This study evaluated whether an augmented reality (AR)-based training system improves preparation for simulated vaginal birth compared with traditional text- and video-based learning. Vaginal birth is a complex clinical skill that requires integration of technical actions, situational awareness, and professional behaviors, and opportunities for hands-on training may be limited during undergraduate education.

Undergraduate medical students and midwifery students from two universities in Chile and Colombia were randomly assigned to either conventional preparation (text and instructional video) or the same preparation supplemented with an AR training module. The AR system allowed students to explore a simulated vaginal birth scenario in a self-directed manner before participating in hands-on simulation.

All students then completed a standardized simulated vaginal birth using a high-fidelity simulator as part of their regular curriculum. Performance during the first simulation was assessed by blinded evaluators using a validated Direct Observation of Procedural Skills (DOPS) checklist. The primary outcome was achievement of a predefined minimum competency threshold, with secondary outcomes including overall performance scores, completion of critical tasks, and learner satisfaction.

The goal of this study was to determine whether AR-based pre-simulation training enhances early performance in simulated vaginal birth and could serve as a scalable educational tool to support competency-based training in obstetrics.

This multicenter randomized controlled educational study examined the effectiveness of an augmented reality (AR)-based pre-simulation training system for vaginal birth. The study was conducted at two universities in Chile and Colombia and included undergraduate medical students and midwifery students enrolled in obstetrics and gynecology or women's health courses as part of their regular curriculum.

Participants were randomly assigned to one of two groups. The control group received conventional pre-simulation preparation consisting of written materials and an instructional video covering the management of uncomplicated vaginal birth. The intervention group received the same preparation supplemented with a self-directed AR training module, which allowed learners to explore a simulated vaginal birth scenario, navigate procedural steps, and rehearse task sequencing prior to hands-on simulation.

All participants subsequently completed a standardized simulated vaginal birth using a high-fidelity childbirth simulator. Performance during the first simulation attempt was assessed by blinded evaluators using a previously published and validated Direct Observation of Procedural Skills (DOPS) checklist. The primary outcome was achievement of a predefined minimum competency threshold. Secondary outcomes included overall performance scores, completion of critical tasks, and learner satisfaction with the training experience.

The study was designed to isolate the effect of pre-simulation preparation on initial performance, before learning gains from repeated simulation and debriefing. The findings aim to inform the role of augmented reality as a scalable educational tool to support competency-based training in obstetric education.

Inclusion Criteria:

• Undergraduate medical students or midwifery students enrolled in obstetrics and gynecology or women's health courses at the participating universities.
• Enrollment in the corresponding academic cohort during the study period.
• Age 18 years or older.
• Willingness to participate and provision of informed consent.

Exclusion Criteria:

• Declined participation or withdrawal of consent.
• Incomplete participation in the simulation session.
• Incomplete or missing performance assessment data.

Individual participant data will not be shared due to ethical and confidentiality considerations. The dataset includes educational performance assessments of students, collected under informed consent for the purposes of this study only. Data are stored in accordance with institutional policies and applicable regulations, and no plans for public data sharing were approved by the ethics committees.

Outcome assessors were blinded to group allocation. Students were identified only by numeric codes during the simulation, and evaluators completed performance assessments without knowledge of whether participants had received augmented reality training.