BackgroundThe global health care environment is transforming rapidly in response to technological advances, evolving population health needs, and increasingly complex patient care expectations. Nurses and midwives constitute the majority of the health care workforce globally and are central to achieving universal health coverage and the Sustainable Development Goals [1,2]. Their education and ongoing clinical training are therefore critical to improving health outcomes, particularly in resource-constrained settings such as South Africa and other African countries.
Traditional teaching methodologies, including lectures and observational clinical placements, often fall short of equipping students with the hands-on, decision-making, and critical-thinking skills required for contemporary practice [3]. These conventional modalities may not provide adequate exposure to rare but critical clinical events, nor consistently promote learner engagement or the safe exploration of clinical judgment [4]. Growing restrictions on clinical placement availability, patient safety concerns, and educator workload further limit traditional education approaches [5].
Virtual reality (VR) has emerged as a promising educational innovation that addresses these challenges. VR refers to computer-generated environments simulating real-life clinical scenarios, allowing students to practice skills and make decisions in risk-free, engaging, and repeatable settings [6]. Research indicates that VR can enhance psychomotor skills, clinical reasoning, and student satisfaction compared to traditional methods [7]. VR-based birthing simulations have demonstrated improved confidence and decision-making among midwifery students [8], while usability studies report increased realism and engagement [9].
The proliferation of primary studies on VR in nursing and midwifery education has led to numerous systematic reviews and meta-analyses synthesizing this evidence. Recent meta-analyses have demonstrated that VR significantly improves knowledge acquisition, skill performance, and problem-solving abilities in nursing education, with effects varying by immersion level and learner population [10,11]. Chen et al [12] conducted a meta-analysis demonstrating the effectiveness of VR for knowledge acquisition and skill performance. Liu et al [4] provided an updated systematic review and meta-analysis confirming positive effects on clinical competence. Kiegaldie and Shaw [13] examined the feasibility and effectiveness of VR across nursing contexts. In midwifery education specifically, emerging evidence suggests VR enhances student engagement and learning outcomes in complex clinical scenarios such as anatomy instruction and childbirth training [14]. Most recently, Tene et al [15] published an umbrella review of VR and augmented reality across all medical education, noting that nursing and midwifery-specific syntheses remain limited.
The growing number of systematic reviews on virtual and immersive technologies in nursing and midwifery education signals a field that is both dynamic and rapidly evolving. A quick scan of PROSPERO records illustrates this diversity: from early effectiveness reviews such as the review conducted in 2018 on VR in nursing education [16], to more recent syntheses comparing desktop versus immersive VR [17], focused explorations of pediatric and psychiatric applications [18], broader reviews of simulation, and even studies incorporating AI [19].
This richness, however, comes with fragmentation. Each review tends to pursue its own narrow question, whether about student experience, obstetric training, or specific clinical domains, using different methodologies, populations, and definitions of technology. While findings often overlap, they remain siloed. As a result, we lack a consolidated understanding of how evidence aligns across clinical areas, whether certain immersive tools consistently outperform others, and how robust or trustworthy the existing reviews truly are.
An umbrella review provides the opportunity to step back and integrate these different threads. By systematically examining where findings converge, where they diverge, and where evidence is genuinely strong, we can offer a more coherent picture of immersive VR in clinical skills education. Importantly, this is not just an academic exercise. Our intention is to produce a synthesis that is directly useful to educators and decision-makers. Beyond mapping effectiveness, we will pay close attention to implementation—how these technologies can be adopted, adapted, and optimized in nursing education settings.
The ultimate goal is to move beyond isolated findings and provide a clear, evidence-informed guide for the next stage of practice and policy. In doing so, this umbrella review seeks to bridge the gap between research and application, ensuring that the promise of immersive technologies translates into meaningful improvements in nursing and midwifery education.
An umbrella review, a systematic review of existing systematic reviews and meta-analyses, is therefore timely and necessary. Umbrella reviews occupy the highest level of the evidence hierarchy, providing comprehensive overviews for decision-makers while identifying inconsistencies, gaps, and methodological limitations across existing syntheses [20,21]. This approach will consolidate evidence on VR effectiveness specifically for nursing and midwifery education, inform curriculum development and technology integration, and guide future research priorities.