title: A randomized controlled trial of birth simulation for medical students.
abstract: OBJECTIVE
  The objective of the study was to evaluate the effectiveness of a high-fidelity birth simulator (Noelle; Gaumard Scientific, Coral Gables, FL) compared with a lower-cost, low-tech, birth simulator (MamaNatalie; Laerdal Medical, Stavanger, Norway) in teaching medical students how to perform a spontaneous vaginal delivery (SVD).
  
  
  METHODS
  Prior to the obstetrics-gynecology clerkship, students were randomly assigned to 2 groups. The MamaNatalie group (MG) completed 45 minutes of SVD simulation using an obstetrical abdominal-pelvic model worn by an obstetrics-gynecology faculty member. The Noelle group (NG) completed 45 minutes of SVD simulation using a high-fidelity, computer-controlled mannequin facilitated by an obstetrics-gynecology faculty member. The primary outcome was student performance during his or her first SVD as rated by supervising preceptors. Surveys were also completed by students on confidence in performing steps of a SVD (secondary outcome).
  
  
  RESULTS
  One hundred ten medical students (95% of those eligible) participated in this research study. The final postclerkship survey was completed by 93 students (85% follow-up rate). There were no significant differences in performance of SVD steps between MG and NG students as rated by preceptors. The SVD step with the least involvement by students was controlling the head (20.5% in MG, 23.3% in NG performed step with hands-off supervision). Delivery of the placenta was the SVD step with the most involvement (65.9% in MG, 52.3% in NG performed step with hands-off supervision). Baseline presimulation confidence levels were similar between MG and NG. On the immediate postsimulation survey of confidence, MG students were significantly more confident in their ability to deliver the abdomen and legs and perform fundal massage with hands-off supervision (P < .05) than NG students. Following the clerkship, MG students were significantly more confident in their ability to control the head and deliver the abdomen and legs (P < .05) than NG students.
  
  
  CONCLUSIONS
  MamaNatalie is as effective as Noelle in training medical students how to perform a SVD and may be a useful, lower-cost alternative in teaching labor and delivery skills to novice learners. Because birth simulation interventions involve both a simulation model and facilitator, research is required to further determine the effect of human interaction on learning outcomes.
authors.affiliation: Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: cdestep1@jhmi.edu.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: DeStephano
authors.affiliation: Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Betty
authors.initials: B
authors.lastname: Chou
authors.affiliation: Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Silka
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Slattery
authors.affiliation: Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Nancy
authors.initials: N
authors.lastname: Hueppchen
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000193:education*; D006801:Humans; D008953:Models, Anatomic; D009774:Obstetrics / Q000193:education; D013337:Students, Medical; D013663:Teaching / Q000379:methods*
keywords: medical student education; obstetric simulation