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The use of a stronger instructional design by implementing repetitive practice in simulation-based obstetric team training: trainees’ satisfaction
  1. Anne A C van Tetering1,
  2. Annemarie F Fransen1,
  3. M Beatrijs van der Hout-van der Jagt1,2,
  4. S Guid Oei1,3
  1. 1Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, The Netherlands
  2. 2Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
  3. 3Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
  1. Correspondence to Anne A C van Tetering, Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands; anne_van_tetering{at}


Objective This study compares satisfaction levels from multiprofessional obstetric care teams about simulation-based obstetric team training courses with and without the instructional design feature repetitive practice.

Methods The present study is part of a multicentre cluster-randomised controlled trial (TOSTI trial) that investigated the effectiveness of a 1 day, multiprofessional, simulation-based obstetric team training. The initial training group received a training which was designed based on best practice. After 1 year, the control group received a training course in which the instructional design was changed by providing repetitive practice. All participants were asked to fill in a 29-item evaluation form with seven questions about baseline characteristics and 22 questions about training features. The questions about training features could be rated on a scale of 1 to 5. Finally, all participants were asked to rate the total training day on a scale of 1–10.

Results The best practice group consisted of 471 trainees and the repetitive practice group of 549, including gynaecologists, residents, midwives and nurses. The best practice group rated the total training day significantly higher than the repetitive practice group (mean 8.8, SD 0.6 and mean 8.7, SD 0.6; p<0.003, Cohen’s d=0.19). Several training features were also scored higher in the best practice group.

Conclusion This study showed that obstetric healthcare professionals rated a simulation-based obstetric team training course, with and without repetition of scenarios, both high. The training without the repetitive elements gained higher scores for the total training dayand several, and several training features were scored higher. The difference between the mean scores and the effect sizes for the training features were small. This implies that repetitive practice can be integrated in simulation-based team training to optimise learning effects, with small effects on trainees satisfaction.

  • instructional design
  • repetitive practice
  • simulation training
  • teamwork

Statistics from


  • Contributors GO was involved in conception and design of the study. AF and AACvT were responsible for data collection and for conducting the analysis. AACvT and AF drafted the manuscript. All authors reviewed the manuscript critically and approved submission.

  • Funding The TOSTI trial is funded by ZonMW, the Netherlands Organisation for Health Research and Development, grant (170992303). This organisation was not involved in the design, implementation or analysis of the study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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