The impact of three-dimensional visualisation on midwifery students’ application of knowledge of the third stage of labour to practice: Qualitative findings of a pilot randomised controlled trial



      Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Online resources for midwifery education are limited.


      Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Virtual and artificial realities have been shown to increase confidence in decision making during clinical practice.


      Explore the impact of using three-dimensional (3D) visualisation in midwifery education, on student’s application, when educating women about the birth of the placenta, and membranes.


      Face to face individual interviews were performed, to collect deep, meaningful experiences of students, learning about the third stage of labour.


      Prior clinical experiences impacted on student’s ability to articulate how they would discuss birth of the placenta and membranes, and the process of haemostasis with women.


      The narrative findings of this pilot study identified ways that students traditionally learn midwifery, through theory, and clinical practice. Interview narratives illustrated how midwifery students who had previous experiences of witnessing birth, had superior ability to discuss the third stage of labour with women. While students with limited birth experiences, found the 3DMVR assisted them in their understanding of the physiology of the third stage of labour.


      In an environment of increasing technological advances, clinical placements remain an essential component of midwifery education.


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        • Downer T.
        • Gray M.
        • Andersen P.
        3D technology: a pilot quality improvement initiative evaluating the use of visualisation in contemporary midwifery education.
        J. Clin. Simul. Nurs. 2019; 39: 27-32
        • Hanson J.
        • Andersen P.
        • Dunn P.K.
        The effects of a virtual learning environment compared with an individual handheld device on pharmacology knowledge acquisition, satisfaction, and comfort ratings.
        Nurse Educ. Today. 2020; 92: 1-8
        • Gray M.
        • Downer T.
        • Hartz H.
        • Andersen P.
        • Hanson J.
        • Gao Y.
        The impact of three-dimensional visualisation on midwifery students’ application of knowledge of the third stage of labour to practice: qualitative findings of a pilot randomised controlled trial.
        Nurse Educ. Today. 2022; 108: 105184
        • Downer T.
        • Gray M.
        • Capper T.
        Online learning and teaching approaches used in midwifery programs: a scoping review.
        Nurse Educ. Today. 2021; 103104980
        • Bogossian F.
        • Cooper S.
        • Kelly M.
        • et al.
        Best practice in clinical simulation education – are we there yet? A cross sectional survey of simulation in Australian and New Zealand pre-registration nursing education.
        Collegian. 2018; 25: 327-334
        • Cooper S.
        • Cant R.
        • Porter J.
        • Bogossian F.
        • Mckenna L.
        • Brady S.
        • Fox-Young S.
        Simulation based learning in midwifery education: a systematic review.
        Women Birth. 2012; 25: 64-78
        • Frost J.
        • Delaney L.
        • Fitzgerald R.
        Exploring the application of mixed reality in nurse education.
        BMJ Simul. Technol. Enhanc. Learn. 2020; 6: 214-219
        • King D.
        • Tee S.
        • Falconer L.
        • Angell C.
        • Holley D.
        • Mills A.
        Virtual health education: Scaling practice to transform student learning: using virtual reality learning environments in health care education to bridge the theory/practice gap and improve patient safety.
        Nurse Educ. Today. 2018; 71 ( 7-9
        • Awoke A.
        • Burbelo H.
        • Childs E.
        • Mohammad F.
        • Stevens L.
        • Rewkowski N.
        • Manocha D.
        An overview of enhancing distance learning through augmented and virtual reality technologies.
        Comput. Sci. 2021; : 11000
        • Ferguson C.
        • Davidson P.M.
        • Scott P.J.
        • Jackson D.
        Augmented reality, VR and gaming: an integral part of nursing.
        Contemp. Nurse. 2015; 51: 1-7
        • Carolan-Olah M.
        • Kruger G.
        • Garvey-Graham A.
        Midwives’ experiences of the factors that facilitate normal birth among low risk women at a public hospital in Australia.
        Midwifery. 2015; 31: 112-121
        • Chen F.
        • Leng Y.
        • Ge J.
        • Wang D.
        • Li C.
        • Chen B.
        • Sun Z.
        Effectiveness of virtual reality in nursing education: meta-analysis.
        J. Med. Internet Res. 2020; 22e18290
        • Ghoman S.K.
        • Patel S.D.
        • Cutumisu M.
        • von Hauff P.
        Serious games, a game changer in teaching neonatal resuscitation? A review.
        Arch. Dis. Child. Fetal Neonatal. 2020; 105: 98-107
        • Malmström B.
        • Nohlert E.
        • Ewald U.
        • Widarsson M.
        Simulation-based team training improved the self-assessed ability of physicians, nurses and midwives to perform neonatal resuscitation.
        Acta Paediatr. Nuturing Child. 2017; 106: 1273-1279
        • Chan H.
        • Chang H.
        • Huang T.
        Virtual reality teaching in chemotherapy administration: randomised controlled trial.
        J. Clin. Nurs. 2021; 00: 1-10
        • Hale K.S.
        • Stanney K.M.
        Effects of low stereo acuity on performance, presenceand sickness within a virtual environment.
        Appl. Ergon. 2006; 37 (http://doi:10.1016/j.apergo.2005.06.009): 329-339
        • Hussain R.
        • Chessa M.
        • Solari F.
        Mitigating cybersickness in virtual reality systems through foveated depth-of-field blur.
        Sensors. 2021; 21: 4006
        • Weech S.
        • Kenny S.
        • Barnett-Cowan M.
        Presence and cybersickness in virtual reality are negatively related: a review.
        Front. Psychol. 2019; 10 (http://doi:10.3389/fpsyg.2019.001568): 158
        • Ghanbarzadeh R.
        • Ghapanchi A.H.
        • Blumenstein M.
        • Talaei-Khoei A.
        A decade of research on the use of three-dimensional virtual worlds in health care: a systematic literature review.
        J. Med. Internet Res. 2014; 16 (1)e47
      1. Vichitvejpaisal, P., Yamee. N., Marsertsri, P., 2016. Firefighting simulation on virtual reality platform. In: Proceedings of the 13th International Joint Conference on Computer Science and Software Engineering (JCSSE), pp. 1–5. doi: 10.1109/JCSSE.2016.7748912.

