The effectiveness of simulation-based training in preparing healthcare providers as childbirth simulation facilitators

Background Improving the quality of maternity care is critical to reduce preventable maternal and newborn mortality and morbidity. Simulation-based learning strengthens clinical competence and confidence, yet sustainable implementation in low-resource settings depends on locally trained facilitators. In the Democratic Republic of the Congo (DRC), persistent gaps in quality of care contribute to poor health outcomes. This study aimed to determine the effectiveness of simulation-based training in preparing healthcare providers to function as facilitators in childbirth simulation. Methods A mixed-methods explanatory sequential design was employed. Twelve healthcare providers (six midwife students and six medical doctors) from five clinical sites in Eastern DRC participated in a four-day training programme covering the courses Essential Care for Labor and Birth, Vacuum-Assisted Birth (VAB), and Bleeding after Birth Complete (BABC). To assess the statistical significance of the change in knowledge, quantitative data was collected through pre- and post- knowledge tests for each course, and Objective Structured Clinical Examinations (OSCE). Qualitative data were collected through two focus group interviews (n = 11) and analyzed using deductive content analysis guided by Moore’s process evaluation framework. Effectiveness was evaluated across four domains: fidelity, dose/exposure, reach, and acceptability. Results The simulation-based training was delivered with high fidelity, adhering to the intended schedule and pedagogical structure. Regarding dose/exposure, all participants passed the OSCEs, demonstrating achievement of competency targets. Significant knowledge gains were observed in courses introducing new clinical skills, including VAB (p = 0.021) and BABC (p = 0.027). Reach was reflected by participant engagement and a successful interprofessional mix of midwives and physicians, with role-rotation strengthening their confidence to function as facilitators. The training demonstrated acceptability, being perceived as innovative and relevant to the context, although participants identified structural barriers—such as staff shortages and limited resources—as challenges to the sustainability and long-term feasibility of the intervention. Conclusions Structured simulation-based training can effectively prepare healthcare providers for facilitator roles in childbirth simulation, enhancing both clinical competence and pedagogical confidence. Integrating facilitator preparation into existing educational structures represents a feasible strategy for sustainable capacity building in low-resource settings. Continued institutional support is essential to sustain implementation in clinical practice. Trial Registration: The study is registered with ISRCTN number: 10049855.