Overview:
Diagnosing and suturing a simple perineal trauma or an episiotomy is specified as part of the European Union Standards for Midwifery¹. In traditional medical training, including midwifery training, William S Halsted’s “see one, do one, teach one” principle has been applied for many decades². Leaning how to diagnose and classify lacerations can be challenging during midwifery education because: • Patients may not wish to take part in a teaching opportunity during clinical training in birth units • The midwifery student may feel insecure and uncomfortable with the diagnostic procedure involving vaginal or rectal examination • Different types of perineal lacerations from 1 st to 4 th degree may not be present at births during the clinical placement • There may be time constrains in busy delivery wards not favourable for learning opportunities

Aims and objectives:
We aim to develop a systematic and transparent learning pathway for midwifery students on how to diagnose and classify perineal trauma after childbirth.

Methods:
We have developed a blended learning approach for educational purposes. Medical illustrations and video cases from a birth unit introduces how to diagnose and classify perineal lacerations according to the RCOG classification system³. A theoretical quiz provides the opportunity to watch clinical cases of 1st – 4th degree perineal lacerations and button-hole defects⁴. Simulation models allowing for a tactile sensation of the various types of lacerations has also been developed in collaboration between midwives, obstetricians, urogynaecologist and textile designers. These low-fidelity medical skills training models include prototypes of how to diagnose perineal lacerations from 1 st to 4 th degree. Buttonhole defects, rectovaginal fascia defects and extensive vaginal lacerations can also be assessed using more advanced simulators⁵.

Results:
This standardized online introduction exposes students to watch a large variety in perineal trauma that they would likely not be exposed to in a standard clinical training pathway. Midwifery students express a good theoretical understanding of perineal trauma when exposed to clinical video cases. Including the option of using low-fidelity medical training models for a tactile experience adds to muscle memory and a 3D understanding of pelvic floor muscles and anatomical structures.

Conclusion:
Midwifery educations in Scandinavia, Australia, New Zealand, USA and Canada have adapted this learning approach in their curriculum. We will demonstrate the online learning program and the medical simulators for participants in this conference.