Accepted for/Published in: JMIR Medical Education
Date Submitted: Dec 2, 2019
Date Accepted: Jun 13, 2020
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Evaluating the instructional design and the effect on knowledge, teamwork, and skills of a technology-enhanced simulation-based training in obstetrics in Uganda: a stepped-wedge cluster randomized trial
ABSTRACT
Background:
Simulation-based training is a common strategy for improving the quality of facility-based maternity services and is often evaluated using Kirkpatrick’s theoretical model. However, the results on the Kirkpatrick’s levels are closely related to the quality of the instructional design of a training program. The instructional design is generally considered as the ‘set of prescriptions for teaching methods to improve the quality of instruction with a goal of optimizing learning outcomes’.
Objective:
The aim of this study is to evaluate both the instructional design of a technology-enhanced simulation-based training in obstetrics, the reaction of participants, and the effect on knowledge, teamwork, and skills in a low-income country.
Methods:
A stepped-wedge cluster randomized trial was performed in a University Hospital in Kampala, Uganda, with an annual delivery rate of over 31,000. In November 2014 a medical simulation center was installed with a full body birthing simulator (Noelle® S550, Gaumard, Miami), an interactive neonate (new-born Simon® S102, Gaumard, Miami) and an audio- and video recording system. Twelve local obstetricians were trained and certified as medical simulation trainer. From 2014 to 2016 training was provided to 57 residents in groups of six to nine students. Descriptive statistics were calculated for the instructional design of the training course measured by the 42-item ID-SIM. Wilcoxon signed rank test was conducted to investigate the difference in scores on knowledge, medical technical skills, and the clinical teamwork scale.
Results:
Overall the training was rated 92.8 out of 100 (95%CI 89.5 – 96.1). The highest score regarding the instructional design was for feedback (84.3, 95%CI 80.9 – 87.6), and the lowest scores for repetitive practice (62.8, 95%CI 55.8 – 69.8) and controlled environment (54.9, 95%CI 48.5 – 61.3). Knowledge improved significantly with a test score of 63.4 (95%CI 60.7 – 66.1) percent before and 78.9 (95%CI 76.8 – 81.1) percent after the training (P < .001). Most medical technical skills and teamwork did not show changes.
Conclusions:
Results on the instructional design, measured by the ID-SIM, showed the lowest scores on the instructional design features repetitive practice and controlled environment. Knowledge did improve after the training program, but no changes in (most) technical skills and teamwork were found. Results of the ID-SIM showed suggestions for improvement of the instructional design of the training program to achieve learning aims. Clinical Trial: ISRCTN98617255, retrospectively registered
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