Simulation-based education improves postpartum hemorrhage management knowledge and skills: a randomized controlled trial

Background Postpartum hemorrhage is a time-sensitive obstetric emergency that requires rapid assessment and coordinated management. This study evaluated the effects of simulation-based education on midwifery students' postpartum hemorrhage management knowledge, skill performance, and self-efficacy . Methods An assessor-blinded randomized controlled trial was conducted with 45 third-year midwifery students. Participants were randomly allocated to an intervention group that received traditional theoretical education followed by simulation-based education ( n = 23) or a control group that received traditional theoretical education only ( n = 22). Knowledge and self-efficacy were assessed before, immediately after, and four weeks after the intervention; skill performance was assessed immediately after and at four weeks. Results Knowledge scores increased in both groups. A significant between-group difference was observed immediately after the intervention ( p = 0.047), whereas the between-group difference at four weeks was not statistically significant ( p = 0.541). In the linear mixed-effects analysis, the overall group × time interaction for knowledge was not significant [Wald χ 2 (2) = 2.56, p = 0.279]. Skill performance was substantially higher in the intervention group at both post-intervention assessments (both p < 0.001); the post-test mean difference was 8.83 points (95% CI 4.85–12.81; Cohen's d = 1.358), and the group × time interaction from post-test to four weeks was not significant ( p = 0.742), indicating stability of the between-group difference over follow-up. Self-efficacy increased in both groups, with no significant overall group × time interaction [Wald χ 2 (2) = 3.10, p = 0.212]. Conclusion Simulation-based education was associated with a short-term between-group advantage in PPH-related knowledge and with a large, stable post-intervention advantage in skill performance across four weeks. No clear additional effect on self-efficacy was demonstrated. Because skill performance was not measured at baseline, the skill findings should be interpreted with appropriate caution. Clinical trial registration ClinicalTrials.gov NCT07618442, https://clinicaltrials.gov/study/NCT07618442 .