Objective:

To evaluate the effectiveness of combined virtual and high-fidelity clinical simulation compared with virtual simulation only on theoretical knowledge and clinical judgment in undergraduate midwifery students managing severe preeclampsia.

Study Population:

Thirty-two undergraduate midwifery students enrolled in a maternal health clinical course at Universidad de los Andes, Chile.

Interventions:

Group 1 (intervention): Virtual and Clinical Simulation combined (VSim® case followed by hands-on clinical simulation with a manikin).

Group 2 (control): Virtual Simulation only (VSim® case).

Primary Outcomes:

Development of theoretical knowledge (measured by a test) on severe preeclampsia.

Improvement in clinical judgment skills (assessed using the Spanish Lasater Clinical Judgment Rubric).

Secondary Outcomes:

Student satisfaction with the training. Perceived self-efficacy in managing severe preeclampsia.

Duration:

The intervention period lasted five days, including baseline assessment, access to learning activities, and post-intervention evaluation.

Methodology:

Randomized controlled trial with parallel groups (1:1 allocation). Changes over time and differences between groups were analysed using linear mixed-effects models.

Inclusion Criteria:

• Enrollment Status: Students in the second cycle of the midwifery program at the University of Los Andes.
• Educational Background: Participants must have completed the foundational courses in obstetrics and gynecology, as well as their initial clinical rotations.
• Consent: Participants must provide written informed consent to participate in the study.

Exclusion Criteria:

• Previous Clinical Experience: Students who have had prior clinical experience in high-risk obstetric units, or in preeclampsia management, will be excluded.
• Other Professional Backgrounds: Individuals with a degree or professional certification in obstetric or gynecological nursing (e.g., technicians with a title in obstetric nursing) will not be eligible.
• Exchange Students: Midwifery students participating in exchange programs will not be permitted to participate in the study.

Outcome assessors were blinded to group allocation to minimise assessment bias. Evaluators were not informed whether participants belonged to the virtual simulation only group or the combined virtual and clinical simulation group.

For clinical judgment assessment, performance was evaluated using the Spanish Lasater Clinical Judgment Rubric. All participants were identified using unique codes, and assessors received only coded performance records without any information regarding group assignment.

This procedure ensured that outcome evaluation was conducted independently and without knowledge of the educational intervention received.