Virtual reality simulation training for childbirth: A cluster randomized crossover study

Objective: To compare knowledge acquisition and domain-specific feedback between virtual reality (VR) and mannequin-based simulation for teaching medical students normal vaginal delivery (NVD). Methods: We conducted a cluster randomized crossover study comparing a novel in-house-developed NVD VR simulator utilizing an Oculus (R) Quest 2 HMD with the PROMPT Flex (R) mannequin. We randomly assigned medical student clinical groups to either VR or mannequin simulation. Participants took an 11-item knowledge quiz before and after their first simulation before crossing over to the alternate simulation. Participants took a six-domain, 14-item feedback questionnaire evaluating both simulations. The primary outcome was percentage improvement in knowledge scores, while the secondary outcome was adjusted mean difference in mean feedback scores between each simulation. Results: Twenty clinical groups comprising 111 medical students participated. There was no difference in either arm for baseline characteristics and pre-simulation knowledge scores. Medical students undergoing VR simulation had significantly higher overall post-simulation mean percentage correct scores (79.0% vs. 54.0%; P < 0.001). The mannequin simulator had significantly higher feedback scores (61.0 vs. 58.3; adjusted mean difference 2.45 [95% confidence interval 0.95-3.95]; P = 0.002) and in five of six domains. A total of 40.5% of respondents preferred the mannequin simulation, 4.5% preferred the VR simulation, and 42.5% preferred a mixture of the two. Conclusions: Our novel VR NVD simulator was superior to traditional mannequin simulation in content delivery. As more respondents preferred a mixed approach over any single method, VR simulation could complement legacy mannequin simulation methods by serving as a primer or a distance-learning tool and help increase skill birth attendant training.