Exploring the use of virtual reality technology in neonatal resuscitation simulation for midwifery students: a mixed-methods study examining the impact on confidence and stress

Background: Confidence and stress are important variables when training midwifery students to become safe and competent practitioners. Simulation training has been used to help improve self-confidence and stress management capabilities for students when training in neonatal resuscitation. Neonatal resuscitation is the most frequent neonatal emergency encountered by midwives in Australia and is taught using a multi-modal approach involving hands-on simulation and theoretical teaching and learning methods. Virtual reality (VR) is an emerging form of simulation that has not previously been researched in relation to neonatal resuscitation training. Method: The primary aim of this research was to examine the impact of a VR intervention on student confidence and biological stress markers (heart rate and skin temperature) when performing neonatal resuscitation in a simulated learning environment. Confidence was measured through pre-test and post-test surveys. Biological stress markers were measured using specialised sensor belts worn under clothing. This data was collected at two timepoints: a practice Objective Structured Clinical Assessment (OSCA) on neonatal resuscitation at the commencement of the study, and a formal OSCA 6-7 weeks later. The secondary aim was to understand the students’ experience of using multi-modal teaching methods, which included VR, when learning neonatal resuscitation. This research utilised a sequential mixed-methods design consisting of a randomised controlled trial (two-armed study with parallel groups) and qualitative focus groups. Participants were 2nd year Bachelor of Midwifery students at the University of Newcastle, Callaghan Campus (n=53) who were randomised into either the control group (n=27) receiving usual teaching, or intervention group (n=26) receiving usual teaching plus the VR intervention. Results: There were no statistically significant differences observed between the control and intervention groups for confidence scores or biological stress marker measurements. Participants in both groups reported an increase in confidence that translated to the real clinical environment. A significant increase in heart rate (16–19bpm) from the baseline was observed in all participants when presenting for the formal OSCA. Skin temperature was seen to increase for all participants throughout the duration in which the sensor belt was worn. In relation to the student experience, a multi-model approach to learning neonatal resuscitation was voiced as beneficial to participants in the research, with hands-on simulation being the preferred learning method when preparing for a formal OSCA. The VR intervention received mixed feedback regarding its usefulness as a learning method for neonatal resuscitation, with benefits seen when completing procedural tasks within the scenario. The uptake of the VR intervention throughout the research period was significantly lower than expected. Conclusion: The implementation of a VR intervention as part of a multi-modal teaching model for neonatal resuscitation did not have a significant effect on participant confidence levels or biological stress markers compared with participants who did not have access to the VR intervention. Undergoing a formal OSCA on neonatal resuscitation initiated a stress response in all students, regardless of the use of the VR intervention. Participants valued hands-on practice as the most beneficial learning method for learning neonatal resuscitation. Improvements should be made to the accessibility of hands-on simulation practice when preparing for a neonatal resuscitation OSCA. The best combination of multi-modal teaching and learning methods needs to be determined in future research.