"Practice so that the skill does not disappear": mixed methods evaluation of simulator-based learning for midwives in...

Area of Science:

• Medical Education
• Public Health
• Simulation Training

Background:

• Postpartum hemorrhage and neonatal asphyxia are leading causes of maternal and neonatal mortality in sub-Saharan Africa.
• Rare occurrence of these emergencies in low-volume facilities can hinder birth attendant readiness and skills.
• Simulator-based training, such as low-dose, high-frequency (LDHF) practice, is suggested to maintain critical life-saving skills.

Purpose of the Study:

• To evaluate the facilitating factors and barriers to participation in LDHF simulator-based practice sessions.
• To identify strategies that enhance the consistency and effectiveness of skills maintenance for birth attendants.

Main Methods:

• A trial in 125 Ugandan facilities compared three strategies for supporting LDHF practice.
• Quantitative analysis of practice logs (Stata) compared practice frequency across study arms.
• Qualitative analysis of 29 in-depth interviews and 19 focus group discussions (Atlas.ti) identified motivational factors and barriers.

Main Results:

• Simulator practice was more frequent in facilities with practice coordinators and in health centers compared to hospitals.
• Motivations for practice included skill maintenance, emergency preparedness, external recognition, and set schedules.
• Barriers included low staffing, heavy workloads, and the belief that routine care alone ensures competency.

Conclusions:

• Appointing practice coordinators enhances consistent simulator-based skills practice in frontline health facilities.
• Sustaining LDHF practice requires ongoing support, scheduled sessions, and addressing motivational factors.
• LDHF practice can serve as a model for continuing professional development in healthcare.