The effects of simulated patients and simulated gynecologic models on student anxiety in providing IUD services

Effectiveness of Simulation with a Standardized Patient on Knowledge Acquisition, Knowledge Retention, and Self-Efficacy Among Moroccan Nursing Students: A Quasi-Experimental Study

Background: Simulation is a crucial component in the training of healthcare professionals, offering a safe environment for practical learning without posing risks to patients. Aim: This study aims to evaluate the effect of simulation with a standardized patient on the acquisition and retention of knowledge, as well as on the self-efficacy of nursing students. Methods: A quasi-experimental study with a pre-test and post-test design was conducted with 120 nursing students, who were randomly assigned to two groups. The experimental group (60) received training through simulation with a standardized patient, supplemented by a lecture-based course. The control group (60) received only the same lecture-based course. A pre-test was conducted to assess students' baseline knowledge and self-efficacy before any intervention. Student performance was then assessed with a post-test immediately after the training to measure knowledge acquisition and self-efficacy and a post-test three months after the intervention to measure long-term knowledge retention. Results: The results showed a statistically significant difference in mean scores between the intervention and control groups in terms of knowledge acquisition (14.92 vs. 13.32; p < 0.001; d = 0.99), self-efficacy (33.02 vs. 31.05; p < 0.001; d = 1.03) and knowledge retention three months after training (12.4 vs. 10.6; p < 0.001; d = 0.94). Conclusions: The results of this study confirmed the effectiveness of simulation in knowledge acquisition and retention, as well as in the self-efficacy of nursing students. These findings support the integration of this method into training programs to strengthen the skills of future healthcare professionals.

Feelings and thoughts of midwifery students during their first birth suite placement: A qualitative study

This descriptive qualitative study aimed to understand the feelings and thoughts experienced by 4th year midwifery students during the first birth they attended during clinical practice. Focus group interviews were conducted with 22 final year midwifery students in Istanbul, Türkiye December 2020. The transcribed data were analyzed by the descriptive qualitative analysis method. The students experienced not only negative feelings such as fear, torment, anxiety but also positive feelings such as hope, excitement, and curiosity during the first birth practice. The situations that caused negative feelings and thoughts were not only the feelings of the students but also the conditions that negatively affected the care provided to the patient in the clinic. The clinical practice environment affects the feelings and thoughts of midwifery students about the birth process. For this reason, improving the clinical practice environment and supporting students throughout the education process may contribute to the development of positive feelings and thoughts when attending as a student for their first birth suite placement.

Gender Differences in Anxiety, Attitudes, and Fear among Nursing Undergraduates Coping with CPR Training with PPE Kit for COVID

BACKGROUND

The aim of this study was to examine the attitudes, fears, and anxiety level of nursing students faced with a critical clinical simulation (cardiopulmonary reanimation) with and without personal protective equipment (PPE).

METHODS

A pilot before-after study as conducted from 21 to 25 June 2021, with 24 students registered in the nursing degree of the Faculty of Health Sciences of the Castilla-La Mancha University (UCLM) in the city of Talavera de la Reina (Toledo, Spain). From 520 possible participants, only 24 were selected according to the exclusion and inclusion criteria. The STAI Manual for the State-Trait Anxiety Inventory, a self-evaluation questionnaire, was used to study trait STAI (basal anxiety), trait STAI before CPR, state STAI after CPR, total STAI before CPR, and total STAI after CPR as the main variables. A t-test was used to study the STAI variables according to sex and the physiological values related to the anxiety level of participants. An ANOVA statistical test was used to perform a data analysis of the STAI variables.

RESULTS

A total of 54.2% of participants (IC 95% 35.1-72.1) suffered from global anxiety before the cardiopulmonary reanimation maneuvers (CPR). The results of the STAI before CPR maneuvers showed significant differences according to gender in state anxiety (p = 0.04), with a higher level of anxiety in women (22.38 ± 7.69 vs. 15.82 ± 7.18).

CONCLUSIONS

This study demonstrates different levels of anxiety in terms of gender suffered by nursing students in high-pressure environments, such as a CPR situation.