        • Wang P.
        • Wu P.
        • Wang J.
        • Chi H.
        • Wang X.
        A critical review of virtual reality in construction engineering education and training.
        Int. J. Environ. Res. Public Health. 2018; 15: 1204
      2. Mi, S.H., Hou, Z.B., Yang, F., Xie, X.L., & Bian, G.B., 2014. A 3D virtual reality simulator for training of minimally invasive surgery. In: Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society 2014, pp. 349–352.

        • Garnett B.M.
        • Anthony J.
        • Jackson C.
        Using mobile augmented reality to enhance health professional practice education.
        Curr. Issues Emerg. eLearn. 2018; 4 (Article 10)
        • Ewens B.
        • Geale S.
        • Vafeas C.
        • Loessl B.
        • Smyth A.
        • McCafferty C.
        Humanising the curriculum: the role of a virtual world.
        J. Nurs. Educ. Pract. 2016; 6: 80-88
        • Williams J.
        • Jones D.
        • Walker R.
        Consideration of using virtual reality for teaching neonatal resuscitation to midwifery students.
        Nurse Educ. Pract. 2018; 31: 126-129
        • Lopreiato J.O.
        Healthcare Simulation Dictionary.
        Agency for Healthcare Research and Quality, Rockville, MD2016: 0043
        • Oxford University
        Oxford Languages.
        Oxford University Press, 2021
        • Braun V.
        • Clarke V.
        • Terry G.
        Thematic analysis.
        in: Rohleder P. Lyons A. Qualitative Research in Clinical and Health Psycholog. Palgrave MacMillan, Basingstoke, UK2014
        • Rob M.
        • Rob F.
        Dilemma between constructivism and constructionism: leading to the development of a teaching-learning framework for student engagement and learning.
        J. Int. Educ. Bus. 2018; 11: 273-290
        • Chau M.
        • Wong A.
        • Wang M.
        • Lai S.
        • Chan K.W.Y.
        • Li T.M.H.
        • Chu D.
        • Chan I.K.W.
        • Sung W.K.
        Using 3D virtual environments to facilitate students in constructivist learning.
        Decis. Support Syst. 2013; 56: 115-121
        • Moss J.D.
        • Muth E.R.
        Characteristics of head-mounted displays and their effects on simulator sickness.
        Hum. Factors. 2011; 53: 308-319
        • Dan A.
        • Reiner M.
        Reduced mental load in learning a motor visual task with virtual 3D method.
        J. Comput. Assist. Learn. 2018; 34: 84-93