Barrows HSChapel Hill, NC: Health Sciences Consortium; 1987

Bokken L, Linssen T, Scherpbier A, van der Vleuten C, Rethans JJ Feedback by simulated patients in undergraduate medical education: a systematic review of the literature. Medical Education. 2009; 43:(3)202-10

Brackbill Y, Boblitt WE, Davlin D, Wagner JE Amplitude of response and the delay-retention effect. J Exp Psychol. 1963; 66:(1)57-64

Cleland JA, Abe K, Rethans JJ The use of simulated patients in medical education: AMEE Guide No 42. Med Teach. 2009; 31:(6)477-86

Cooper S, Cant R, Porter J Simulation based learning in midwifery education: A systematic review. Women Birth. 2012; 25:(2)64-78

Dow A Clinical simulation: a new approach to midwifery education. British Journal of Midwifery. 2008; 16:(2)94-8

Elman D, Hooks R, Tabak D, Regehr G, Freeman R The effectiveness of unannounced standardised patients in the clinical setting as a teaching intervention. Medical Education. 2004; 38:(9)969-73

Ende J Feedback in clinical medical education. JAMA. 1983; 250:(6)777-81

Fullerton JT, Johnson P, Lobe E A Rapid Assessment Tool for affirming good practice in midwifery education programming. Midwifery. 2016; 34:36-41

Gaba DM The future vision of simulation in health care. Qual Saf Health Care. 2004; 13:i2-i10

Issenberg SB, Mcgaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005; 27:(1)10-28

Johnson M Feedback effectiveness in professional learning contexts. Review of Education. 2016; 4:(2)195-229

Klima C, Norr K, Vonderheid S, Handler A Introduction of CenteringPregnancy in a public health clinic. J Midwifery Womens Health. 2009; 54:(1)27-34

Kulhavy RW, Anderson RC Delay-retention effect with multiple-choice tests. Journal of Educational Psychology. 1972; 63:(5)505-12

Kulik JA, Kulik CLC Timing of feedback and verbal learning. Rev Educ Res. 1988; 58:(1)79-97

Kurtz SM, Silverman JD The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Medical Education. 1996; 30:(2)83-9

Levett-Jones T, Pitt V, Courtney-Pratt H, Harbrow G, Rossiter R What are the primary concerns of nursing students as they prepare for and contemplate their first clinical placement experience?. Nurse Educ Pract. 2015; 15:(4)304-9

Madani A, Watanabe Y, Vassiliou MC Long-term knowledge retention following simulation-based training for electrosurgical safety: 1-year follow-up of a randomized controlled trial. Surgical Endoscopy. 2016; 30:(3)1156-63

May W, Park JH, Lee JP A ten-year review of the literature on the use of standardized patients in teaching and learning: 1996–2005. Med Teach. 2009; 31:(6)487-92

McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ A critical review of simulation-based medical education research: 2003–2009. Medical Education. 2010; 44:(1)50-63

Merién AER, van de Ven J, Mol BW, Houterman S, Oei SG Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstetrics and Gynecology. 2010; 115:(5)1021-31

Murray C, Grant MJ, Howarth ML, Leigh J The use of simulation as a teaching and learning approach to support practice learning. Nurse Educ Pract. 2008; 8:(1)5-8

Nestel D, Burn CL, Pritchard SA, Glastonbury R, Tabak D The use of simulated patients in medical education: Guide supplement 42.1 – Viewpoint. Med Teach. 2011; 33:(12)1027-9

Pairman SNew York: Churchill Livingstone; 2006

Pennaforte T, Moussa A, Loye N, Charlin B, Audétat MC Exploring a New Simulation Approach to Improve Clinical Reasoning Teaching and Assessment: Randomized Trial Protocol. JMIR Res Protoc. 2016; 5:(1)

En manque de places de stage, les écoles achètent des robots. 2012. (accessed 15 November 2016)

Ricketts B The role of simulation for learning within pre-registration nursing education – a literature review. Nurse Educ Today. 2011; 31:(7)650-4

