The purpose of the educational program was to improve the clinical educator’s ability to educate novice midwives about clinical judgment during labor and delivery. Tanner’s clinical judgment model [10] was suitable for the educational program as a theoretical foundation as described in previous studies [12] [13] [14] [15] [16], for extracting educational methods that promote clinical judgment in this study. Based on the above, the content of the educational program focused on reflecting on one’s own attitude as a clinical educator, understanding the characteristics of novice midwives, and educational methods that encourage novice midwives to think clinically during delivery.

Blended learning was used as an educational method that combines e-learning and face-to-face learning [17]. The educational program consisted of e-learning (individual learning) and a face-to-face seminar (group learning), including simulation to allow participants to acquire not only basic knowledge but also practice applying skills (Table 1).

E-learning was designed to motivate participants to learn the educational skills and knowledge that will be useful in educating novice midwives and enhanced by reflecting on their own attitudes and involvement. We referred to the previous studies based on Tanner’s clinical judgment model to extract four elements [10]: 1) questioning [12] [13] [14] [15] [18], 2) teaching answers verbally [14] [15], 3) thinking aloud [14], and 4) engaging the five senses [14] [15]. The face-to-face seminar was designed to teach clinical educators educational methods to promote these clinical judgments for novice midwives using the four elements.

The two-hour and 30-minute seminar consisted of a lecture on educational methods to promote clinical judgment, simulations to practice what was learned, and discussions to share what was learned among participants. The simulation was divided into four roles: educator, novice midwife, pregnant woman, and observer. It was designed to provide an opportunity for participants to share their experiences as clinical educators, novice midwives, and observers, to reflect on what they did, and discuss what worked well and what could be improved. By taking the role of a clinical educator, participants had an opportunity to practice the methods of promoting clinical judgment that they learned in the lectures. By taking the role of a novice midwife, participants experienced the position of a novice midwife to increase their empathy. The role of an observer was to observe others’ educational situations and to find out what worked well and what could

be improved. In constructing simulations, we relied on the INACSL Standards Committee [19] [20]. The development of two simulation scenarios was based on previous studies [15] [16]. Scenario 1 was a scene from the beginning of work at the nurses’ station (Table 2). The goal of Scenario 1 was to 1) be able to respect and sympathize with the novice midwife, 2) behave in a way that would promote the novice midwife’s tension relief, 3) understand the novice midwife’s understanding of the situation, and 4) use questioning to stimulate thinking when the novice midwife did not understand the situation. Scenario 2 was a scene of the first stage of delivery, and the goal was for the novice midwife to be able to work from the five senses. Each scenario consisted of the briefing, first simulation, debriefing, second simulation, and second debriefing. In the first briefing, the goals of each scenario and the scenario setting were explained. The simulations were performed after checking the level of understanding of each role and recorded with the permission of participants. The debriefing was conducted using the debriefing guide sheet and the recorded video with the researcher acting as a facilitator. In the discussion, participants shared what they learned throughout the program, the feasibility of implementing it in clinical practice, and the difficulties encountered.

The content of the e-learning and seminar was reviewed and revised by four midwives, who had experience in educating novice midwives, to ensure that the goals and the contents of the educational program were appropriate.

As for the speed of narration and the length of e-learning, seven participants answered “just right” for each (Table 3). The open-ended comments were positive such as “It was short and easy to read” and “I was able to reconsider my feelings about the characteristics of novice midwives, how they are perceived, and how they feel about teaching”.

Concerning the seminar, seven participants thought the length was just right, the content easy to understand and both scenarios were easy to understand (Table 3). The respondents who found the simulation scenarios difficult to understand indicated that they wanted to know the level of the novice midwife before the simulation and they were told that the simulation should take about 5 minutes, but they did not know how far they should go in the simulation. Another commented in the debriefing that it was easier to reflect after reviewing the simulation on video.

All respondents answered that the atmosphere of the group discussion was comfortable. The reasons for this were that they were members of the same facility (n = 4) and the facilitator’s way of facilitating the discussion was good. Throughout the discussion, participants commented, “It was good to hear the opinions of others” and “It was good to share the learning with others”. All respondents answered that the speaker’s speaking speed was “just right” for the progress of the seminar. In the open-ended section, the participants were positive about the seminar, saying, “It was good that the facilitator checked the status of our understanding while proceeding”, “It was good that the feedback was accurate,” and “It was smooth”.

Acceptability of the overall program was evaluated in terms of burden, usefulness, and willingness to implement the program. Most of the participants responded positively across all three criteria (Table 5). The reasons given for the burden were “lack of experience as a clinical educator” and “long hours”. The overall impressions and opinions of the program were as follows: “It was an opportunity to reflect on my own educating of novice midwives,” “I noticed areas of weakness and my own habits,” “It was good to learn again about the characteristics of novice midwives,” “It was good to learn how to teach again,” and “It was easy to understand through the simulation”.

In this feasibility study, e-learning was set to be conducted on the same day as the seminar, so everyone was able to take all the contents. No one was late to the seminar, no one left before the seminar, and everyone was able to attend the seminar from start to finish. Due to the management of the wards, it was difficult for all participants to get leave on the seminar day or to attend the seminar during their working hours. Therefore, at one facility, all participants attended the

seminar outside of work hours, while at the other facility, some attended outside of work hours and some attended during work hours. However, even those who participated during work hours were able to attend the seminar during their work hours. Because of projector problems, the educational program took about 3.5 hours, which was about 30 minutes longer than the scheduled time.

Most of the participants were positive about the ease of viewing the screen, the speed of the narration and the length of e-learning. It is said that novice midwives’ comprehension and ability to practice are immature, and that there is a difference between the clinical educator’s comprehension and ability to apply their learning in “real-life” situation [24]. The participants were able to recognize again that there is a difference in grasping the content and ability to practice between themselves and novice midwives.

About 70% of the respondents answered that the length of the seminar was “just right,” and the time of the educational program was generally good. The reason why two respondents answered “long” is probably because the duration of the seminar was extended due to problems with the projector. Regarding the simulation, most of the respondents found the scenarios easy to understand, although a few found the scenarios difficult to understand. Therefore, it is necessary to present the level of novice midwives and confirm the objectives of each scenario in the briefing before the simulation is conducted [19]. By confirming the objectives and goals of the scenarios, the participants can understand what is expected of them in the simulation and what they are expected to be able to do. In addition, by understanding the level of the novice midwife in each scenario prior to the simulation, it is possible to think about how to approach the novice midwife in the simulation, which may lead to more effective learning. Video-assisted debriefing has been reported to improve knowledge, skills, and satisfaction. [25] [26]. In this study, the participants were able to understand their own instruction more objectively by reflecting on the simulation while watching the video during the debriefing. In the discussion, the participants were positive about exchanging their opinions and sharing their learning with others. In previous studies [27], learners sought to interact and share their learning with others, and they learned more effectively by having group discussions and opportunities for feedback. Therefore, recording the simulation and viewing the video to share the situation in the debriefing will facilitate the participants’ learning. The inclusion of simulations will deepen the learners’ understanding and provide them with applied practice in a clinical setting.