European Journal of Cardiovascular Medicine

The landscape of medical education is rapidly evolving to address the dual imperatives of robust knowledge acquisition and the development of essential clinical competencies. In high-stakes fields such as obstetrics and gynaecology, where clinical precision and timely decision-making are critical, the method and quality of training play a pivotal role in shaping competent healthcare professionals^1,2.

Traditionally, bedside clinic-based teaching has served as the cornerstone of clinical education. It provides learners with real-time patient interaction, fostering the development of communication skills, bedside manners, clinical reasoning, and procedural proficiency under supervision^2,4. However, bedside learning is frequently constrained by inconsistent patient availability, ethical concerns, variability in case complexity, and a lack of uniformity in clinical exposure⁴.

In response to these limitations, simulation-based learning has gained prominence as a complementary educational strategy. It employs high-fidelity mannequins, task trainers, and virtual simulation to replicate obstetric emergencies and procedural scenarios in a controlled, risk-free setting^1,3. Simulation allows for repetitive practice, immediate feedback, and exposure to high-risk or rare clinical situations, which are often missed in conventional bedside teaching^3,5. Studies have demonstrated that simulation improves team communication, procedural accuracy, and learner confidence in managing obstetric emergencies⁶.

Despite its increasing adoption, the relative effectiveness of simulation-based learning compared to traditional bedside teaching remains a subject of ongoing inquiry. This study aims to compare both modalities in terms of knowledge retention, skill acquisition, student confidence, and satisfaction, thereby contributing evidence to optimize teaching strategies in undergraduate obstetrics and gynaecology education.

Study Design and Setting:
This was a descriptive cross-sectional, quasi-experimental institutional study conducted in the Department of Obstetrics and Gynaecology at a tertiary medical college. The study was carried out over a period of one year, from May 2024 to April 2025.

Study Population:
The participants included undergraduate MBBS students from Phase II, Phase III Part 1, and Phase III Part 2 who had completed their obstetrics and gynaecology clinical postings. A total of 450 students were included using a purposive sampling technique based on inclusion criteria.

Inclusion Criteria:

Students who completed their clinical postings in the Department of Obstetrics and Gynaecology.

Students who consented to participate in the study.

Exclusion Criteria:

Students who were absent for any part of the intervention.

Incomplete questionnaire responses.

Intervention:
All participants were exposed to two distinct teaching-learning modalities over two-week periods:

Bedside Clinic Learning: Included direct patient interactions for history taking, physical examination, obstetric and gynaecological examinations, and supervised participation in routine obstetric procedures.

Simulation-Based Learning: Conducted using structured simulation sessions with high-fidelity mannequins, task trainers, and virtual reality modules replicating common and high-risk obstetric scenarios.

Data Collection Tools and Procedure:
A validated and pre-tested questionnaire was administered at the end of each teaching module. It assessed four domains: knowledge retention, skill acquisition (via OSCE), self-reported confidence, and satisfaction. Feedback was collected after each session and at the end of the postings. Formative assessments were also conducted using structured checklists and grading rubrics.

Quality Control and Confidentiality:
Participants were instructed to complete the questionnaire only once with genuine responses. Confidentiality was ensured by anonymizing the responses and securing data access to authorized personnel only.

Data Analysis:
Descriptive statistics were used to summarize demographic variables and outcomes. Differences between groups were analyzed using independent t-tests and chi-square tests as appropriate. A p-value of <0.05 was considered statistically significant.

Ethical Considerations:
The study protocol was approved by the Institutional Ethics Committee. Written informed consent was obtained from all participants. Confidentiality and voluntary participation were maintained throughout the study.

A total of 450 undergraduate medical students from Phase II, Phase III Part 1, and Part 2 MBBS participated in the study. All students underwent both simulation-based learning and bedside clinic-based teaching in obstetrics and gynaecology, followed by assessments on knowledge retention, skill acquisition, confidence, and satisfaction.

Knowledge Retention:
post-session evaluations revealed that students who participated in simulation-based learning scored higher in knowledge assessments compared to those in the bedside clinic group. The mean score for simulation-based learning was 81.6 ± 6.4, whereas it was 76.2 ± 7.8 for the bedside clinic group, with the difference being statistically significant (p < 0.01) (Table 1).

Table 1: Knowledge Retention Scores

Figure1. Knowledge Retention Scores by Learner Method

Skill Acquisition:
Objective Structured Clinical Examination (OSCE) scores were used to assess clinical skill acquisition. Students trained through simulation scored significantly higher (84.2 ± 5.1) compared to their bedside-trained counterparts (77.5 ± 6.3), with p < 0.001, indicating superior skill performance among those in the simulation-based learning group (Table 2).

Table 2: Skill Acquisition (OSCE Scores)

Figure 2. Skill Acquisition (OSCE Scores) by Learning Method

Student Confidence:
Self-reported confidence levels, assessed using a 5-point Likert scale, showed that 78% of students felt “very confident” in managing obstetric procedures following simulation-based training, in contrast to 58% in the bedside clinic group. Moderate confidence levels were reported by 18% of simulation group and 30% of bedside group, while low confidence levels were minimal in both groups (Table 3).

Table 3: Student Confidence Ratings (Likert Scale 1–5)

Figure 3. Student Confidence Ratings by Learner Method

Student Satisfaction:

Feedback on teaching methods revealed higher satisfaction levels among students exposed to simulation. About 85% of students rated simulation-based learning as “highly effective” compared to 71% for bedside clinics. A small proportion of students in both groups rated their experience as “neutral” (3% vs. 7%, respectively), indicating overall favorable perceptions for both modalities, with a preference towards simulation (Table 4).

Table 4: Student Satisfaction Ratings

Figure 4. Student Satisfaction Ratings by Learner Method

Qualitative Feedback:
Thematic analysis of qualitative feedback highlighted that simulation-based learning was appreciated for reducing procedural anxiety and enhancing conceptual clarity. However, it was noted to be less effective in areas such as real-time decision-making, communication skills, and empathy, which were better fostered through bedside clinical exposure. Bedside clinics were particularly valued for providing realistic patient interactions and developing holistic clinical competencies

This study sought to evaluate and compare the effectiveness of bedside clinic-based learning and simulation-based learning in obstetrics and gynaecology education among undergraduate medical students. The findings demonstrate that simulation-based learning significantly improves knowledge retention and procedural skill acquisition, while bedside clinics contribute more substantially to the development of communication, empathy, and real-time clinical decision-making abilities.

Students exposed to simulation-based modules scored higher in both knowledge tests and OSCEs. This aligns with prior evidence suggesting that simulation provides a structured and repetitive learning environment that enhances psychomotor skills and clinical preparedness, especially for managing high-risk and uncommon obstetric conditions^8,9. Additionally, simulation has been shown to reduce performance anxiety and foster confidence among learners by allowing them to practice without the fear of harming real patients¹¹. Virtual simulation, as emphasized in recent literature, offers scalable and interactive platforms that enhance learner engagement and conceptual clarity^8,12.

However, despite these advantages, simulation was found to be relatively less effective in cultivating interpersonal communication and emotional responsiveness. Students trained through bedside clinics reported greater improvement in empathy, patient-centered communication, and adaptability skills that are essential in clinical practice but difficult to replicate in simulated environments^7,10. The authentic patient interactions inherent to bedside teaching provide valuable experiential learning that strengthens clinical reasoning and professional identity formation¹⁰.

Although satisfaction levels were high in both groups, a slight preference was noted for simulation-based learning, likely due to its predictability, feedback mechanisms, and structured design. Nevertheless, students acknowledged the indispensable role of bedside clinics in contextualizing their learning experiences and reinforcing theoretical knowledge.

These findings reinforce the notion that neither modality alone is sufficient to fulfill all educational objectives. A hybrid model—integrating simulation and bedside teaching—may represent the most effective strategy for comprehensive training in obstetrics and gynaecology. Such an approach would allow educators to simultaneously address the cognitive, technical, and affective learning domains, thereby producing well-rounded and clinically competent graduates^7,9,12.

Limitations:
This study was conducted at a single institution, which may limit generalizability. Additionally, subjective feedback may have introduced response bias despite efforts to maintain anonymity.

This study highlights the distinct advantages of both simulation-based learning and bedside clinic teaching in obstetrics and gynaecology education. Simulation-based learning significantly enhances knowledge retention and procedural skill acquisition, providing a safe and structured environment for repeated practice. In contrast, bedside clinics promote real-world clinical reasoning, patient communication, and empathy—key aspects of holistic medical training. While students favored simulation for its clarity and reduced anxiety, bedside exposure was invaluable for developing interpersonal skills. Therefore, an integrated or hybrid teaching approach, combining both modalities, is recommended to optimize learning outcomes and prepare medical students for the diverse challenges of clinical practice in obstetrics and gynaecology.

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