1 Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences

2 Departments of Therapy , Mashhad University of Medical Sciences, Mashhad, Iran

3 Departments of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran


INTRODUCTION: Shoulder dystocia is one of the obstetric emergencies that are accompanied to
serious risks for mother and fetus. It necessitates making the method of training of shoulder dystocia
management more efficient, i.e., better management and giving services with higher quality. Thus,
this study was carried out to compare the impact of training by simulation and oral technique on
the skill of the employed midwives in obstetric clinics at Mashhad city (Iran) in shoulder dystocia
management during 2012.
METHODS: The current research is a double‑group clinical trial that was conducted on 51 members of
the employed midwives in the obstetric clinic at Mashhad city in 2012. The questionnaire of personal
specification and awareness about shoulder dystocia and practical examination (objective‑structured
clinical examination) were employed as tools for data collection. The learners were divided into two
groups by randomized allocation. Training was done by the presentation of lecture in the oral content
group and a short movie was displayed at the end of it. The shoulder dystocia management technique
was simulated in another group and through role‑playing of instructor application of moulage (station)
training was conducted. The period of the training course (4 h) and content of the educational
workshop was identical for both groups. The practical examination was held for the learners
before and immediately after training course. The given data were analyzed by means of statistical
descriptive tests including Mann–Whitney U‑test and Wilcoxon test via SPSS software (version 16).
The significance level was considered as (P < 0.05) in all cases.
RESULTS: The total mean score was significantly increased for the variable of shoulder
dystocia management skill after intervention in both groups (P < 0.0001). Similarly, the results of
Mann–Whitney U‑test statistical tests indicated that total mean score for the variable of shoulder
dystocia management skill after the intervention was significantly greater in simulation group than
in an oral group (P = 0.040).
CONCLUSION: Training in simulated delivery room by means of role‑playing is an efficient method
for training shoulder dystocia management skill, so it is recommended to use this program in the
training of this skill.


1. Crofts JF, Fox R, Ellis D, Winter C, Hinshaw K, Draycott TJ.
Observations from 450 shoulder dystocia simulations: Lessons
for skills training. Obstet Gynecol 2008;112:906‑12.
2. Deering S, Poggi S, Macedonia C, GhermanR, Satin AJ. Improving
resident competency in the management of shoulder dystocia
with simulation training. Obstet Gynecol 2004;103:1224‑8.
3. Cuningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ,
Spong CY. Williams Obstetrics. New York: McGrawhill; 2010.
4. Dajani NK, Magann EF. Complications of shoulder dystocia.
Semin Perinatol 2014;38:201‑4.
5. McFarland MB, Langer O, Piper JM, Berkus MD. Perinatal
outcome and the type and number of maneuvers in shoulder
dystocia. Int J Gynaecol Obstet 1996;55:219‑24.
6. Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott TJ. Training
for shoulder dystocia: A trial of simulation using low‑fidelity and
high‑fidelity mannequins. Obstet Gynecol 2006;108:1477‑85.
7. Ramezani M, Kermanshahi S. A survey of the quality of clinical
education in nursing. Jahrom Med J 2011;9:9‑12.
8. Rahimikian F, Mirmolaei T, Samizadeh Z, Shirazi M, Mehran A.
Evaluation of knowledge and practice of newly graduated
midwives in normal vaginal delivery in hospitals affiliated
to Tehran university of medical sciences. Iran J Med Educ
9. Modares M, Mirmolaee ST, Mirmohammadalie M, Valizadeh MA,
Ziyaee M, Hashemi FA. The Effects of Education on the Use of
Partogram to Control the Quality of Care Offered by Midwives.
Research Journal of Biological Sciences. 2009;4:152.
10. Borotis S, Poulymenakou A. E‑learning readiness components:
Key issues to consider before adopting e‑learning interventions.
In: Nall J, Robson R, editors. Proceedings of World Conference on,
E‑Learning in Corporate G, Healthcare, and Higher Education.
Chesapeake, VA: AACE; 2004 p. 1622‑9.
11. Erfanian F, Khadivzadeh T, Khadem N, KhajedelooieM. The effect
of teaching by role playing on students’ counseling and screening
skills toward IUD clients. Iranian J Med Educ 2008‑2009;8:275‑83.
12. Kordi M, Rashidi Fakari F, Mazloum SR, Khadivzadeh T,
Akhlaghi F. Comparison between the efficacy of web‑based,
simulation and conventional training on knowledge and skills
retention of midwifery students in management of postpartum
hemorrhage. Iran J Obstet Gyneocol Infertil 2014;16:8‑14.
13. Goffman D, Heo H, Chazotte C, Merkatz IR, Bernstein PS. Using
simulation training to improve shoulder dystocia documentation.
Obstet Gynecol 2008;112:1284‑7.
14. Blue AV, Stratton TD, Plymale M, DeGnore LT, Schwartz RW,
Sloan DA. The effectiveness of the structured clinical instruction
module. Am J Surg 1998;176:67‑70.
15. Kooiker CH, Scutchfield FD. Barriers to prescribing the
Copper T 380A intrauterine device by physicians. West J Med
16. Hamilton R. Nurses’ knowledge and skill retention following
cardiopulmonary resuscitation training: A review of the literature.
J Adv Nurs 2005;51:288‑97.
17. Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D,
Scalese RJ. Features and uses of high‑fidelity medical simulations
that lead to effective learning: A BEME systematic review. Med
Teach 2005;27:10‑28.
18. Gaba DM. The future vision of simulation in health care. Qual
Saf Health Care 2004;13 Suppl 1:i2‑10.
19. Comeau R, Craig C. Does teaching of documentation of shoulder
dystocia delivery through simulation result in improved
documentation in real life? J Obstet Gynaecol Can 2014;36:258‑65.
20. Reynolds A, Ayres‑de‑Campos D, Pereira‑Cavaleiro A,
Ferreira‑Bastos L. Simulation for teaching normal delivery and
shoulder dystocia to midwives in training. Educ Health(Abingdon)
21. Amini A, Hassanzadeh Salmasi S, Shaghaghi A, Safaii N,
Sedaghat K. The effect of clinical skills training on medical
students clinical competencies in the management of vaginal
delivery. Iran J Med Educ 2005;5:7‑12.
22. Sharemi H, Asgari F. A training course on basic gynecological
clinical skills and its effect on medical student’s performance
in Guilan university of medical sciences. Iran J Med Educ
23. Woolliscroft JO. Medical student clinical education. International
Handbook of Research in Medical Education.Springer
Netherlands; 2002. p. 365‑80.
24. Craik FI, Lockhart RS. Levels of processing: A framework for
memory research. J Verbal Learning Verbal Behav 1972;11:671‑84.
25. Petty RE, Cacioppo JT. Attitudes and Persuasion: Classic and
Contemporary Approaches. Dubuque Westview Press; 1981.
26. Rochester S, Kilstoff K, Scott G. Learning from success: Improving
undergraduate education through understanding the capabilities
of successful nurse graduates. Nurse Educ Today 2005;25:181‑8.