Beyond Confidence: A Narrative Review Assessing Educational Outcomes in Simulation-Based Obstetric Training for Medical Students

Simulation-based education has become an increasingly important component of undergraduate medical training, particularly in obstetrics, where exposure to rare but high-risk emergencies may be limited during clinical rotations. Simulation provides a safe environment in which students can acquire procedural skills, improve decision-making, and develop confidence before encountering critical clinical situations. However, educational effectiveness is assessed differently across simulation-based obstetric training studies. This narrative review examines the educational outcomes and assessment approaches used in simulation-based obstetric training among medical students. Particular attention is given to knowledge acquisition, technical and procedural performance, non-technical skills, self-confidence and self-efficacy, learner satisfaction, retention of acquired competencies, and transfer to clinical practice. The review also explores the assessment tools used to measure these outcomes, including structured checklists, global rating scales, objective structured clinical examination-based approaches, and investigator-developed instruments. Current evidence suggests that simulation frequently improves learners' knowledge, perceived preparedness, and confidence. Nevertheless, subjective outcomes are often reported alongside, or sometimes in place of, objective measures of clinical competence. Furthermore, heterogeneity in assessment instruments and limited evaluation of long-term retention and clinical transfer make cross-study comparisons difficult. By critically examining how educational outcomes are defined and measured, this review seeks to identify current limitations in simulation assessment and highlight priorities for future research, including greater use of validated objective measures, standardized outcome frameworks, delayed assessment, and evaluation of transfer from simulated to clinical environments.