Effectiveness of Simulation in a Midwifery Curriculum in India

Sunday, 28 July 2019: 12:00 AM

Jennifer Shearer, PhD, RN, CNE
College of Nursing, Medical University of South Carolina (at time of research, now retired), Charleston, SC, USA
Leena Raj, MSc, MPhil, RN
Nursing Institute, Nursing Institute and School of Nursing and Midwifery, Bangalore Baptist Hospital, Bangalore, India, Bengaluru, Karnataka, India

Purpose: The purpose of this study was to evaluate the learning outcomes of midwifery students using medium fidelity simulation instruction to determine if technology contributes value to didactic methods in a country, such as India where neonatal deaths are often related to midwife assisted home deliveries. The integration of simulation in midwifery education has been recommended as part of the standardized curriculum for midwives throughout the world by the World Health Organization. Current evidence shows that simulated education has been found useful for teaching midwifery skills. By examining skill performance as an outcome, this study contributes to the evidence of simulation in nursing education and provides justification for the cost of simulation in resource poor countries.

Methods: The research design was an evaluative, comparative two group pretest-post test design with randomization of 28 third year baccalaureate nursing students to clinical simulation experience (intervention) or traditional instruction (control). Safe practice and essential skills critical to a vaginal delivery were measured using the course level checklist as a pretest and post test in the beginning of the clinical semester and at the end of the semester. Assessment scores for confidence were recorded by the clinical facilitator. Skills were measured using the rated checklist titled, “Evaluation of Student Performance in Midwifery.” Observed abilities were scored 1 if behavior was present and 0 if absent. Total possible score was 10. Paired t-tests were used to show differences in pre and post scores for the class.

Results: On post test 57% of experimental group displayed moderate knowledge and 43% displayed adequate knowledge. Of the control group, 29% displayed moderate knowledge and none displayed adequate knowledge. Mean knowledge scores and confidence as well as recognizing labor mechanisms and performing skillful conduction of labor were significantly different between the two groups.

Conclusion: This study evaluated the effect of simulation on skills in an instructional check-off of a normal delivery in an educational setting in India. Rather than measure student perceptions of confidence and satisfaction with simulation, the clinical evaluation tool was used as an outcome measure to reflect impact of simulation on learning and skill performance.