Abstract
Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide, necessitating robust, hands-on clinical competencies among graduating midwifery students. This randomized controlled educational trial evaluated the efficacy of a high-fidelity simulation-based training (SBT) program compared to conventional lecture-based instruction on midwifery students' clinical competencies, knowledge retention, and self-efficacy in managing acute obstetric hemorrhage. A cohort of 84 final-year undergraduate midwifery students was randomized into an intervention group (n = 42), which received high-fidelity scenario-based simulation with structured debriefing, and a control group (n = 42), which received traditional didactic instruction and video demonstrations. Objective structured clinical examinations (OSCEs), standardized knowledge questionnaires, and validated self-efficacy scales were administered at baseline, immediately post-intervention, and at a six-week follow-up. The intervention group demonstrated significantly higher overall OSCE performance scores (mean = 88.45, SD = 5.32) compared to the control group (mean = 71.20, SD = 6.84; p < 0.001) immediately post-training, with superior retention at six weeks (p < 0.001). Furthermore, students undergoing simulation training exhibited markedly shorter time-to-intervention intervals for blood loss quantification and uterotonic administration, as well as heightened perceived self-efficacy in emergency communication. These findings confirm that integrating high-fidelity simulation into midwifery curricula significantly bridges theoretical knowledge and clinical execution, fostering essential non-technical and procedural proficiencies required to mitigate preventable maternal morbidity.
