Impact of a Virtual Reality–Enhanced Learning Program for Maternal Positioning in Midwifery Students: An Exploratory Multicenter Pre– Post Study

Abstract

Introduction: Understanding maternal positioning and pelvic biomechanics is a core competency in midwifery education; however, conventional teaching methods provide limited opportunities to visualize internal anatomical changes during labor. The PROGRESSION project developed a virtual reality (VR)–enhanced educational program aimed at improving midwifery students' knowledge and supporting immersive learning on the relationship between maternal positioning and labor progression. This study explored the educational effect, usability, and learner experience associated with the PROGRESSION VR training. Methods: A prospective, multicenter, pre–post intervention study was conducted between March and July 2025 across three midwifery education institutions in the Czech Republic, Germany, and Portugal. The intervention comprised a theoretical online module, a familiarization session, self-directed VR practice, and facilitated VR clinical scenarios. Knowledge of maternal positioning and pelvic biomechanics was assessed using a 10-item questionnaire administered before and immediately after the VR session. Usability was evaluated using the System Usability Scale (SUS) and the Virtual Reality System Usability Questionnaire (VRSUQ). Quantitative data were analyzed using nonparametric methods, and qualitative feedback was explored through thematic analysis. Results: Fifty-seven students completed both knowledge assessments and usability surveys. Although overall knowledge scores improved after the intervention, the change was not statistically significant (Sign test, p = 0.46). Only the Czech cohort demonstrated a significant knowledge increase (p = 0.02). SUS (mean 68 ± 13) and VRSUQ (mean 64 ± 13) scores indicated generally above-average usability, with no significant differences across institutions. Students reported high engagement, enhanced understanding of maternal positioning, and strong perceived educational value. Qualitative analysis identified three themes: functionality, visual clarity and realism, and educational value. Discussion: The PROGRESSION VR-enhanced training was well received and demonstrated high usability, offering an engaging and immersive learning experience that students perceived as educationally beneficial. Although knowledge gains were modest, the VR intervention was well accepted and perceived as a valuable complement to traditional instruction. The findings suggest that VR can enrich learning experiences, enhance students' confidence in maternal positioning, and support comprehension of complex internal processes. Further research should explore repeated VR exposure, longitudinal curriculum integration, and assessment methods capable of capturing spatial and conceptual learning outcomes.