The Impact of Limited Clinical Sites on Prelicensure Nursing Education Programs: Current Issues and Recommendations for the Future. 2013. (accessed 17 October 2016)

Scholes J, Endacott R, Biro M Clinical decision-making: midwifery students recognition of, and response to, post partum haemorrhage in the simulation environment. BMC Pregnancy Childbirth. 2012; 12:(1)

Stunden A, Halcomb E, Jefferies D Tools to reduce first year nursing students' anxiety levels prior to undergoing objective structured clinical assessment (OSCA) and how this impacts on the student's experience of their first clinical placement. Nurse Educ Today. 2015; 35:(9)987-91

Vadnais MA, Dodge LE, Awtrey CS, Ricciotti HA, Golen TH, Hacker MR Assessment of long-term knowledge retention following single-day simulation training for uncommon but critical obstetrical events. J Matern Fetal Neonatal Med. 2012; 25:(9)1640-5

Vyas D, Ottis EJ, Caligiuri FJ Teaching clinical reasoning and problem-solving skills using human patient simulation. Am J Pharm Educ. 2011; 75:(9)

Wallace PNew York: Springer Publishing; 2009

Yudkowsky R, Otaki J, Lowenstein T, Riddle J, Nishigori H, Bordage G A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence. Medical Education. 2009; 43:(8)729-40

Impact of immediate vs delayed feedback in a midwifery teaching activity with a simulated patient

02 December 2016
Volume 24 · Issue 12



Literature on evidence-based midwifery demonstrates a lack of simulation in antenatal consultation.


This study aims to explore whether immediate individual feedback (IIFB) is more effective than delayed group feedback (DGFB) following a teaching activity for midwifery students, and evaluate students' satisfaction.


A teaching activity with simulated patients was developed to improve midwifery students' competence in conducting a holistic antenatal session. Clinical and communication skills were evaluated using a validated grid adapted from the Calgary-Cambridge Referenced Observation Guide on communication. Students (n = 51) were randomly separated into two groups, IIFB or DGFB.


Non-parametric tests showed that students who received IIFB significantly improved their competence in conducting history-taking in comparison to the students who received DGFB (P = 0.034), including higher satisfaction (P < 0.001).


Competence in leading holistic antenatal care sessions is essential for midwives. Students' clinical and communication skills, as well as satisfaction, improve with opportunities to work with simulated patients. Students who received IIFB showed a greater improvement of clinical skills and reported higher satisfaction with the timing of feedback than those who had DGFB.

Simulation is defined as ‘a technique, not a tech nology, to replace or amplify real experi ences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner’ (Gaba, 2004: 1). Simu lation in midwifery provides learners with a unique opportunity to practise hands-on skills and competencies and allow them to learn from mistakes in repeated teaching activities, integrating new knowledge rapidly and without putting a woman or infant at risk (Scholes et al, 2012). The use of simulation in midwifery predominates in obstetric emergencies such as shoulder dystocia and cord prolapse emergencies (Merién et al, 2010; Cooper et al, 2012), rather than more routine training such as how to perform a full antenatal consultation.

The antenatal consultation is of particular interest because it is a major part of midwifery, incorporating elements of bio-psychosocial screening, prevention, health promotion and professional skills. However, its teaching is sometimes underestimated, and educators tend to favour training in obstetric complications (Pairman, 2006; Klima et al, 2009; Fullerton et al, 2016). In nursing and medical science, authors advocate that simulated learning encompasses the cognitive, psychomotor and affective domains of learning to accommodate the preferences of all nursing students and enable them to provide holistic care (Ricketts, 2011; Vyas et al, 2011). A standardised approach to simulated learning in nursing education, with the development of clinical scenarios linked to relevant theory and lectures, would offer measurable learning outcomes to meet professional and regulatory requirements (May et al, 2009). Simulation in midwifery education with simulated patients (SPs) is useful when psychomotor and cognitive skills are taught in an integrative manner with communication and relationship competencies (Cooper et al, 2012). There is a clear benefit of simulation in terms of communication and relationship skills.

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