The efficiency of digital midwifery training: a randomized controlled trial in Benue State, Nigeria

Background: Health education institutions in African countries like Nigeria are experiencing major increases in the number of students enrolled, but lack sufficient instructors to train them. Digital learning could improve efficiency in health education if proven to successfully augment knowledge and skills. A needs assessment with midwifery students confirmed that digital learning could be feasible and welcomed. Our study objective was to determine if digital delivery of the Fundamental Interventions, Referral and Safe Transfer (FIRST) course is at least equally effective for training midwifery students as small-group delivery of the same program. Methods: A noninferiority crossover randomized controlled trial was conducted with 130 second-year students from 2 midwifery schools in Benue State, Nigeria. Students were randomly assigned into 6 cohorts. Each cohort received half of the course on a mobile phone Learning Management Platform, and the other half through standard small-group teaching. Students' knowledge, thinking and technical skills were assessed using a pre-test and post-test, Objective Structured Clinical Exam (OSCE) and daily modular quizzes. A difference-in-difference analysis was used. Results: Students' knowledge and thinking skills in the digital learning arm (75.26%) did not significantly differ from that in the small-group learning arm (75.02%, p = 0.404). Students in both groups significantly improved their knowledge by 20% compared with pre-test results. Some differences were observed between digital and small-group learning, disaggregating by module and midwifery school. Although there was a trend in small-group teaching of technical skills being more effective, no significant differences between groups were observed in the OSCE (p = 0.06). Students in both learning groups learned equally well regardless of age, gender and entrance score. Conclusion: Digital learning is as effective as small-group learning to augment knowledge, thinking and technical skills in midwifery, and more efficient as it requires fewer human resources. The finding of noninferiority of digital learning may be relevant to other disciplines and should be evaluated across clinical education programs.