Efficacy of simulated video on test anxiety in objective structured clinical examination among nursing and midwifery students: A quasi-experimental study

AIM

This research investigated the effectiveness of simulated video on test anxiety in the Objective Structured Clinical Examination (OSCE) among nursing and midwifery students.

DESIGN

A quasi-experimental study with a two-group pre-test and post-test design.

METHODS

This study was conducted on 118 nursing and midwifery students in Shahroud northeast of Iran in 2019 using the census sampling method. The intervention group received a 15-minute OSCE simulation video half an hour before the test. Data were collected using the Sarason test anxiety questionnaire in two stages: one week before the test and after the simulation film was screened. Data were analysed using descriptive and inferential statistics (Independent t-test, Chi-square, Exact fisher and Paired t-test).

RESULTS

At baseline, no significant difference was observed between groups in the total mean score of test anxiety. The mean score of test anxiety significantly decreased in the OSCE simulation video group after the intervention.

Improving Medical Student Comfort and Competence in Performing Gynecological Exams: A Systematic Review

PURPOSE

Performing a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams.

METHOD

The authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments.

RESULTS

The search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams.

CONCLUSIONS

The literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.

Effect of Psychophysiological Stress and Socio-Emotional Competencies on the Clinical Performance of Nursing Students during a Simulation Practice

Psychophysiological stress can affect the cognitive response and effective learning of students during medical simulation practices. This study aimed to explore the effect of psychophysiological stress and socio-emotional competencies on clinical performance during a simulation experience. A pre-test/post-test design was used to assess physiological (blood pressure, heart rate and blood oxygen saturation) and psychological parameters (stress and anxiety) as well as socio-emotional skills (cognitive load, self-efficacy and motivation) in nursing students (n = 40) before and after the simulation of a cardiopulmonary resuscitation practice. Physiological responses showed statistically significant differences between pre-test and post-test conditions for blood pressure and heart rate (p < 0.0001). Moderate and significant correlations were also observed when comparing self-efficacy with stress (r = −0.445, p = 0.004), anxiety (r = −0.467, p = 0.002) and motivation (r = −0.406, p = 0.009) measures. Similarly, cognitive-load dimensions were significantly associated with either physiological (r = −0.335, p = 0.034) or psychological (r = −0.448, p = 0.004) indicators. The analysis of multiple regression models revealed a relationship between the effectiveness of the simulated experience, post-test blood oxygen saturation, heart rate, workload and self-efficacy (R² = 0.490; F (3, 39) = 8.305; p < 0.0001; d = 1.663). Therefore, the evaluation of psychophysiological parameters and socio-emotional skills seems to provide a promising framework for predicting the quality of simulated clinical practices.

Job role and stress influence student movement during postpartum haemorrhage simulation: an exploratory study

Introduction

Postpartum haemorrhage is the leading cause of maternal death. Healthcare simulations are an educational tool to prepare students for infrequent high-risk emergencies without risking patient safety. Efficiency of movement in the simulation environment is important to minimize the risk of medical error. The purpose of this study was to quantify the movement behaviours of the participants in the simulation and evaluate the relationship between perceived stress and movement.

Methods

N=30 students participated in 10 high-fidelity medical simulations using an adult patient simulator experiencing a postpartum haemorrhage. The participants completed the State-Trait Anxiety Inventory prior to the simulation to measure perceived stress. Physical movement behaviours included walking around the simulation, time spent at bedside, arm movements, movements without purpose, looking at charts/vitals and total movement.

Results

Midwife (MW) students spent significantly more time walking (p=0.004) and looking at charts/vitals (p=<0.001) and significantly less time at bedside (p=<0.001) compared to obstetric (OB) students. The MW students demonstrated significantly more total movements compared to the OB students (p=<0.001). There was a significant, moderate, positive relationship between perceived stress and total movement during the simulation for the MW group (r=0.50, p=0.05). There was a trend for a moderate, positive relationship between perceived stress and total movement during the simulation for the OB group (r=0.46, p=0.10).

Conclusions

Physical movement during a simulation varies by job role and is influenced by perceived stress. Improved understanding of physical movement in the simulation environment can improve feedback, training and environmental set-up.

Hybrid simulation of pediatric gynecologic examination: a mix-methods study of learners' attitudes and factors affecting learning

BACKGROUND

Children and adolescents with reproductive health issues may require immediate or emergency care, however in many countries availability of the pediatric and adolescent gynecology (PAG) service is low. That being said, teaching PAG examination to OBGYN, pediatrics and emergency medicine residents seems reasonable, and cannot be underestimated. In order to provide residents with opportunity to learn PAG examination, a high-fidelity hybrid simulation workshop was implemented in our institution.

METHODS

The study aimed to investigate learners' attitudes towards the high-fidelity simulation (HFS) hybrid model as compared with task trainer-SP (simulated patient)-voice model in the HFS environment and the factors connected to learners' attitudes towards the hybrid model that could influence learning in high-fidelity simulation (HFS). The concept of attitude was used as the theoretical framework and the mixed method approach to study design was utilized with simultaneous collection of quantitative (original questionnaires) and qualitative data (semi-structured interviews).

RESULTS

Residents valued the HFS hybrid model higher over task trainer-SP-voice model in regards to all three attitude components: cognitive (95%), affective (87.5%) and behavioral (83.7%). Analysis of qualitative data revealed six themes important to learners and informing learning of PAG examination in HFS. Further analysis of the themes allowed to develop a conceptual model, in which six factors connected to attitude components influenced learning. These factors were: task difficulty, attention, emotional realism of the simulation, patient's emotions, physical realism of the simulation, and technical issues.

CONCLUSIONS

Participants of our study appreciated learning experience with the HFS hybrid model more, based on attitude questionnaire. Moreover, findings revealed that multiple, various factors connected to attitude may influence learning of PAG examination in HFS with hybrid model, and we propose a conceptual model illustrating relationships between those factors.

Clinical simulation in teaching Pediatric Nursing: students' perception

OBJECTIVES

to comprehend the perception of undergraduate nursing students about learning to care for the child and family through clinical simulation.

METHODS

this is a qualitative research conducted with ten nursing students through semi-structured interviews. Data were analyzed through content analysis.

RESULTS

data were organized into two categories: "learning a new way to learn," in which students describe their experiences during the simulation, and "learning a new way to care," in which they reflect on learning through simulation.

FINAL CONSIDERATIONS

we believe that clinical simulation practice in teaching should be encouraged because of the benefits it can offer to the students, faculty, patients and their families. However, we recommend further studies to validate scenarios of child and family healthcare.

Intrauterine Device Training Workshop for Preclinical Medical Students

INTRODUCTION

Medical school reproductive health curricula often lack adequate education regarding intrauterine devices (IUDs). When placed in clinical scenarios, students may have insufficient knowledge and training to counsel patients about IUDs.

METHODS

We developed a workshop for preclinical medical students and assessed whether it improved knowledge of and comfort with counseling patients on IUDs. The workshop consisted of a 45-minute lecture and a 45-minute IUD simulation training. Each session was taught to groups of 40 to 50 students. The workshop was evaluated between January 2016 and November 2017. Participants completed pre- and postsurveys. The primary outcome was comfort level with IUD counseling.

RESULTS

One hundred forty-two students completed the workshop, and 137 completed both pre- and postsurveys (96% response rate). At baseline, more than half (56%, n = 77) had not seen an IUD inserted. Students scoring 75% or higher on the IUD knowledge questions increased from 51% (n = 70) on presurveys to 87% (n = 119) on postsurveys (p < .0001). Students agreeing or strongly agreeing that they felt comfortable counseling patients on IUDs increased from 27% (n = 37) to 92% (n = 122, p < .0001) on postsurveys. All students felt the workshop was worthwhile.

DISCUSSION

Preclinical students showed increased knowledge of and comfort with IUDs after a simple IUD simulation. Medical schools could utilize this workshop to ensure students have hands-on training and experience related to IUDs prior to clinical rotations and for their future careers.

Reinvigorating postpartum intrauterine contraceptive device use in Pakistan: an observational assessment of competency-based training of health providers using low-cost simulation models

BACKGROUND

Improved training approaches have the potential to overcome barriers to the use of postpartum intrauterine devices (PPIUDs) in Pakistan, including a shortage of female providers who are able to insert the device. This study assessed the effectiveness and acceptability of a competency-based onsite training approach that employed a newly developed anatomic model (the Mama-U) to train doctors and midwives on postpartum family planning (PPFP) and the insertion of PPIUDs.

METHODS

An observational, mixed methods study conducted training evaluations and knowledge and skills assessments with 11 trainers and 88 doctors and midwives who participated in eight PPIUD training sessions. Two months later, follow-up interviews and clinical assessments were conducted with 20 providers, and interviews and a focus group discussion were conducted with 85 married women who received a PPIUD from a trained provider.

RESULTS

The training significantly improved provider knowledge (p < 0.001), and follow-up assessments showed that clinical skills were retained for at least two months post-training. After training, 81.8% of providers were confident in their ability to provide PPIUD services, and midwives and doctors had similar PPIUD insertion skills. However, midwives were more likely than doctors to meet all 10 key requirements during PPIUD counseling sessions (63.9% versus 13.3%, p = 0.004). Providers found the Mama-U model to be a useful tool for client counseling as well as training and skills practice, and clients agreed. Trainers identified the low cost, light weight, and portability of the Mama-U model as advantages over the conventional training model and noted that its abstract shape reduced embarrassment among trainers, providers, and clients.

CONCLUSIONS

Competency-based training with the Mama-U model can improve the quality of PPIUD counseling and PPIUD insertion services and has the potential to extend PPFP/PPIUD service delivery to midwives working in rural Pakistan. The portable, low-cost Mama-U permits onsite, on-the-job PPIUD insertion training that is tailored to the local setting; it is also well suited for the continuing practice that providers need to maintain their skills. Further research is needed to confirm the usefulness and cost-effectiveness of the Mama-U at scale and in other settings.

Evaluation of the effectiveness of four different training techniques in the development of non-stress testing application skills: A randomised controlled trial

BACKGROUND

A range of teaching methods are employed to upgrade students' skills, lower anxiety levels and improve satisfaction in nursing and midwifery education.

AIM

This study was conducted to evaluate the effect of different training techniques on the development of students' non-stress test (NST) application skills, satisfaction with education and reduction of their anxiety levels.

METHOD

The study was designed as a single-blind randomised controlled trial and carried out in four groups (n = 82), namely, video demonstration (VD), simulation with birth model (SBM), hybrid simulation (HS) and control (CG). A student information form, the NST skills evaluation form and the Spielberger State Anxiety Inventory were used to collect the study data.

RESULTS

Satisfaction with education was higher in the HS and SBM groups compared to the CG and VD groups (p < 0.001). No differences were found between the groups in terms of students' anxiety levels (p > 0.05). While there were no differences between the groups in the preparation phase in terms of NST skill scores (p > 0.05), the differences between the groups in the application and evaluation stages of the procedure were significant (p < 0.001). The highest score regarding the total score medians of NST skills belonged to the HS group, and the differences between the groups were found to be statistically significant (p < 0.001).

CONCLUSION

The findings of this study indicated that simulation techniques enhanced the students' clinical practice skills and satisfaction with their education.

Intrauterine contraceptive device insertion simulation training in primary care

Background and objectives:

Insertion of a intrauterine contraceptive device (IUCD) is one of the services provided at our public primary care polyclinics. We evaluate the effectiveness of a simulation workshop using low-fidelity mannequins to train primary care doctors.

Methods:

Questionnaire feedback was collected before and after the workshop. Participants rated their confidence level in performing the insertion of IUCDs using a 10-point scale.

Results:

A total of 37 out of 44 (84%) participants completed the survey. The median score for confidence level in performing the procedure increased from 2 out of 10 (interquartile range (IQR) 1 to 5) before the workshop to 8 out of 10 (IQR 7 to 9) after the workshop ( p < 0.01). The increase in confidence level was most pronounced among the participants with no previous experience with the procedure and those who had inserted only one or two IUCDs before the workshop. Participants rated a median score of 9 out of 10 (IQR 8 to 10) in their interest level to perform the procedure after the workshop. The overall experience of the workshop recorded a median score of 5 out of 5 using a five-point Likert scale.

Conclusions:

Bedside procedural training has been challenging. The teaching of the procedure via a structured workshop format including a simulation of the procedure using a low-fidelity mannequin increases the confidence level of participants to perform the procedure. A similar format can be employed for training of other primary care procedural skills.

The Modification of Vital Signs According to Nursing Students' Experiences Undergoing Cardiopulmonary Resuscitation Training via High-Fidelity Simulation: Quasi-Experimental Study

Background

High-fidelity simulation represents a primary tool in nursing education, especially when hands-on practical training is involved.

Objective

We sought to determine the influence of high-fidelity clinical simulation, applied during cardiopulmonary resuscitation (CPR) training, on blood pressure, heart rate, stress, and anxiety levels in 2 groups of nursing students. One group had experience in health contexts, whereas the other group had none.

Methods

We performed a quasi-experimental study. Data were collected between May and June 2015 and included measurements of all the resting values, before and after participation in CPR clinical simulations regarding the 2 groups of university students (ie, with and without experience).

Results

An increase in vital signs was observed in students after participating in a clinical simulation scenario, especially the heart rate. In all students, increased stress and anxiety levels were observed before the first simulation case scenario. Also, in all study groups, a decrease in vital signs, stress levels, and anxiety was observed throughout the study.

Conclusions

Participation in high-fidelity simulation experiences has both physiological and psychological effects on students.

An Innovative Approach: Using Simulation to Teach Primary Care Gynecologic Procedures

INTRODUCTION

In response to the growing body of evidence that simulation is a satisfactory way to instruct procedural skills, we developed an innovative model to teach common gynecologic procedures such as cervical cancer screening, cervical polyp removal, intrauterine device removal, and endometrial biopsy. The objectives of this study were to describe the construction of the model and to assess participants' satisfaction and confidence in applying the learning objectives to their clinical practice.

METHODS

The researchers created the model with reusable and readily available materials. During a hands-on skills workshop, practicing clinicians performed simulated cervical cancer screening, endocervical polyp removal, intrauterine device removal, and an endometrial biopsy on a low-fidelity gynecologic model. Using convenience sampling, each participant completed a survey designed to measure satisfaction with the workshop and self-confidence in their newly acquired skills.

RESULTS

All (N = 30,100%) of the participants agreed at the "agree" or "strongly agree" level that the gynecologic skills workshop using lecture and a hands-on model was a satisfying and self-confidence-building experience.

CONCLUSIONS

An easily reproducible and reusable gynecologic procedure simulator was highly rated as a means of teaching common primary care gynecologic procedures. The simulated model provided an opportunity for hands-on skills learning for clinicians who wish to expand their gynecologic procedure skill set.

Structured integration of family planning curriculum: comparative assessment of knowledge and skills among new medical graduates in Ethiopia

OBJECTIVE

The objective was to assess if structured integration of a comprehensive family planning (FP) training into a medical school curriculum improves FP knowledge and skill scores of medical interns.

STUDY DESIGN

We compared mean contraception knowledge scores of interns in a medical school with the integrated FP curriculum [intervention school] (n=56) to interns at four conventional medical curriculum schools without structured reinforcement of FP content [control schools] (n=161) in Ethiopia. A survey with 19 multiple choice contraception questions was administered. We also compared the mean contraception skills scores of the two groups at four Objective Structured Clinical Examination stations. The survey included self-reported number of contraception procedures and self-assessed competencies on a Likert scale.

RESULTS

A total of 217 interns who have completed an Obstetrics and Gynecology rotation participated in the study. Interns from the intervention school reported performing substantially higher numbers of contraception procedures and rated themselves as being competent/highly competent across all procedures compared to the control schools (p<.001 for both). The mean knowledge score was significantly higher in the intervention school [13.1 vs. 8.7, difference 4.5, 95% CI: (3.7-5.2), p<.001]. The mean contraceptive implant insertion skill score was twofold higher for interns in the intervention school [22 points vs. 11, difference 10.7, 95% CI: (8.6-12.8), p<.001 out of a maximum possible point of 30]. Statistically significant differences in skill scores were also observed for intrauterine device IUD insertion [15 vs. 12, p<.01] and implant removal [11 vs. 9, p=.01].

CONCLUSION

A structured integration of family planning curriculum was associated with higher scores in knowledge, clinical skills and self-assessed competencies.

IMPLICATIONS

Integrating comprehensive family planning training in medical curriculum can lead to graduating physicians who are more competent to offer the full range of FP options.

Randomized trial of high- and low-fidelity simulation to teach intrauterine contraception placement

BACKGROUND

High-fidelity simulation creates conditions that resemble real circumstances, and can help teach procedures such as intrauterine contraception placement. Its impact on skill retention has not been studied.

OBJECTIVE

We sought to evaluate novice learners' skills, attitudes, and knowledge on placement of intrauterine contraception when trained using a high-fidelity commercially available simulator compared with a low-fidelity simulator.

STUDY DESIGN

We recruited senior nurse practitioner students and interns in obstetrics and gynecology and family medicine inexperienced with intrauterine contraception placement. In this unblinded, randomized controlled trial, participants were assigned to practice within a high-fidelity simulator group or a coasterlike model group. We evaluated intrauterine contraception placement skills, self-perceived comfort and competence, and knowledge before and after simulation, as well as at 3 months. Our primary outcome was the change in scores for intrauterine contraception placement skills before and after practice. Assuming a standard deviation of 15 points, we needed 10 participants per group to detect a 20-point difference in scores with 80% power.

RESULTS

From June through July 2014, 60 participants enrolled; 59 completed the initial study visit and 1 withdrew. In all, 48 (80%) completed the second study visit at 3 months. Demographic characteristics were similar for the randomization groups. We observed an improvement in intrauterine contraception placement skills for both groups following practice on simulators (P < .01); the proportion that improved was similar (20% for the high-fidelity simulator group and 15% for the coaster group, P = .55). Increases in self-perceived comfort and competence with placing copper, levonorgestrel 52-mg, and levonorgestrel 13.5-mg devices were similar (all P ≥ .11). Knowledge assessment scores were comparable between the 2 groups postsimulation (73% for the high-fidelity simulator group and 80% for the coaster group, P = .29) and at 3 months (87% for both groups, P = 1.0).

CONCLUSION

Trainees' knowledge, intrauterine contraception placement skills, and self-perceived comfort and competence were comparable whether they used high- or low-fidelity simulators.

Fear, an unpleasant experience among undergraduate midwifery students: A qualitative study

Fear is a normal emotion that can evoke an appropriate response when facing threat. However, sometimes the consequences of fear can lead to responses that are maladaptive. Fear can have negative effects on learning. Research has focused on the experience of fear and its consequences among midwifery students during their undergraduate program. A qualitative analysis was conducted of interviews with ten midwifery students in different years of an undergraduate program. The data was analyzed through a content analysis approach. Two main categories and five subcategories emerged. The first category, areas of fear in midwifery students, consisted of the following subcategories: fear of doing harm, fear of encountering their first childbirth, and fear of penalties. The second category, consequences of fear, consisted of the following subcategories: general physical and psychological consequences and interference in adopting the professional role. In this study, fear not only raised the students' stress levels thereby, leading to physical and psychological issues but also hindered their adoption of their professional role. These findings will potentially inform support and retention strategies within midwifery undergraduate programs in the future.

