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In partnership with

project partners image Royal College of Midwives Royal College of Obstetricians and Gynaecologists

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Obstetricians and midwives, both those training and those who have completed their training are required to independently interpret cardiotocographs (CTGs) in the crucial lead up to birth.

eFM educates learners using assessment-driven, case-based learning. Interactive learning sessions will test knowledge of CTG interpretation and clinical management, and will provide feedback to the learner regarding their performance. This feedback is based on the collective responses of three experts.

eFM teaches and assesses by mirroring real-life cases and situations. Learners will evaluate, interpret and reflect on a variety of situations presented, with the aim of minimising errors in the labour ward. Learners will be able to see the results of their actions including any life threatening harm to a baby and the subsequent litigation consequences for the doctor or midwife.

Midwives and obstetricians, both those in training and those who have completed their training, will be able to assess themselves regularly and apply their knowledge in the same way they do in real-life situations. The Royal College of Obstetricians and Gynaecologists (RCOG) will add 60 cases every five years in order to reflect the continuing professional development cycle. Evidence of achievement can be used for recertification of healthcare professionals by the RCOG, the RCM and the Nursing and Midwifery Council (NMC).

eFM currently has 24 case studies (2011 and 2013) for reference purposes only now, with 12 new ones (2015) developed in accordance with the 2014 NICE guidelines. Three or more expert opinions have populated the clinical cases with their answers. Answers can now be collated and scored to give a final % score, to allow for CPD points. Users are allowed as many attempts as they like to improve their score.


Course Information 

Course 1 - Background and Practical Issues

Course 1

Background and Practical Issues

This course has three sessions covering:

  • History of fetal heart rate (FHR) monitoring, the importance of intrapartum (IP) fetal hypoxia and using the FHR as a screen for IP fetal hypoxia

  • Indications for continuous electronic FHR monitoring (EFM) in labour (risk for fetal hypoxia) and the role of admissions test

  • A review of the evidence of the value of EFM in terms of maternal, fetal and neonatal outcomes

Course 2 - Care in Normal Labour

Course 2

Care in Normal Labour

This course has two sessions covering:

  • Care of women

  • Appropriate fetal monitoring in women at low risk for IP fetal hypoxia

Course 3 - Normal and Non-normal CTGs

Course 3

Normal and Non-normal CTGs

This course has six sessions covering:

  • The normal CTG (control, terminology, definitons; basic interpretation)

  • The impact of IP fetal hypoxia on the FHR (split into two sessions)

  • More complicated FHR traces (e.g. sinusoidal)

  • Interpretation in special circumstances (e.g. breech, preterm, multiple pregnancy) (split into two sessions)

Course 4 - Management Issues

Course 4

Management Issues

This course has four sessions covering:

  • Labour interventions that can affect the FHR (e.g. oxytocics, medication, regional analgesia)

  • Interventions intended to improve the FHR (e.g. maternal postions, oxygen, reducing uterine contractions)

  • Additonal tests that help clarify fetal status (e.g. fetal pH, fetal ECG)

  • NICE Guidelines

Course 5 - Education and Governance

Course 5

Education and Governance

This course has two sessions covering:

  • Educational methods for improving EFM interpretation and management

  • Risk management issues including governance and audit



This course includes 4 assessments designed to test learners' knowledge following completion of the sessions within each of the knowledge-based courses.

Case Studies

Case Studies

  • Case Studies 2011 - For reference purposes only

  • Case Studies 2013 - For reference purposes only

  • Case Studies 2015 - Released in accordance with the latest NICE guidelines

  • Case Studies 2016 - To be released early 2017

  • Case Studies 2017 - To be released mid/late 2017



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