title: Simulation training improves medical students' learning experiences when performing real vaginal deliveries.
abstract: OBJECTIVE
  To determine the relationship between simulation training for vaginal delivery maneuvers and subsequent participation in live deliveries during the clinical rotation and to assess medical students' performance and confidence in vaginal delivery maneuvers with and without simulation training.
  
  
  METHODS
  Medical students were randomized to receive or not to receive simulation training for vaginal delivery maneuvers on a mannequin simulator at the start of a 6-week clerkship. Both groups received traditional didactic and clinical teaching. One researcher, blinded to randomization, scored student competence of delivery maneuvers and overall delivery performance on simulator. Delivery performance was scored (1-5, with 5 being the highest) at weeks 1 and 5 of the clerkship. Students were surveyed to assess self-confidence in the ability to perform delivery maneuvers at weeks 1 and 5, and participation in live deliveries was evaluated using student obstetric patient logs.
  
  
  RESULTS
  Thirty-three students were randomized, 18 to simulation training [simulation group (SIM)] and 15 to no simulation training [control group (CON)]. Clerkship logs demonstrated that SIM students participated in more deliveries than CON students (9.8 +/- 3.7 versus 6.2 +/- 2.8, P < 0.005). SIM reported increased confidence in ability to perform a vaginal delivery, when compared with CON at the end of the clerkship (3.81 +/- 0.83 versus 3.00 +/- 1.0, respectively, P < 0.05). The overall delivery performance score was significantly higher in SIM, when compared with CON at week 1 (3.94 +/- 0.94 versus 2.07 +/- 1.22, respectively, P < 0.001) and week 5 (4.88 +/- 0.33 versus 4.31 +/- 0.63, P < 0.001) in the simulated environment.
  
  
  CONCLUSIONS
  Students who receive simulation training participate more actively in the clinical environment during the course of the clerkship. Student simulation training is beneficial to learn obstetric skills in a minimal risk environment, demonstrate competency with maneuvers, and translate this competence into increased clinical participation and confidence.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10461, USA. adayal@montefiore.org
authors.forename: Ashlesha K
authors.initials: AK
authors.lastname: Dayal
authors.forename: Nelli
authors.initials: N
authors.lastname: Fisher
authors.forename: Diane
authors.initials: D
authors.lastname: Magrane
authors.forename: Dena
authors.initials: D
authors.lastname: Goffman
authors.forename: Peter S
authors.initials: PS
authors.lastname: Bernstein
authors.forename: Nadine T
authors.initials: NT
authors.lastname: Katz
mesh_terms: D002983:Clinical Competence; D003625:Data Collection; D036861:Delivery, Obstetric / Q000193:education*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D008348:Manikins; D008962:Models, Theoretical; D011214:Practice, Psychological; D020377:Self Efficacy; D013337:Students, Medical