BACKGROUND

Maternity care in Iran is provided mainly within a medical model of care. The majority of women give birth in hospital, where care is provided by midwives who work under the direction and supervision of an obstetrician. Midwives within the medically dominated system lack autonomy and have very little opportunity to gain experience in providing continuity of care for women as midwife-led models of care are rare. This practice context means that midwifery students have very little opportunity to gain experience in autonomous midwifery practice. Midwifery undergraduate program in Iran is for four years. Admission to the undergraduate program is implemented via a direct entry route. Nearly all of the midwifery students are school leavers with their first exposure to university and hospital systems. Most of the midwifery students have chosen this career without sufficient understanding about midwifery and the work that it involves (Arfaee et al., 2008). The midwifery undergraduate program comprises theoretical and clinical elements. After the first semester, students enter clinical settings under the supervision of their clinical instructors.

Simulation training for family planning procedures

PURPOSE OF REVIEW

To review the current evidence for use of simulation in family planning procedural training.

RECENT FINDINGS

A variety of simulation models exist for abortion, contraception, and sterilization procedures, ranging from low to high fidelity. Most models for abortion and contraception are low fidelity, inexpensive, and provide opportunities for acquisition and practice of procedural skills. Hysteroscopic and laparoscopic simulation models for sterilization procedures are generally higher fidelity, and their use has been shown to increase knowledge, skill performance, and procedural comfort.

SUMMARY

Existing evaluation of family planning simulation education shows consistently positive results related to improved procedural knowledge and comfort. Although some studies have shown increased provision of family planning services following simulation-training interventions, further evaluation is needed to determine the impact on clinical outcomes.

Clinical simulation with dramatization: gains perceived by students and health professionals

Objective:

to identify in the literature the gains health students and professionals perceive when using clinical simulation with dramatization resources.

Method:

integrative literature review, using the method proposed by the Joanna Briggs Institute (JBI). A search was undertaken in the following databases: Latin American and Caribbean Health Sciences Literature, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, Scientific Electronic Library Online.

Results:

53 studies were analyzed, which complied with the established inclusion criteria. Among the different gains obtained, satisfaction, self-confidence, knowledge, empathy, realism, reduced level of anxiety, comfort, communication, motivation, capacity for reflection and critical thinking and teamwork stand out.

Conclusion:

the evidence demonstrates the great possibilities to use dramatization in the context of clinical simulation, with gains in the different health areas, as well as interprofessional gains.

Development and evaluation of a clinical simulation for new graduate nurses: A multi-site pilot study

BACKGROUND

New nursing graduates have revealed that they perceive a gap between theory and practice with reference to their education and the real workplace setting. Additionally, many nurses experience a reality shock when they participate in clinical practice.

PURPOSE

The purpose of this study was to develop and test the effects of a scenario-based simulation training program on new graduate nurses' competency, critical thinking dispositions, and interpersonal communication skills.

METHOD

This pilot multi-site study used a pretest-posttest control group design. It was conducted at four sites of a university-affiliated simulation center in Korea. Participants were recruited utilizing a convenience sample from four tertiary hospitals in Korea. Twenty-four new graduate nurses participated in this study.

RESULTS

At the three-month follow-up, the levels of communication skills used in practice among the intervention group were statistically significantly higher than those of the control group participants (U=151.50, p=.005). However, there were no significant differences between the groups in changes in nursing competency (U=287.50, p=.992) or critical thinking disposition scores (U=269.50, p=.702). The participants' mean rating scores concerning the objectives, intentions, and recommendations for other nurses were positive and high.

CONCLUSION

The involvement of current practicing of nursing in certain scenarios and the implementation of simulation learning could enhance the readiness of new graduate nurses.

Medical student simulation training in intrauterine contraception insertion and removal: an intervention to improve comfort, skill, and attitudes

Background

Opportunities for medical students to place intrauterine contraception (IUC) in patients are rare. Our objective was to determine whether participation in an IUC insertion and removal simulation exercise would increase medical students’ comfort level with, attitudes towards, and willingness to recommend IUC.

Methods

A prospective cohort study was undertaken in all students completing the obstetrics and gynecology clerkship at a major academic hospital during the 2010–2011 academic year. The exposure consisted of a 45-minute interactive didactic session and a 30-minute, hands-on practicum in IUC placement and removal using medical instruments and realistic pelvic models. Both levonorgestrel and Cu380A IUC devices were utilized. Participants completed a pre- and post-simulation survey instrument, designed to examine students’ IUC-specific knowledge, comfort, and attitudes. Pre- and post-simulation responses were compared by McNemar’s test for paired samples.

