Susannah Brady

Simulation based learning in Australian midwifery curricula: results of a national electronic survey.

OBJECTIVE The primary aim of this paper is to describe the extent, nature and types of simulation used as a learning method in contemporary Australian midwifery curricula. METHOD An electronic survey was developed using Graduate e-Cohort Pro and administered to key midwifery academics who had responsibility for 38 curricula leading to initial midwifery registration in Australia. FINDINGS Engagement of midwifery academics in the survey was high with a response rate of 82%. There is a range of midwifery programs by type and level of award across Australia that vary in duration, enrolments, and by component theoretical and clinical hours. The proportion of simulation hours in curricula varied across programs accounting for up to 17% of clinical program hours. However simulation was used extensively to teach all identified generic technical skills (n=16) midwifery technical skills (n=51) and generic non-technical skills (n=6). Most commonly used simulation types were scenarios, peer-to-peer learning, partial task trainers and standardised patients. Simulation types were suited to the learning tasks. CONCLUSION Simulation is used extensively in midwifery education in Australia. Further research is required to understand the curriculum development imperatives of simulation and there is a need to adequately resource and support staff in the use of simulation to provide high quality simulation learning experiences for students.

Team decision making: design, implementation and evaluation of an interprofessional education activity for undergraduate health science students.

Abstract An undergraduate health science student curriculum activity in interprofessional education (IPE) focused on team decision making was piloted. The IPE activity included a lecture, small group learning activity and an onsite observation of an interprofessional health care team (IPHCT) meeting. Measures included the Readiness for Interprofessional Learning scale, Interdisciplinary Education Perception scale and the Role Perception Questionnaires. The students completed a workbook to assess decision making capacity in IPHCTs. The results indicated that students (n = 61) were willing to share their knowledge and skills as a way of understanding clinical problems in the workplace and had professionally oriented perceptions and related affective domains. They also showed a positive role perception of their own role and that of other professions. Analysis of the workbooks revealed that students were able to identify positive and negative impacts on effective team decision making and its effects on a patient centred approach to health care.

A protocol for evaluating progressive levels of simulation fidelity in the development of technical skills, integrated performance and woman centred clinical assessment skills in undergraduate midwifery students

BackgroundSimulation as a pedagogical approach has been used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice. However, evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity are lacking.Woman centred care is a core premise of the midwifery profession and describes the behaviours of an individual midwife who demonstrates safe and effective care of the individual woman. Woman centred care occurs when the midwife modifies the care to ensure the needs of each individual woman are respected and addressed. However, a review of the literature demonstrates an absence of a valid and reliable tool to measure the development of woman centred care behaviours. This study aims to determine which level of fidelity in simulated learning experiences provides the most effective learning outcomes in the development of woman centred clinical assessment behaviors and skills in student midwives.Methods/DesignThree-arm, randomised, intervention trial.In this research we plan to:a) trial three levels of simulation fidelity - low, medium and progressive, on student midwives performing the procedure of vaginal examination;b) measure clinical assessment skills using the Global Rating Scale (GRS) and Integrated Procedural Performance Instrument (IPPI); andc) pilot the newly developed Woman Centred Care Scale (WCCS) to measure clinical behaviors related to Woman-Centredness.DiscussionThis project aims to enhance knowledge in relation to the appropriate levels of fidelity in simulation that yield the best educational outcomes for the development of woman centred clinical assessment in student midwives. The outcomes of this project may contribute to improved woman centred clinical assessment for student midwives, and more broadly influence decision making regarding education resource allocation for maternity simulation.

The effectiveness of varied levels of simulation fidelity on integrated performance of technical skills in midwifery students — A randomised intervention trial ☆

BACKGROUND Simulation as a pedagogical approach is used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice, in complex healthcare environments. Evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity is lacking. OBJECTIVES To evaluate the effectiveness of varying levels of fidelity on simulated learning experiences and identify which best contributes to integrated and global clinical skills development in midwifery students. DESIGN Randomised three arm intervention trial. PARTICIPANTS Midwifery students who had yet to receive theoretical instruction in the performance of the clinical skill of vaginal examination. METHODS Midwifery students (n=69) received theoretical instruction in the performance of vaginal examination following random allocation into one of three intervention arms. Participants were recorded performing the procedure using low fidelity (part task trainer only), medium fidelity (part task trainer and life sized poster of a pregnant woman) or progressive fidelity (part task trainer and a simulated standardised patient). Senior midwifery students were recruited to act in the role of standardised patients. RESULTS There was a statistically significant difference in the mean total Global Rating Scale score between at least two of the three groups (p=0.009). The progressive fidelity group revealed as different from both the low fidelity group (p=0.010) and medium fidelity group (p=0.048). There was a statistically significant difference in the mean total Integrated Procedural Performance Instrument score between at least two of the three groups (p=0.012). The progressive fidelity group revealed as different from both the low fidelity group (p=0.026) and medium fidelity group (p=0.026). CONCLUSIONS Progressive and medium fidelity simulation yields better outcomes than low fidelity simulation and where resources are constrained medium fidelity equipment, such as a life sized poster can produce effective learning experiences for midwifery students.

Development and piloting the Woman Centred Care Scale (WCCS)

PROBLEM/BACKGROUND In midwifery we espouse a woman centred care approach to practice, yet in midwifery education no valid instrument exists with which to measure the performance of these behaviours in midwifery students. AIM To develop and validate an instrument to measure woman centred care behaviours in midwifery students. METHOD We identified four core concepts; womans sphere, holism, self-determination and the shared power relationship. We mapped 18 individual descriptive care behaviours (from the Australian National Competency Standards for the Midwife) to these concepts to create an instrument to articulate and measure care behaviours that are specifically woman centred. Review by expert midwifery clinicians ensured face, content and construct validity of the scale and predictive validity and reliability were tested in a simulated learning environment. Midwifery students were video recorded performing a clinical skill and the videos were reviewed and rated by two expert clinicians who assessed the woman centred care behaviours demonstrated by the students (n=69). FINDINGS/DISCUSSION Test and re-test reliability of the instrument was high for each of the individual raters (Kappa 0.946 and 0.849 respectively p<0.001). However, when raters were compared there were differences between their scores suggesting variation in their expectations of woman centred care behaviours (Kappa 0.470, p<0.001). Midwifery students who had repeated exposures to higher levels of simulation fidelity demonstrated higher levels of woman centred care behaviours. CONCLUSION The WCCS has implications for education and the wider midwifery profession in recognising and maintaining practice consistent with the underlying philosophy of woman centred care.