Simulation Teaching Method and Vaginal Examination in Midwifery Students

This study was planned to evaluate the effect of simulation teaching method on the ability to apply vaginal examination in labor and self-confidence in midwifery students.

Two skills, abdominal palpation and vaginal examination, are used to clinically monitor the progress of labor. Vaginal examination is the most accepted method to measure the progress of labor.Vaginal examination, which is routinely applied in the evaluation of labor progress, is an important part of midwifery care. However, it is reported that the accuracy level of vaginal examination for new students is low. This essential skill is a learned tactile/tactile skill that requires consistency to properly manage women in labor. Therefore, it cannot be learned through observation alone; In order to acquire this skill, students need to perform a large number of vaginal examinations in women who have given birth. The usual/classic training technique for teaching vaginal examination is that the midwifery student performs a vaginal examination on the woman in labor under the supervision of an experienced obstetrician, and then the experienced obstetrician repeats this examination to determine the accuracy of the trainee student's assessment. Simulation-based learning improves the understanding, retention and active use of knowledge and skills, reduces the student's pre-application anxiety, and increases self-confidence. It is seen that simulation, which has been widely used in medical education in recent years, is also used as a teaching method in the development of practice skills of midwifery students.There are several studies in the literature evaluating the effect of simulation training on students' vaginal examination skills and self-confidence.In a study conducted to evaluate the benefits of simulation training in teaching obstetric vaginal examination techniques to medical students, it was found that the vaginal examination accuracy of students who received simulation training was significantly higher than those who did not receive simulation training. In this study, it was concluded that simulation training helped inexperienced students improve their vaginal examination skills before performing such procedures on real patients, interns who performed simulated examination showed significantly higher accuracy in vaginal examination evaluations than the control group. However, according to the available data, no study has been found that examines the effect of simulation training on vaginal examination skills in midwifery students.

This study was planned to evaluate the effect of simulation teaching method on the ability to apply vaginal examination in labor and self-confidence in midwifery students.

Type of Study: The study was planned as a randomized controlled trial.

Place and Time of the Research: The research was carried out at Tokat Gaziosmanpaşa University Faculty of Health Sciences, Tokat Gaziosmanpaşa University Health Research and Application Hospital and Tokat Provincial Health Directorate Tokat State Hospital between 10.02.2020-17.05.2020.

Population and Sample of the Research:

The universe of the research consisted of 66 students who took the Normal Birth and Postpartum Period and Risky Birth and Postpartum Period course for the first time in the Department of Midwifery, Faculty of Health Sciences, Tokat Gaziosmanpaşa University.

Students who agreed to participate in the study voluntarily were included in the study.

66 midwifery students forming the research sample were ranked from high to low according to their general academic grade point average. After the group with the highest grade point average was determined randomly (by drawing lots), the students were assigned to the experimental and control groups, respectively.

Data Collection Tools

The Effect of Simulation Teaching Method on Vaginal Examination Practice Skills and Self-Confidence Development in Midwifery Students Questionnaire The questionnaire consists of three parts.

A. Socio-demographic characteristics of students

In this section, midwifery students' age, marital status, graduated school, family structure, place of residence, education level of the mother and father, perception of income, where the family lives, the presence of health personnel in the family members, their position, if any, their satisfaction with the midwifery department. There are a total of 18 questions about how they evaluate the difference between the preference order of the midwifery profession, the general academic grade point average, the level of finding sufficient theoretical knowledge and skills in vaginal examination, previous vaginal examination practice and examination findings, and the findings of an experienced obstetrician.

B. Students' self-confidence ratings on performing the vaginal examination application steps This is the section in which the students rank their self-confidence in performing the vaginal examination application steps (22 items) prepared by the researchers by examining the literature. It is scored as I do not trust myself at all-1, I do not trust myself-2, I have little confidence in myself-3, I have confidence in myself-4, I am very confident in myself-5.C. Vaginal examination evaluation results of the students in the clinic

C. Vaginal examination evaluation results of the students in the clinic This is the section where the evaluation results (cervical effacement, cervical dilatation, presence of amniotic membrane, presenting fetus part and fetal descent) of the midwifery student and experienced health professional (midwife, nurse and doctor) in vaginal examinations performed on women in the clinic for both groups are recorded.

Application of the Research:

All students who took the Normal Birth and Postpartum Period and Risky Birth and Birth and Postpartum Period courses were given a theoretical lecture on the steps of vaginal examination in labor and the criteria to be evaluated in vaginal examination, and a video on the subject was watched.

After giving information about the study, informed consent was obtained from all students who voluntarily agreed to participate in the study.

The students were asked to fill in the questionnaires prepared by the researchers, examining the socio-demographic characteristics and vaginal examination experiences of the students, and to rate their self-confidence in performing the vaginal examination application steps.

The experimental group students, which were determined as random, performed eight different vaginal examination scenarios on the fetal monitoring and labor progress model set in terms of cervical effacement, dilatation and the presence of the presenting part and amniotic sac.

The control group did not receive any simulation training.

The students in both groups were asked to rate their self-confidence in performing the steps of performing the vaginal examination for the second time before performing the first vaginal examination on the woman in the clinic.

Vaginal examination results (cervical effacement, cervical dilatation, presence of amniotic membrane, presenting fetus part, and fetal descent) of the midwifery student and experienced health professional (midwife, nurse and doctor) were recorded in the vaginal examinations performed on women in the clinic for both groups.

In this study, the vaginal examination procedure normally used by midwifery students during their professional practice in health institutions was used.

An experienced health professional performed the vaginal examination in the woman in labor, then the midwifery student repeated the vaginal examination on the same woman under the supervision of an experienced health professional and the evaluation findings were compared.

Informed consent was obtained from the women before the vaginal examination, infection control measures were taken during the examinations (hand washing, wearing sterile gloves and avoiding frequent vaginal examinations), and the privacy of the women was respected as much as possible. The findings of experienced health professionals were accepted as the gold standard in the study. Student findings consistent with the findings of the experienced healthcare professional were evaluated as correct, and student findings that were not compatible with or could not be evaluated with the findings of the experienced healthcare professional were evaluated as incorrect.

Evaluation of Research Data:

Descriptive statistics were calculated to give information about the general characteristics of the research groups. Qualitative data were expressed as percentages and compared using the Chi-Square Test or the Fisher Exact Test. Quantitative data were expressed as mean±standard deviation, and were compared using the Independent Two-Group T-Test. P\<0.05 was considered statistically significant. Calculations were made with ready-made statistical software.

Ethical Aspect of Research:

Institutional permission from Tokat Gaziosmanpaşa University Faculty of Health Sciences, Tokat Gaziosmanpaşa University Health Research and Application Hospital and Tokat Provincial Health Directorate Tokat State Hospital and Tokat Gaziosmanpaşa University Clinical Research Ethics Committee approval were obtained for the research. Informed consent was obtained from all participants (midwifery students and women in labor) who would participate in the study.

Parameters Students' self-confidence ratings in performing the vaginal examination application steps

-Vaginal examination evaluation parameters (cervical effacement, cervical dilatation, presence of amniotic membrane, presenting fetus part and fetal descent)

Eligibility Criteria:
Inclusion Criteria:

* Midwifery students enrolled in Normal Birth and Postpartum Term Course in the 2019-2020 academic year

Exclusion Criteria:

* Students who did not volunteer to participate in the study
* Students who did not perform vaginal examination on real women at the clinic