Results

Thirty-five paired pre- and post-simulation surveys were analyzed, representing a 78 % response rate. Composite IUC-related knowledge scores increased by a median of 3 out of 10 points after the intervention (p < 0.01). Students were significantly more comfortable counseling patients about IUC as well as inserting IUC after the intervention, compared to before. Seven (20 %) students before, compared to 27 (77 %) after, agreed with the statement, “I feel comfortable placing an IUC in a patient under the supervision of an experienced doctor” (p < 0.01). Students developed significantly more favorable attitudes towards IUC through the intervention. Nineteen (54 %) participants before, compared to 27 (77 %) after, agreed with the statement, “I would recommend an IUC to my family member” (p = 0.02).

Conclusions

A hands-on simulation during the obstetrics and gynecology clerkship increased medical students’ knowledge of and comfort with IUC and resulted in more favorable attitudes toward the method. Intrauterine contraception simulation in medical curricula may help expand utilization of this effective contraceptive method.

Assessment of a high-fidelity mobile simulator for intrauterine contraception training in ambulatory reproductive health centres

Objectives. Little is known about the utility of simulation-based training in office gynaecology. The objective of this cross-sectional study was to evaluate the self-reported effectiveness and acceptability of the PelvicSim™ (VirtaMed), a high-fidelity mobile simulator, to train clinicians in intrauterine device (IUD) insertion. Methods. Clinicians at ambulatory healthcare centres participated in a PelvicSim IUD training programme and completed a self-administered survey. The survey assessed prior experience with IUD insertion, pre- and post-training competency and comfort and opinions regarding the acceptability of the PelvicSim. Results. The 237 participants were primarily female (97.5%) nurse practitioners (71.3%). Most had experience inserting the levonorgestrel LNG20 IUD and the copper T380A device, but only 4.1% had ever inserted the LNG14 IUD. For all three devices, participants felt more competent following training, with the most striking change reported for insertion of the LNG14 IUD. The majority of participants reported increased comfort with uterine sounding (57.7%), IUD insertion on a live patient (69.8%), and minimizing patient pain (72.8%) following training. Of the respondents, 89.6% reported the PelvicSim IUD insertion activities as “valuable” or “very valuable.” All participants would recommend the PelvicSim for IUD training, and nearly all (97.2%) reported that the PelvicSim was a better method to teach IUD insertion than the simple plastic models supplied by IUD manufacturers. Conclusions. These findings support the use of the PelvicSim for IUD training, though whether it is superior to traditional methods and improves patient outcomes requires evaluation.

Effectiveness of patient simulation in nursing education: meta-analysis

BACKGROUND

The use of simulation as an educational tool is becoming increasingly prevalent in nursing education, and a variety of simulators are utilized. Based on the results of these studies, nursing facilitators must find ways to promote effective learning among students in clinical practice and classrooms.

OBJECTIVE

To identify the best available evidence about the effects of patient simulation in nursing education through a meta-analysis.

METHODS

This study explores quantitative evidence published in the electronic databases: EBSCO, Medline, ScienceDirect, and ERIC. Using a search strategy, we identified 2503 potentially relevant articles. Twenty studies were included in the final analysis.

RESULTS

We found significant post-intervention improvements in various domains for participants who received simulation education compared to the control groups, with a pooled random-effects standardized mean difference of 0.71, which is a medium-to-large effect size. In the subgroup analysis, we found that simulation education in nursing had benefits, in terms of effect sizes, when the effects were evaluated through performance, the evaluation outcome was psychomotor skills, the subject of learning was clinical, learners were clinical nurses and senior undergraduate nursing students, and simulators were high fidelity.

CONCLUSIONS

These results indicate that simulation education demonstrated medium to large effect sizes and could guide nurse educators with regard to the conditions under which patient simulation is more effective than traditional learning methods.