Blending virtual with conventional learning to improve student midwifery skills in India.

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India's state of Bihar has suboptimal quality of pre-service training for auxiliary nurse midwives. To address this, state government of Bihar implemented a blended training model to supplement conventional classroom teaching with virtual training. A 72-hour virtual training package with updated content on key maternal and newborn health practices was developed for final year students and broadcasted from one instructor location simultaneously to two auxiliary nurse midwives training centres. This pre-post intervention study compared skills of two auxiliary nurse midwife student cohorts. Eighty-five students from pre-intervention cohort of academic year 2012-13, received only conventional teaching during the final year. The 51 students in the post-intervention cohort from successive academic year 2013-14, received a combination of the both conventional and virtual training. The two cohorts were objectively assessed on identified midwifery skills. A passing score was set at achieving 75% or higher. The students exposed to blended learning scored 32.57 points (p=<0.001) more than their counterparts, who received only conventional teaching. In the post-intervention cohort, 55% students (N=28) passed as compared to none in the pre-intervention cohort. We found blended learning approach effectively improved access to quality training, and identified key midwifery skills of auxiliary nurse midwife students from remote locations.