title: Shoulder dystocia and postpartum hemorrhage simulations: student confidence in managing these complications.
abstract: BACKGROUND
  Simulation is an effective teaching strategy for educating health professionals. However, little is known about the effectiveness of simulations in midwifery education. The purpose of this project was to determine whether the use of high-fidelity simulations for the obstetric emergencies of shoulder dystocia and postpartum hemorrhage increases student confidence in managing these complications.
  
  
  METHODS
  The participants were registered nurses enrolled in a graduate midwifery education program in the Southeastern United States. Student confidence in learning to manage shoulder dystocia and postpartum hemorrhage was studied in 2 groups of students. The control group (n = 10) received standard teaching methods consisting of discussion, watching a video, and low-fidelity teaching methods. The intervention group (n = 18) received a high-fidelity simulation learning experience. Student confidence was measured before and after each learning experience using a validated, 8-item, Likert-type scale.
  
  
  RESULTS
  In the control group, student confidence did not significantly increase after a classroom discussion or low-fidelity simulation experience. Student confidence increased significantly (P < .01) after the high-fidelity simulation learning experiences. When the differences between the pretest and posttest scores were compared for the control and intervention groups, there was a moderate effect size (0.54) for the intervention group for the shoulder dystocia simulations and a large effect size (1.68) for the postpartum hemorrhage simulations.
  
  
  CONCLUSIONS
  High-fidelity simulations for shoulder dystocia and postpartum hemorrhage significantly increased student confidence in managing these complications.
authors.affiliation: The Frontier School of Midwifery and Family Nursing, 10 View Street, Northfield, NH 03276, USA. tia.andrighetti@frontierschool.edu
authors.forename: Tia P
authors.initials: TP
authors.lastname: Andrighetti
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Knestrick
authors.forename: Amy
authors.initials: A
authors.lastname: Marowitz
authors.forename: Cheryl
authors.initials: C
authors.lastname: Martin
authors.forename: Janet L
authors.initials: JL
authors.lastname: Engstrom
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004420:Dystocia / Q000451:nursing*; D004506:Education, Nursing / Q000379:methods; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008348:Manikins; D008880:Midwifery / Q000193:education*; D009773:Obstetric Nursing / Q000193:education; D016544:Patient Simulation; D006473:Postpartum Hemorrhage / Q000451:nursing*; D011247:Pregnancy; D018794:Problem-Based Learning / Q000379:methods; D020377:Self Efficacy; D012782:Shoulder; D015144:Southeastern United States