Augmented reality enhances competency-based training in simulated vaginal birth: A multicenter randomized controlled trial.

Abstract

Introduction: Simulation is essential for teaching procedural skills in obstetrics, yet access to high-fidelity simulators remains limited. Augmented reality (AR) offers an innovative and scalable way to enhance pre-simulation learning. This study evaluated whether AR-based training improves student performance in simulated vaginal births compared with traditional text- and video-based preparation.

Methods: We conducted a multicenter, prospective, randomized controlled trial with blinded evaluators involving 401 undergraduate medical and midwifery students from two universities (Chile and Colombia). Participants were assigned to AR-based training (experimental group) or conventional preparation (control group). All students completed high-fidelity childbirth simulations assessed using a validated Direct Observation of Procedural Skills (DOPS) checklist. The primary outcome was achievement of the minimum competency threshold; secondary outcomes included mean DOPS scores, critical task performance, and student satisfaction.

Results: Students trained with AR achieved significantly higher DOPS scores (11.9 ± 0.14 vs 10.6 ± 0.15; p < .001) and greater critical task completion (3.6 ± 0.07 vs 3.3 ± 0.07; p < .001) than controls. The proportion reaching the competency threshold doubled in the AR group (12.8% vs 6.2%; RR 2.23; 95% CI 1.07-4.01; p < .05). Both groups reported high satisfaction, though AR users noted opportunities to improve realism.

Discussion: AR-based pre-simulation training enhances performance and competency attainment in simulated vaginal birth care. This scalable and cost-effective approach complements traditional simulation, supporting competency-based medical education while broadening access to high-quality procedural training in obstetrics.