Effect of an Extended Reality Simulation Intervention on Midwifery Students' Anxiety: Systematic Review.

Background: Midwifery students often experience anxiety due to several factors, such as the clinical experiences faced. Simulation-based learning in nursing and midwifery studies using extended reality (XR) tools offers the opportunity to manage better educational processes while reducing this anxiety. Objective: This study aims to evaluate the current knowledge and understanding of how the use of XR gesture-simulation-based tools allows a better understanding of the anxiety levels of midwives and nurses in educational settings. Methods: We conducted a systematic review, a scientific literature search following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Using PubMed, IEEE, Scopus, and Web of Science, up to March 2024, 1005 articles were found to identify studies that reported the effectiveness of these technologies for gesture simulation in education and training on nursing and midwifery student anxiety. The inclusion-exclusion criteria were based on the PICO (population, intervention, control, and outcomes) framework. The population included nurses, midwives, and nursing and midwifery students of any kind using any virtual or augmented or mixed reality simulation training tool to perform a procedure aimed at reducing anxiety. In addition, the Cochrane risk of bias tool was used to evaluate the quality of the systematic review and the bias in the included studies. A narrative synthesis was conducted due to the heterogeneity of study designs and outcome measures. Key findings were summarized in a structured table and grouped according to the learning objective, simulating and performing procedures in an educational setting. Results: Overall, 7 articles, involving a total of 428 participants, were included in this review. The findings indicate that XR can effectively reduce anxiety in midwifery and nursing education. However, the limited number of studies highlights a research gap in the field, particularly in the area of mixed reality, which warrants further exploration. Conclusions: This systematic review highlights the potential of XR-based gesture-simulation tools in reducing anxiety among midwifery and nursing students. The included studies suggest that XR-enhanced training provides a more immersive and controlled learning environment, helping students manage stress and improve procedural confidence. However, the limited number of studies, methodological variations, and the underrepresentation of mixed reality applications indicate the need for further research. Future studies should focus on standardized anxiety measurement tools, larger sample sizes, and long-term impact assessments to strengthen the evidence base. Expanding research in this field could enhance the integration of XR technologies into midwifery and nursing education, ultimately improving both learning experiences and clinical preparedness.