Simulation and clinical skills sessions support student midwives in developing their clinical and communication abilities, and link theory to practice in a safe environment (Lendahls and Oscarsson, 2017; Yuill, 2017). Evidence suggests that simulation workshops can increase students' understanding, confidence and clinical abilities, which are then consolidated in practice (Catling et al, 2016). This is particularly important for managing emergency situations, which are unpredictable in nature and, in any event, the wellbeing of the woman and baby must take precedence over students' learning opportunities. This can result in some students not having the opportunity to manage an obstetric emergency until post-qualification (Yuill, 2017).
There is a strong rationale for embedding simulation and clinical skills sessions into the pre-registration midwifery programme, as they are key components in preparing student midwives for the demands of the unpredictable clinical environment. That said, providing these learning opportunities in a university setting requires approved educational institutions to have the appropriate equipment and manpower to maintain and set up the equipment. The Midwives In Teaching (MINT) Project (Fraser and Avis, 2010) highlighted that the demands on midwifery lecturers' time to ensure that all students have the chance to observe, practice and be assessed on clinical skills in a safe environment are high. The introduction of specialist support in the form of Laboratory/Clinical Skills Technicians not only makes best use of equipment and time, it also empowers lecturers to focus on facilitating learning.
Laboratory/clinical skills technician
Role and responsibilities
Lin is a laboratory/clinical skills technician for human bioscience and clinical skills in the Faculty of Health and Social Care at the University of Northampton. Her key duties are to support all subject areas with clinical skills and laboratory equipment; however, midwifery is the only discipline where she is actually involved in the simulation and clinical skills sessions, as well as setting up and maintaining the equipment (Box 1).
A different perspective on the pros and cons of simulation: Lin's observations
High-tech mannequins have the ‘wow factor’ and it's amazing to watch the students. They come in appearing very anxious, but within a few minutes they are ‘in the zone’, responding like it's a lady in an emergency situation and reassuring her. I love being involved in the shoulder dystocia and breech practice, as your heart is with the student as they carry out the assessment. I feel I can contribute in a small way by making sure the model works effectively and the baby delivers as it should, and by ensuring that the assessment is consistent for all the students. By making sure the model performs as it should, the student or assessors have one less thing to worry about, and this means that the scenario runs smoothly, allowing the lecturers to concentrate on assessing the students' performance, rather than monitoring the functionality of the equipment.
There are sometimes technical issues that need to be managed, such as when equipment loses Wi-Fi connection, which can negatively impact on the learning experience. Successful simulation ‘suspends reality’, which is difficult when equipment malfunctions, so it is important to be flexible and remember that high-tech, complicated and expensive set ups are not the only option for effective learning. SimMom and Sim NewB demand a lot of time to programme and set up, so more low-tech sessions (such as estimating blood loss with a variety of pads and bowls and artificial blood; abdominal examinations; safe injection techniques; and venepuncture) always get very positive reactions.
The future of simulation and clinical skills in the midwifery pre-registration curriculum
Standards for pre-registration nursing education have recently been updated (Nursing and Midwifery Council (NMC), 2018) to meet the demands of an ever-changing contemporary health service and in relation to simulation they stipulate that approved educational institutions must:
‘Ensure technology enhanced and simulation-based learning opportunities are used effectively and proportionately to support learning and assessment.’
While current Standards for Pre-Registration Midwifery Education state that ‘the programme must have a variety of learning and teaching strategies, which may include simulation’ (NMC, 2009:19), it is expected that new standards, due for implementation in September 2020, will be aligned with those of nursing pre-registration programmes in relation to simulation and clinical skills. Consequently, it is important to continue to develop and facilitate well-organised, well-funded and well-evaluated simulation and clinical skills sessions, providing student midwives with a range of learning opportunities. By practising in a ‘safe environment’, students should then be more confident to transfer these skills into clinical practice. By making best use of lecturers' time and expertise with the support of trained laboratory/clinical skills technicians, approved educational institutions can continue to work with clinical placement providers to link theory to practice and positively affect the quality of services and the experiences of service users.