Augmented Reality Training for Simulated Vaginal Birth

Augmented Reality Enhances Competency-Based Training in Simulated Vaginal Birth: A Multicenter Randomized Controlled Trial

This study evaluated whether an augmented reality (AR)-based training system improves preparation for simulated vaginal birth compared with traditional text- and video-based learning. Vaginal birth is a complex clinical skill that requires integration of technical actions, situational awareness, and professional behaviors, and opportunities for hands-on training may be limited during undergraduate education.

Undergraduate medical students and midwifery students from two universities in Chile and Colombia were randomly assigned to either conventional preparation (text and instructional video) or the same preparation supplemented with an AR training module. The AR system allowed students to explore a simulated vaginal birth scenario in a self-directed manner before participating in hands-on simulation.

All students then completed a standardized simulated vaginal birth using a high-fidelity simulator as part of their regular curriculum. Performance during the first simulation was assessed by blinded evaluators using a validated Direct Observation of Procedural Skills (DOPS) checklist. The primary outcome was achievement of a predefined minimum competency threshold, with secondary outcomes including overall performance scores, completion of critical tasks, and learner satisfaction.

The goal of this study was to determine whether AR-based pre-simulation training enhances early performance in simulated vaginal birth and could serve as a scalable educational tool to support competency-based training in obstetrics.

Study Overview

• Status: Completed
• Conditions: Vaginal Birth Education
• Intervention / Treatment: Other: Conventional Training; Other: Augmented Reality Training

Detailed Description

This multicenter randomized controlled educational study examined the effectiveness of an augmented reality (AR)-based pre-simulation training system for vaginal birth. The study was conducted at two universities in Chile and Colombia and included undergraduate medical students and midwifery students enrolled in obstetrics and gynecology or women's health courses as part of their regular curriculum.

Participants were randomly assigned to one of two groups. The control group received conventional pre-simulation preparation consisting of written materials and an instructional video covering the management of uncomplicated vaginal birth. The intervention group received the same preparation supplemented with a self-directed AR training module, which allowed learners to explore a simulated vaginal birth scenario, navigate procedural steps, and rehearse task sequencing prior to hands-on simulation.

All participants subsequently completed a standardized simulated vaginal birth using a high-fidelity childbirth simulator. Performance during the first simulation attempt was assessed by blinded evaluators using a previously published and validated Direct Observation of Procedural Skills (DOPS) checklist. The primary outcome was achievement of a predefined minimum competency threshold. Secondary outcomes included overall performance scores, completion of critical tasks, and learner satisfaction with the training experience.

The study was designed to isolate the effect of pre-simulation preparation on initial performance, before learning gains from repeated simulation and debriefing. The findings aim to inform the role of augmented reality as a scalable educational tool to support competency-based training in obstetric education.

• Study Type: Interventional
• Enrollment (Actual): 389
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Chile
  • Santiago Metropolitan
    • Santiago, Santiago Metropolitan, Chile
      • Pontificia Universidad Catolica de Chile

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Undergraduate medical students or midwifery students enrolled in obstetrics and gynecology or women's health courses at the participating universities.
• Enrollment in the corresponding academic cohort during the study period.
• Age 18 years or older.
• Willingness to participate and provision of informed consent.

Exclusion Criteria:

• Declined participation or withdrawal of consent.
• Incomplete participation in the simulation session.
• Incomplete or missing performance assessment data.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Conventional Training; Participants received conventional pre-simulation preparation consisting of text-based materials and an instructional video covering uncomplicated vaginal birth.	Other: Conventional Training; Text- and video-based preparation for simulated vaginal birth.
Experimental: Augmented Reality Training; Participants received conventional text- and video-based preparation supplemented with an augmented reality-based pre-simulation training module.	Other: Augmented Reality Training; Augmented reality-based pre-simulation training module for vaginal birth.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants achieving the minimum competency threshold during simulated vaginal birth	Achievement of a predefined minimum competency threshold assessed using a validated Direct Observation of Procedural Skills (DOPS) checklist during a standardized simulated vaginal birth. Competency was defined as a DOPS score ≥35 with successful completion of all critical items.	Periprocedural (Day 1, during the first standardized simulated vaginal birth)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Direct Observation of Procedural Skills (DOPS) score during simulated vaginal birth	Overall performance score obtained using the Direct Observation of Procedural Skills (DOPS) checklist (range 0-37), where higher scores indicate better performance, assessed during a standardized simulated vaginal birth.	Periprocedural (Day 1, during the first standardized simulated vaginal birth)
Number of participants completing all critical tasks during simulated vaginal birth	Successful completion of all predefined critical motor and attitudinal tasks on the DOPS checklist during the first standardized simulated vaginal birth.	Periprocedural (Day 1, during the first standardized simulated vaginal birth)
Learner satisfaction with the training experience	Participant satisfaction assessed using a post-simulation satisfaction questionnaire on a Likert-type scale (range 1-5), where higher scores indicate greater satisfaction.	Immediately after the simulation session

Collaborators and Investigators

• Sponsor: Pontificia Universidad Catolica de Chile
• Collaborators: Universidad de Los Andes, Bogota, Colombia
• Investigators: Principal Investigator: Jorge A Carvajal, PhD, Pontificia Universidad Catolica de Chile

Publications and helpful links

General Publications

• Valenzuela, M. T., & Carvajal Cabrera, J. A. (2022). Eficiencia del entrenamiento simulado del parto vaginal en estudiantes de enfermería/obstetricia: The efficiency of simulated vaginal birth training in nursing/midwifery students. ARS MEDICA Revista De Ciencias Médicas, 47(4), 25-31. https://doi.org/10.11565/arsmed.v47i4.1911

Helpful Links

• Demonstration video of the augmented reality training module used in the study.

Study record dates

Study Major Dates

• Study Start (Actual): March 8, 2023
• Primary Completion (Actual): November 27, 2024
• Study Completion (Actual): December 23, 2024

Study Registration Dates

• First Submitted: January 20, 2026
• First Submitted That Met QC Criteria: January 28, 2026
• First Posted (Actual): February 5, 2026

Study Record Updates

• Last Update Posted (Actual): February 5, 2026
• Last Update Submitted That Met QC Criteria: January 28, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: medical education; augmented reality; vaginal birth; midwifery education; competency-based education; simulation-based education; obstetric training
• Other Study ID Numbers: IRB-UC-221212006-2023

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared due to ethical and confidentiality considerations. The dataset includes educational performance assessments of students, collected under informed consent for the purposes of this study only. Data are stored in accordance with institutional policies and applicable regulations, and no plans for public data sharing were approved by the ethics committees.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No