Learning in Pairs in Episiotomy Training

February 18, 2026 updated by: Şilan YAVUZ, Sakarya University

The Effect of Using the Learning in Pairs (LiP) Model in Episiotomy Education on Students' Episiotomy Knowledge, Self-Efficacy, and Anxiety Levels

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

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. A study conducted with midwifery students reported a deficiency in the current educational practices of midwives regarding episiotomy. 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. There are significant deficiencies in current educational practices regarding midwives' acquisition of episiotomy skills. 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. 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. In a study using a calf tongue model, participants reported that this model was similar to perineal injury repair in clinical practice. 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. 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. 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.

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. 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. 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.

Study Type

Interventional

Enrollment (Actual)

92

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Adapazarı
      • Sakarya, Adapazarı, Turkey (Türkiye), 00054
        • Sakarya University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Students who agree to participate in the study,
  • Students enrolled in the midwifery program,
  • Students enrolled in the Normal Birth and Postpartum Period course.

Exclusion Criteria:

  • Students who did not attend the theoretical part of the episiotomy course,
  • Students who did not attend the episiotomy laboratory course,
  • Students who have previously taken the Normal Birth and Postpartum Period course and have experience in episiotomy skills.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control group (application with calf tongue)
At Sakarya University Midwifery Department, episiotomy laboratory practice is routinely performed on calf tongues under instructor supervision as part of the Normal Birth and Postpartum Period course.Therefore, the group performing the practice on calf tongues has been accepted as the control group.The instructor will first provide theoretical training on episiotomy to the group arriving at the laboratory.The training content includes the importance of episiotomy, its risks, indications, contraindications, timing of episiotomy, materials used, types of episiotomy, episiotomy repair and timing, suture techniques, and midwifery care in episiotomy.Immediately after the training, episiotomy repair (suture techniques) will be practiced.Eight students will be accepted for the practice at the same time, and each student will sit at a single-person practice table.The instructor will try to pay attention to each student and will assist with suture techniques as long as the student requests it.
Experimental: Experimental group (Application with learning in pairs)
The instructor first provides the group arriving at the episiotomy laboratory with theoretical training on episiotomy,covering the importance of episiotomy,its risks, indications, contraindications, timing of episiotomy,materials used,types of episiotomy,episiotomy repair-timing, suture techniques,midwifery care in episiotomy.At the end of the theoretical training,they will watch videos related to suture techniques.After the training, they will proceed to the episiotomy repair(suture techniques) application.Students will be taken to the laboratory in pairs.A maximum of 4 pairs of students will be taken to the laboratory at the same time.The pairs will share the same table.Students will be instructed to begin episiotomy repair on a calf tongue in accordance with their episiotomy application knowledge and skills and to perform the repair procedure by supporting each other during the repair.Students are expected to repair the incision on the calf tongue separately in pairs.
Other: Application with learning in pairs
Students will be taken to the laboratory in pairs. A maximum of 4 pairs of students will be taken to the laboratory at the same time. The pairs will share the same table. Students will be instructed to begin episiotomy repair on a calf tongue in accordance with their episiotomy application knowledge and skills and to perform the repair procedure by supporting each other during the repair. Students are expected to repair the incision on the calf tongue separately in pairs.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
State Anxiety Inventory (STAI)
Time Frame: One hour before and immediately after the application
The inventory consists of a total of 20 items. Ten items (items 1, 2, 5, 8, 10, 11, 15, 16, 19, and 20) in the state anxiety section are reverse-coded. The inventory is a 4-point Likert scale rated as "Not at all," "A little," "A lot," and "Completely." The total weighted score obtained for direct statements is calculated by subtracting the total weighted score of reverse statements and adding a fixed value (35 points) to this number. The total score ranges from 20 to 80. A high score on the inventory indicates a high level of anxiety, while a low score indicates a low level of anxiety.
One hour before and immediately after the application
Episiotomy Self-Efficacy Scale
Time Frame: One hour before and immediately after the application
The scale consists of a total of 17 items and four subscales (cognitive, emotional, motivational, and psychomotor). The scale is a 5-point Likert scale, and the ratings are (1) Strongly Disagree, (2) Somewhat Disagree, (3) Undecided, (4) Somewhat Agree, (5) Strongly Agree. There are no reverse-coded items on the scale. The lowest possible total score on the scale is 17, and the highest possible score is 85. High scores on the scale indicate high episiotomy self-efficacy. The Cronbach's Alpha reliability coefficient for the scale as a whole is reported as 0.955.
One hour before and immediately after the application
Episiotomy Information Form
Time Frame: One hour before and immediately after the application
This form consists of 25 statements (questions) designed to measure students' level of knowledge about episiotomy. Thirteen of these statements are true, and twelve are false. Participants are asked to respond with "True," "False," or "I don't know." Students' "True" responses to the statements will be scored as 1 point, while 'False' and "No opinion" responses will be scored as 0 points. The lowest possible score on the knowledge form is 0, and the highest possible score is 25.
One hour before and immediately after the application

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sakarya University

Investigators

  • Study Director: Yasemin Hamlacı, Sakarya University Department of Midwifery

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2026

Primary Completion (Actual)

January 31, 2026

Study Completion (Actual)

January 31, 2026

Study Registration Dates

First Submitted

January 7, 2026

First Submitted That Met QC Criteria

January 7, 2026

First Posted (Actual)

January 15, 2026

Study Record Updates

Last Update Posted (Actual)

February 23, 2026

Last Update Submitted That Met QC Criteria

February 18, 2026

Last Verified

December 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 12122025

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Learning in Pairs

Clinical Trials on Application with learning in pairs

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Finland

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe