Job role and stress influence student movement during postpartum haemorrhage simulation: an exploratory study.

Introduction: Postpartum haemorrhage is the leading cause of maternal death. Healthcare simulations are an educational tool to prepare students for infrequent high-risk emergencies without risking patient safety. Efficiency of movement in the simulation environment is important to minimize the risk of medical error. The purpose of this study was to quantify the movement behaviours of the participants in the simulation and evaluate the relationship between perceived stress and movement. Methods: N=30 students participated in 10 high-fidelity medical simulations using an adult patient simulator experiencing a postpartum haemorrhage. The participants completed the State-Trait Anxiety Inventory prior to the simulation to measure perceived stress. Physical movement behaviours included walking around the simulation, time spent at bedside, arm movements, movements without purpose, looking at charts/vitals and total movement. Results: Midwife (MW) students spent significantly more time walking (p=0.004) and looking at charts/vitals (p=<0.001) and significantly less time at bedside (p=<0.001) compared to obstetric (OB) students. The MW students demonstrated significantly more total movements compared to the OB students (p=<0.001). There was a significant, moderate, positive relationship between perceived stress and total movement during the simulation for the MW group (r=0.50, p=0.05). There was a trend for a moderate, positive relationship between perceived stress and total movement during the simulation for the OB group (r=0.46, p=0.10). Conclusions: Physical movement during a simulation varies by job role and is influenced by perceived stress. Improved understanding of physical movement in the simulation environment can improve feedback, training and environmental set-up.