V.T.O.B.S.-Learning birth mechanics in virtual reality: a controlled cohort study in undergraduate medical education.

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 (non-equivalent 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], 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.