Learning in Pairs in Episiotomy Training

Overview

There are significant shortcomings in current educational practices regarding midwives acquiring episiotomy skills. The acquisition of episiotomy skills by midwifery students begins in episiotomy skills laboratories. Students acquiring these skills in the laboratory involves being able to assess the indications for episiotomy and perform appropriate interventions based on the indication. Numerous intervention studies have been conducted on teaching episiotomy skills to students. In most of these studies, sponges, chickens, and cow tongues were preferred as simulators, and the effectiveness of the training was evaluated by applying different teaching methods. In addition to simulators used in episiotomy training, there are teaching methods used in midwifery clinical education, one of which is the paired learning model. This study was designed as a randomized controlled trial to evaluate the effect of the learning in pairs model in episiotomy training on episiotomy knowledge level, episiotomy self-efficacy, and state anxiety levels among midwifery students. The study will be conducted with a total of 92 midwifery students, divided into an intervention group (n=46) and a control group (n=46) (1:1 ratio). Data will be collected using the "Student Information Form," "Episiotomy Information Form," "Episiotomy Self-Efficacy Scale," and "State Anxiety Inventory" in pre-test and post-test formats. The research sample will consist of all students enrolled in the midwifery program and the Normal Birth and Postpartum Period course who agree to participate in the study. At the end of the study, it is expected that the effects of the learning in pairs (LiP) model on students' learning in episiotomy repair training will be explained. It is believed that the research results will contribute to midwifery education by enriching the methods used in midwifery students' education.

Childbirth is a significant turning point in a woman's life and can occur either spontaneously or with intervention. In assisted births, episiotomy and its repair are among the most commonly performed interventions, and midwives play an active role in episiotomy repair. Episiotomy is a common surgical incision made in the bulbocavernosus muscle at the end of the second stage of labor to reduce the risk of laceration and preserve perineal tone (Ahmed et al., 2023; Ghulmiyyah et al., 2022). A study conducted with midwifery students reported a deficiency in the current educational practices of midwives regarding episiotomy (Webb et al., 2021). In particular, a lack of confidence was observed in the decision-making mechanisms regarding when and how to perform clinically indicated episiotomies, especially in recognizing the indications for episiotomy (Gould et al., 2023). There are significant deficiencies in current educational practices regarding midwives' acquisition of episiotomy skills (Webb et al., 2021). Teaching episiotomy skills to midwifery students begins in episiotomy skills laboratories. Students acquiring these skills in the laboratory involves being able to assess the indications for episiotomy and perform the appropriate interventions based on the indication. However, being monitored and observed by the instructor during skills training can cause anxiety in students. The anxiety felt by students can negatively affect the learning process, reducing their success levels and self-efficacy (Demirel et al., 2020). Many intervention studies have been conducted on the type of intervention, anxiety, and self-efficacy levels in teaching episiotomy skills to students. In most of these studies, sponge, chicken, and calf tongue were preferred as simulators, and the effectiveness was evaluated by applying different teaching methods (Gönenç et al., 2025; Yılar Erkek \& Öztürk Altınayak, 2021; Yolcu et al., 2025). In a study using a calf tongue model, participants reported that this model was similar to perineal injury repair in clinical practice (Faithfull-Byrne et al., 2017). In a study using a chicken model, it was determined that it was an effective educational material in increasing midwifery students' perceived confidence in performing episiotomy, but no significant difference was found in terms of its effect on their anxiety levels (Gönenç et al., 2025). In a systematic review evaluating the effectiveness of simulation methods used in episiotomy training, studies using a calf tongue simulator reported that students had higher self-confidence scores compared to those using a sponge model. In a study using only the calf tongue, it was observed that the calf tongue reduced students' anxiety levels and increased their self-efficacy levels (Şen Aytekin et al., 2022). Self-efficacy is an important factor in the process of students acquiring skills, and in every application, the acquired skill should be measured concretely and the level of contribution of the application to education should be proven (Demirel et al., 2020). One of the methods used in midwifery clinical education is the learning in pairs (LiP) model. The learning in pairs model offers collaborative learning opportunities in clinical practice, making it a beneficial and alternative approach to clinical learning, especially when mentors are insufficient (Hill et al., 2020; Widarsson et al., 2025). In this approach, students are guided and supported to work collaboratively with other students under the guidance of a coach to provide patient- or practice-focused care. The coach is a mentor who works with groups of 3-6 students in their field, using only coaching approaches in student supervision. The coach encourages students and, rather than providing them with answers, communicates with them and draws on their knowledge. Student groups receive coaching to provide care in a placement setting (clinic, laboratory, etc.) and to work with other students. In the peer learning model, coaching is a fundamental feature of the learning philosophy. The student's knowledge, questioning power in guidance, ability to collaborate, and taking responsibility are other fundamental characteristics of this model (Faithfull-Byrne et al., 2017; Hill et al., 2020). To the best of our knowledge, there is no literature on a study where this model, primarily applied in the clinic, has been implemented with midwifery students in episiotomy laboratories-which can be considered the preclinical setting of midwifery clinics-using simulators. Therefore, this study aimed to evaluate the effect of episiotomy application training given with the calf tongue and paired learning model on midwifery students' episiotomy knowledge level, episiotomy self-efficacy, and state anxiety levels.