Simulation to Improve Medical Student Understanding of Doulas' Role

Birth doula services in the United States are increasingly covered by insurance and sought out by patients. To be effective team members on labour and delivery (L&D), it is critical that medical students understand doulas' role and how to collaborate with doulas in patient care.

To this end, we developed an L&D simulation for students to practice working with doulas. Preclinical medical students participated with an obstetrician, anesthesiologist, nurse and doula in a simulated patient birth and debrief.

A descriptive evaluation was conducted via presimulation and postsimulation surveys asking students to evaluate their comfort "caring for a patient with a doula" and understanding of the "doula [role] during a delivery" on a 7-point scale. Presimulation to postsimulation comparisons were done with linear regressions with clustering. This project received a nonhuman subjects research determination. In total, 255 students participated across 2 years; 212 students completed surveys. Of students who completed presimulation surveys (N = 201), 17.8% had previous L&D experience. Participating in the simulation significantly increased both students' comfort collaborating with a doula (3.1 points) (95% confidence interval [CI]: 2.9-3.4) and their understanding of the doula role (3.2 points) (95% CI: 2.9-3.5). Presimulation, students with prior L&D experience had higher understanding of doulas' role than those without experience (0.70 points, 95% CI: 0.09-1.3).

Including birth doulas in obstetric simulations is an effective method to improve preclinical medical students' awareness and understanding of the doula role, providing an important opportunity to improve L&D collaboration and patient care.