Development and evaluation of a high-fidelity lactation simulation model for health professional breastfeeding education

Abstract

Background: A key reason for premature cessation of breastfeeding is inadequate support from healthcare providers. Most physicians and nurses do not feel confident in their ability to support families with breastfeeding initiation or maintenance. Increasing health professional confidence in clinical lactation skills is key to improving maternal and child health outcomes. High-fidelity (realistic) simulators encourage learner engagement, resulting in increased clinical skills competency, confidence, and transfer to patient care. Lactation educators teach with lowfidelity cloth and single breast models. There are no high-fidelity breast simulators for health professional education in clinical lactation. Development and evaluation of a high-fidelity lactation simulation model: In this commentary we describe the development of a high-fidelity Lactation Simulation Model (LSM) and how physician residents, nurse-midwifery students, and clinical lactation experts provided feedback on LSM prototypes. Limitations: The user-testing described in this commentary does not represent comprehensive validation of the LSM due to small sample sizes and the significant conflict of interest. Conclusion: For breastfeeding rates to improve, mothers need support from their nurses, midwives, pediatricians, obstetricians and gynecologists, and all healthcare staff who interact with pregnant and lactating women. Clinical education with high-fidelity breastfeeding simulators could be the ideal learning modality for trainees and hospital staff to build confidence in clinical lactation skills. The ability of a high-fidelity breastfeeding simulator to increase a learner's lactation knowledge and psychomotor skills acquisition, retention, and transfer to patient care still needs to be tested.

Are the doctors of the future ready to support breastfeeding? A cross-sectional study in the UK

“…During a development trial, physician residents reported benefits of being able to practice comfortable hand positioning during the breast assessment. Breastfeeding medicine physicians and midwifery students evaluated the final model as having realistic representations of lactation-related pathology and an effective breast pump mechanism to simulate hand expressing [37].…”

Midwifery students better approximate their self-efficacy in clinical lactation after reflecting in and on their performance in the LactSim OSCE

“…One student was removed from all analyses, as she did not have a partner for the OSCE and talked through the case instead of performing the skills. Additional demographic information has been described elsewhere [ 12 ].…”

“…The participants agreed (5.9/7) the expert in-room facilitator provided tangible and realistic suggestions for improvement. The participants ( n = 7) indicated that the LSMs are made very well, improved the realism of the encounter (5.7/7), and they were key for supporting hands-on practice in clinical lactation [ 12 ]. During the focus group, the participants indicated that role-playing is a great modality for learning because of the ability to practice being face-to-face with a mock breastfeeding patient.…”

“…An OSCE in clinical lactation (LactSim OSCE) with all three elements of fidelity including conceptual, psychological, and physical is now possible due to the development of a high-fidelity Lactation Simulation Model (LSM) [ 8 , 12 ]. We developed a hybrid, high-fidelity LactSim OSCE where nurse-midwifery students took turns role-playing as a breastfeeding patient by wearing the LSM.…”

Prenatal Provider Breastfeeding Toolkit: Results of a Pilot to Increase Women’s Prenatal Breastfeeding Support, Intentions, and Outcomes

“…Further effectiveness differs by provider type (Balyakina et al, 2016; Uzumcu et al, 2020; Wallenborn et al, 2018) with women receiving prenatal care from obstetricians less likely to sustain breastfeeding, possibly due to different training, or workload, or competing priorities (Garner et al, 2016; Rosen-Carole et al, 2020), especially in practices that primarily serve women from lower income households (Havens & Wines, 2019; Qureshey et al, 2020; Shen & Rudesill, 2016). Many obstetric providers express interest in initiatives to improve their patients’ breastfeeding rates; more efficient methods for implementing the ACOG recommendations are needed (Lutenbacher et al, 2016; Rosen-Carole et al, 2020; Sadovnikova et al, 2020).…”