Factors influencing implementation of simulation in nursing and midwifery training in Malawi.

Background: The study explored factors influencing implementation of simulation-based education (SBE) in nursing and midwifery education in Malawi. Aim: This study aimed to identify factors influencing nursing and midwifery educators in selected training institutions and clinical sites. Setting: The study covered one district and four central hospitals, five professional training institutions, Ministry of Health and Nurses and Midwives Council of Malawi officials. Methods: Using mixed-methods approach, quantitative data were gathered from 293 participants, including 149 final-year nursing and midwifery students, and 144 clinical instructors. Qualitative data were obtained from 24 faculty members, 11 clinical instructors and two key informants. Researchers conducted 37 in-depth interviews, 10 focus group discussions and eight desk reviews. Descriptive statistics were used to analyse the quantitative data, while content analysis was used for qualitative findings. Results: Five themes emerged from qualitative data: absence of simulation in regulatory body syllabi, insufficient formal training, demand for knowledgeable clinical instructors, inadequate human and material resources, and resistance to change. Survey results indicated that 83% of the participants had theoretical SBE knowledge but lacked practical skills, with only 13% considering SBE as a current teaching method. Educators emphasised lack of infrastructure, skills laboratories, teaching hospitals, equipment, and a deficit in formal training as critical barriers to SBE implementation. Conclusion: The study concluded that skilled educators, appropriate infrastructure and resources could facilitate SBE implementation in Malawi. Contribution: Recommendations included regulatory body support, formal training for educators, utilisation of low-fidelity simulators, and establishment of SBE centres and corners in health facilities.