Student midwives' experiences of high-fidelity simulation in midwifery education in the university setting: a qualitative systematic review

Background: High- Fidelity Simulation is an increasingly popular, evidence-based, and technologically sophisticated pedagogical approach within nursing and midwifery education and simulated practice learning. Various systematic reviews exploring the effectiveness of High- Fidelity Simulation have been undertaken, yet there is limited evidence and no current systematic review about student midwives' experiences of High- Fidelity Simulation. Due to this lack of evidence, the proposed review into student midwives' experiences of High- Fidelity Simulation is highly justified. This review aims to provide new insights into this pedagogical approach within midwifery education and shape recommendations to assist midwifery educators to deliver high-quality High-Fidelity Simulation. Aim: To explore what is known about the experiences of student midwives who have engaged in High- Fidelity Simulation as part of their midwifery education within the university setting. Design and methods: The Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews was followed and the study is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Results/findings: The review found High- Fidelity Simulation to be a beneficial learning process, however some negative experiences were also identified. Two main themes emerged related to barriers and facilitators. Facilitators included the following seven subthemes: practical skill development, authenticity of the manikin and surroundings, application of theory to practice, increased confidence, practicing in a safe learning environment, improved team working skills, and the value of feedback. Barriers included the following 5 subthemes: a lack of realism, stress and pressure whilst role playing, anxiety, feelings of guilt, shame and decreased self-esteem, and group allocation. Conclusions: Overall, the synthesized findings highlight that student midwives perceive the use of High- Fidelity Simulation to be highly beneficial, positively impacting their clinical competence and team working skills. Moreover, if High- Fidelity Simulation was used consistently and alongside adequate preparation and debriefing processes any unnecessary emotional harm could be avoided. Therefore, the application of High-Fidelity Simulation has the potential to develop a midwifery workforce that is better equipped to practice safely and more effectively at the point of registration, which could reduce mortality and morbidity rates for women and babies.