V.T.O.B.S. – Learning Birth Mechanics in Virtual Reality: A Controlled Cohort Study in Undergraduate Medical Education

Jana Adams^1*Christiane Klein²Sebastian Ludwig³Christoph Stosch⁴Kristina Vogel²Nicola H Bauer⁵Christiane Bruns²Rabi R Datta²

• ¹Faculty of Medicine and University Hospital Cologne, Department of Obstetrics, University of Cologne, Cologne, Germany
• ²Faculty of Medicine and University Hospital Cologne, Department of General-, Visceral-, Thoracic- and Transplant Surgery, University of Cologne, Cologne, Germany
• ³Faculty of Medicine and University Hospital Cologne, Department of Gynecology, University of Cologne, Cologne, Germany
• ⁴Faculty of Medicine and University Hospital Cologne, Cologne Interprofessional Skills-Lab and Simulation Centre, University of Cologne, Cologne, Germany
• ⁵Faculty of Medicine and University Hospital Cologne, Institute of Midwifery Science, University of Cologne, Cologne, Germany

Introduction: Virtual reality (VR) is increasingly applied in medical education to enhance learning and patient care. Teaching birth mechanics poses particular challenges, as students must understand complex, dynamic, and rotating intrauterine processes that traditional models cannot adequately represent. VR offers immersive, interactive visualization and has shown promise in other fields, but its role in obstetrics remains underexplored. This study evaluated a novel VR module (Virtual Training for Obstetric Birth Simulation, V.T.O.B.S.) for undergraduate obstetrics education. Methods: In this single-center study, 46 medical students used V.T.O.B.S. during their obstetrical block internship and were compared with 120 students without VR exposure (nonequivalent intervention group design). The module consisted of a single, self-directed session. Knowledge retention was assessed 11–17 weeks later in a theoretical Objective Structured Clinical Examination (OSCE) station consisting mainly of image-based questions on birth mechanics. Secondary outcomes included acceptance, motion sickness, and free-text feedback. Results: No significant differences were found in long-term scores of the OSCE study station between VR and control groups. Subgroup analyses showed no consistent effects, except that visual impairment was associated with significantly lower performance (median 13 [IQR 11– 15] vs. 14.5 [12–16], p=.003). Acceptance of VR was very high (median=5 [IQR 4–5]), and motion sickness was rare and mild (median=2 [1–3]). Free-text responses emphasized the innovative nature of the module, immersive 3D visualization, and the value of VR exposure in a university setting. Observed between-group effects were small and below the detectable threshold, suggesting that minor advantages may have remained uncaptured. Discussion: Although no significant knowledge gain was demonstrated, the strong acceptance and usability support the feasibility of VR in undergraduate obstetrics curricula. The absence of measurable effects may relate to the broad learning objective, brief OSCE assessment, single self-directed exposure, and heterogeneous timing between intervention and assessment. V.T.O.B.S. nonetheless represents an innovative educational tool addressing curricular gaps in visualizing dynamic birth mechanics. Future research should explore repeated exposures, assessment formats that directly capture spatial–conceptual understanding, and integration into interprofessional formats for medical and midwifery students as well as postgraduate training.