of responses to the discussion of
POCs.
Goal
Objectives
Time: 30 – 45 minutes
Materials
To increase staff’s comfort and confidence in talking about products of conception.
At the end of the training, participants will be able to:
 Discuss knowledge of the wide range of feelings and responses when talking about
POC.
 Identify key aspects of patient-centered responses to Frequently
 Asked Questions about POC.
 Demonstrate comfort and confidence in responding to Frequently Asked Questions
(FAQs).
This exercise can be done as part of a longer training on responding to Frequently Asked
Questions about miscarriage or as a separate exercise focused on POC.
 Handout: Products of Conception
 Resource: A Guide to Fetal Development: The First Trimester, Center for Choice
(Toledo, Ohio) Fax a request to 419-259-2644 or call for order form at 419-225-7769.
www.centerforchoice.com
Trainer Tip
1) Research how POC are managed at your site. Be prepared to share protocols around
POC with staff.
2) Review the handout on POC including the FAQs. Clarify any questions you have
regarding how best to respond to the questions.
3) Consider having a copy of A Guide to Fetal Development: The First Trimester available
for staff. It contains written information about fetal development and pictures of
POCs up to 14 weeks gestation. Staff may have a wide range of reactions to the
resource including disgust, fascination or a more emotional response. Encourage staff
to talk about any feelings that they have and allow staff to participate at their own
comfort level. Be aware that staff that have personally experienced an early
pregnancy loss or elective abortion may have a more personal response. Practice
responding to questions using appropriate, patient-centered language
4) Although there is not one correct response to the FAQs, the goal is to see if there is a
way to enhance the response. Invite a variety of responses to the FAQ and ask
Miscarriage Management-Training Initiative
Johnson-May, VanDerhei, Wallace
Prep
participants to listen for the strength in each response. Staff can often start to hear
for him or herself the importance of responding in a thoughtful, clear and patientcentered way.
5) There is often nervous laughter during this exercise and most often, staff warm up to
it and do an excellent job in the role play. As the facilitator, your job is to support
staff in participating and provide positive feedback whenever possible.
Create a set of 3X5 cards with one question from the FAQ handout on each card.
You may want to adapt the questions from the handout based on your setting.
Time & Task
Trainer Notes
5 minutes
Community
Agreements
Setting community agreements prior to an exercise that involves participant’s taking a risk (in this
case, responding “in role” to a question asked by a patient) is important. You can brainstorm
community agreements, create a list, and post or remind the group of the community agreements
you use in your trainings.
5 minutes
Introduction
Key points to cover:
 It is important to not judge a patient’s questions about products of conception. You can
affirm the question by responses such as:
Many women have that question
It’s normal to have questions about your miscarriage
That’s a good question…
 It is important for you, as staff, to have a basic understanding of fetal development and
products of conception so that you can answer our patient’s questions and support them
through their experience.
 A Guide to Fetal Development: The First Trimester book is available to you to look at. I am
available to talk with you about any questions or concerns you have about managing POC or
talking with patients about POC.
 This FAQ exercise is designed to give us the opportunity to practice answering questions or
concerns that our patients may have about POC.
Miscarriage Management-Training Initiative
Johnson-May, VanDerhei, Wallace
 We all have our own personal and/or professional experience with early pregnancy loss and
miscarriage management. Our patients will also have their own personal thoughts, feelings,
and values about their pregnancy and the care they are receiving. It is important to be able
to have comfort and confidence in our ability to respond to patients questions in a neutral,
fact based, patient-centered, supportive and professional way.
 The questions were designed to help us think about the products of conception/tissue.
 Note: Staff are often very reluctant when they first begin this exercise and our job, as
trainers, is to create a safe space for staff to have the opportunity to practice responding to
common questions that patients have in a patient-centered, medically accurate, neutral
manner.
10 minutes
 Products of Conception lecture using the POC handout and site protocols for managing POC.
 Invite questions about how POC are managed at your site.
FAQs Instructions
Sample script:
2 minutes
We are going to use the Round Robin style of answering questions. This means that one person will
pick a question and asks it ‘in role’ to the person seated next to them. The person answers it ‘in role’
to the best of their ability. Most of the questions are written to model a patient asking the question
to a staff person.
As the facilitator, I will support the person in their role by coaching them on their response as
needed. I will also be asking the group to give feedback on the response and we will discuss possible
answers as well as the pros and cons of the answers.
FAQs
10 minutes
Modeling FAQs
 Invite a staff person to pick a FAQ from the stack of 3X5 cards with questions written on
them.
 Instruct the staff to read the card out loud and you (facilitator) model answering the
question. Discuss as appropriate.
 Round Robin FAQs - Continue the Q&A in Round Robin fashion, the person that responds to
the question, picks the next card and asks the question to the person seated next to them.
Note: A handout of suggested answers is available. Suggest that you not share the handout until all
staff has had a chance to participate in the FAQ. If there was a particularly challenging question, it
may be helpful for staff to read the response aloud. This gives all participants the chance to hear
patient- centered language.
Miscarriage Management-Training Initiative
Johnson-May, VanDerhei, Wallace
5 minutes
Process
Evaluations
Quickly go around the room with the following prompt:
I’m glad I participated in today’s training because….
Miscarriage Management-Training Initiative
Johnson-May, VanDerhei, Wallace