Within the last decade, simulation-based learning has become a key educational component in nursing and midwifery programmes to enhance clinical skills (Cooper et al, 2012). However, the concept of simulation is not new to the midwifery profession. As far back as the year 1700, Madame du Coudray, commissioned by King Louis XV, taught student midwives practical skills using a life-sized model made of fabric, bones and leather (Gelbart, 1998). Known for her revolutionary teaching techniques, she educated peasant women and male surgeons alike.
Many midwives are familiar with using manikins, torsos, dolls and pelvis to simulate abdominal palpation, neonatal resuscitation, breech and mechanisms of labour (Cooper et al, 2012). In more recent years, with advancements in technology, we as educators and clinicians now have the ability to work with high-fidelity manikins that physiologically respond to simulated interventions (Tyer-Viola et al, 2012; Deegan and Terry, 2013). Freeth et al (2009) consider that the use of this particular technology allows students to become fully immersed in the simulation. This enhances learning through interactive experiences emulating those the students would encounter in clinical practice. Within a university setting, we have seen first-hand how the use of such technology can facilitate a deeper understanding. Some recent student feedback following a simulation around postpartum haemorrhage included words and phrases such as ‘realistic’, ‘confidence’, ‘applied learning practically’, and ‘appreciated the realness as done in real-time’. Students also report that they feel the use of simulation better prepares them for clinical practice.
Simulation-based learning is not only about the use of high-fidelity manikins. It can be used to prepare students for breaking bad news using bereavement scenarios; a situation that midwives often face only once they have qualified. Providing students with the opportunity to partake in such scenarios allows them to gain experience in real-life events. Gaba (2004), a proponent of simulation, echoes this, as he believes that simulation should replicate important elements of the real world in a significant manner.
Within a university setting, simulation aims to align clinical skills that students acquire in practice alongside theory delivered in a classroom environment (Dow, 2012). Despite simulation being a relatively new introduction into midwifery programmes, evolving evidence suggests it is beneficial, partly as it increases interaction between educators and students (Deegan and Terry, 2013). The Nursing and Midwifery Council (NMC, 2010) has endorsed simulation-based learning by integrating it into pre-registration nursing education, allowing students to use this as practice hours (Moule et al, 2008).
Simulation is an educational strategy that provides students with realistic clinical situations and allows them to practise and learn in a safe environment (Garrett et al, 2011; Arthur et al, 2013) that replicates a clinical setting but without endangering a real woman or baby (Dow, 2012). This reflects the view of the Department of Health (2011), which has stated that simulation-based learning should be used to increase students' learning so as to benefit and improve patient care.
As a pedagogical approach, simulation is used in education with health professional students to focus on the need to evolve safe clinical skills (Brady et al, 2015). Kerr and Bradley (2010) suggest that it encourages experiential learning, a process of learning through experience; it is often defined as ‘learning through reflection on doing’ (Kolb, 1984: 21). An intrinsic component of simulation, and one that aligns itself to the concept of experiential learning, is the inclusion of the debriefing process either during or following the simulation. This allows students to clarify thoughts and feelings and discuss their experiences during the simulation (Arafeh et al, 2010; Shinnick et al, 2011). It has been well recognised by educators that debriefing in simulation is essential in helping to translate experience into learning through the process of reflection. Debriefing by the facilitator and reflection by the student can promote critical thinking through cognitive processes connecting actions and outcomes. As midwifery educators we strive to encourage students to think more critically about clinical situations they may be involved in, and not to accept everything they see at face value. Debriefing is also said to reflect accountability through the process of critical thinking, and can allow for enhanced clinical judgement and decision-making (Mayville, 2011).
The introduction of simulation into midwifery education has not been without some contention. Academics and midwifery students agree that there are some elements, such as the intricacies of birth, that simulation cannot achieve. Alternatively, there is evidence to support simulation through the use of clinical scenarios that students are not always exposed to, such as management of obstetric emergencies, suggesting it is beneficial to their learning and subsequent professional practice. This was echoed in a conversation I had recently with midwives in clinical practice, who said they felt that student midwives do not always have the opportunity to manage obstetric emergencies until they qualify. Literature and anecdotal evidence suggests that the management of emergency situations is most concerning for final-year student midwives as they contemplate becoming qualified midwives (Carolan-Olah et al, 2014). Midwifery programmes of education aspire to equip student midwives with all the skills they must possess on qualifying. With this in mind, simulation is found to increase performance and development of confidence in obstetric clinical emergencies by student midwives (Osman et al, 2009).
Using simulation appears to be a promising way of increasing confidence in students—particularly in relation to decision-making, understanding policies, and where there are limited clinical opportunities for learning. Perhaps this could be an effective solution to the much debated, yet unsolved mystery of the theory–practice gap.