Using a short stress and satisfaction debriefing intervention on midwifery students during perinatal simulation-based training: A randomized controlled intervention

Introduction:
Simulation is an innovative teaching strategy that incorporates active learning and has a positive effect on learning results1,2. In general, students are satisfied with simulation training3, but scientific literature suggests that they may experience stress, including physiological response and psychological distress during the training sessions4. Therefore, attention must be paid to this experience of stress to improve students’ learning experiences and to increase their satisfaction with this process.

Material and Methods:
A randomized controlled intervention (RCT) study5 was conducted to measure midwifery students’ stress levels during perinatal simulation-based trainings using a smart device (Empatica E4 wristband©)6. We also investigated the value of using a brief debriefing intervention on students’ stress to support the process. Student’s satisfaction of the overall process was also evaluated. The actual sample consisted of 55 midwifery students (nintervention=28, ncontrol=27) enrolled in a simulation course at the Erasmus Brussels University of Applied Sciences and Arts (EhB) during the fall semester of the 2022-2023 academic year. Students were randomized into groups. As part of the study protocol, participants were asked to sit at rest for 30 minutes (T0) before the simulation begins. Prior to the start of the scenario, students were briefed about the specific scenario and the role they would be playing (T1). During the debriefing phase, the intervention group received a brief stress and satisfaction debriefing in which stress was discussed, while the control group received only a standard debriefing (T2). After the debriefing phase, participants were also asked to rest for 30 minutes (T3) in a special designated area. Students’ physiological stress parameters (heart rate variability, galvanic skin response, and skin temperature) were assessed using an Empatica E4 wristband continuously (four times each second)7, but divided into T0, T1, T2 and T3 time periods. Their psychological stress level was assessed using the Short Stress State Questionnaire8 at T0 and T3 time periods and, satisfaction was assessed using the Satisfaction with Simulation Experience Scale3 at T3 time period as well as the intervention group interviews at T2 time period. Quantitative data were analysed using IBM SPSS 28.0 SPSS. Qualitative data were analysed using thematic content analysis. Empatica E4 wristband data were processed using Python program©.

Results:
This study found that the mean post-test score level of psychological stress for the intervention group were lower than in the control group (p<0.001), while the mean post-test score on satisfaction with simulation experience in the intervention group were higher than for the control group (p<0.001). During the students’ interviews, most of the comments suggested stress during the simulation, but participants particularly valued the possibility of discussing their emotions during the debriefing session intervention. Empatica E4 wristband data processing and analysis are ongoing.

Conclusions:
Using a brief debriefing intervention in perinatal simulation-based trainings (which is as such a stressful experience), has a positive effect on midwifery students’ by reducing the stress levels, and increasing the satisfaction with simulation training. It is recommended to provide adjusted feedback on students’ stress levels (brief intervention) during the debriefing sessions in the case of simulation-based training. These are initial results and therefore further research is needed.