Transforming Global Surgery Capacity and Capability Through Affordable Virtual Reality

NCT07403526 | Completed

• 1 other identifier: 21-102
• Study Type: interventional
• Target: 33
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this randomized controlled trial was to evaluate whether Deliberate Virtual Reality (VR) training can improve surgical skills, knowledge, and confidence in performing postpartum hysterectomy among junior-level Zambian physicians in training. The main questions it aims to answer are:

1. 1.Can VR-based surgical training improve technical surgical skills in a real-world setting?
2. 2.Does Deliberate VR training enhance knowledge retention and confidence compared to standard clinical training?
3. 3.The Deliberate VR group demonstrated significantly greater improvements in surgical knowledge, confidence, and OSATS scores compared to the standard training group.
4. 4.VR training showed strong skill transfer to real-world surgical performance, suggesting that affordable and scalable VR training can help bridge surgical workforce gaps in resource-constrained settings.

Conditions

Hysterectomy (MeSH nr: E04.950.300.399)

Keywords

Virtual Reality; Simulation Training; Surgical Education; Postpartum Hemorrhage; Hysterectomy; Obstetric Surgical Procedures; Maternal Health Services; Global Health; Clinical Competence; Medical Education; Randomized Controlled Trial; Capacity Building; Educational Technology; Computer-Assisted Instruction; Skill Acquisition; Sub-Saharan Africa; Zambia; Low-Resource Settings

Outcome Measures

Primary Outcomes (1)

• Change in Postpartum Hysterectomy Surgical Skill Performance

  The primary outcome measure is the change in surgical skill performance as measured by Objective Structured Assessment of Technical Skills scale, a validated tool for assessing surgical performance. Scores are based on technical proficiency, respect for tissue, instrument handling, and procedural knowledge, as assessed by blinded evaluators reviewing video-recorded surgical performances on a high-fidelity mannequin. The Objective Structured Assessment of Technical Skills scale consists of seven subscales assessing different aspects of surgical performance. Each subscale is rated on a 5-point Likert scale (1 = poor performance, 5 = excellent performance). The total score is the sum of all seven subscales, ranging from 7 (lowest possible) to 35 (highest possible). Higher scores indicate better surgical skill performance.

  Baseline (pre-training) and post-training (Day 10)

Secondary Outcomes (2)

• Change in Postpartum Hemorrhage Knowledge

  Baseline and post-training (Day 10)

• Change in Surgical Confidence Ratings

  Baseline and post-training (Day 10)

Other Outcomes (1)

• Correlation Between VR Training Engagement and Surgical Performance

  Throughout the 9-day training period

Study Arms (2)

Deliberate Virtual Reality (VR) Training

EXPERIMENTAL

Participants in this arm underwent Deliberate Virtual Reality (VR) Training, a structured 9-day VR-based curriculum designed to improve surgical knowledge, technical skills, and confidence in performing postpartum hysterectomy. The training used interactive VR simulations, real-time performance feedback, and deliberate practice principles to enhance competency.

Behavioral: Deliberate Virtual Reality (VR) Training

Standard Clinical Training

ACTIVE COMPARATOR

Participants initially received standard clinical education on postpartum hysterectomy through traditional clinical training at their assigned hospitals. This included observation, supervised hands-on practice, and self-directed study without VR simulation. After completing the initial training phase, these participants crossed over to the Deliberate VR Training for an additional 9-day VR-based training program.

Behavioral: Standard Clinical Training

Interventions

Deliberate Virtual Reality (VR) Training BEHAVIORAL

Deliberate VR Training is a self-guided, interactive virtual reality-based training program focused on surgical skill acquisition. The VR simulation includes step-by-step procedural guidance, performance tracking, and self-reflection exercises for postpartum hysterectomy training. Participants practiced daily, receiving objective feedback on surgical accuracy and technique. The intervention lasted 9 days, with 6-hour daily training sessions.

Deliberate Virtual Reality (VR) Training

Standard Clinical Training BEHAVIORAL

Standard Clinical Training followed a traditional mentor-based surgical training model at tertiary hospitals. Training included clinical observation, procedural discussions, and hands-on practice under supervision. Unlike the Deliberate VR group, participants did not have access to structured virtual reality simulation during the initial phase. Following post-training assessment, all participants in this arm crossed over to complete the Deliberate VR Training program. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Standard Clinical Training

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Junior-level Zambian physicians.
• Recent graduates of the General Medical Officers (GMO) training program or first-year Obstetrics and Gynecology residents.
• Within the first 18 months of their training at public hospitals in Lusaka, Zambia.
• Actively involved in the clinical and surgical management of postpartum hemorrhage (PPH).
• Available for the full duration of the 9-day training period.
• Provided verbal agreement to participate after being informed about the study objectives and procedures.

You may not qualify if:

• Previously completed formal postpartum hysterectomy training.
• Had prior experience with virtual reality (VR)-based surgical training.
• Unable to commit to the full 9-day training schedule.
• Did not receive permission from clinical supervisors to participate.
• Had a medical condition or visual impairment that prevented the use of VR equipment.

Sponsors & Collaborators

• Southern Methodist University: lead
• King's College London: collaborator

Study Sites (1)

University Teaching Hospital

Lusaka, Zambia, Zambia

Location

MeSH Terms

Conditions

Postpartum Hemorrhage

Condition Hierarchy (Ancestors)

Obstetric Labor Complications; Pregnancy Complications; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Puerperal Disorders; Uterine Hemorrhage; Hemorrhage; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Richard Sullivan, MD, PhD

  King's College London

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Evaluators assessing surgical performance using OSATS scores were blinded to group assignment to minimize bias.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This randomized controlled trial (RCT) with a crossover design assessed the effectiveness of Deliberate VR Training for postpartum hysterectomy training. The intervention included a 9-day, structured VR-based training program, real-time feedback, and skill assessment. Surgical skill assessments were conducted using Objective Structured Assessment of Technical Skills (OSATS) scores, based on video recordings of surgical procedures on lifelike mannequins.

Study Record Dates

• First Submitted: February 20, 2025
• First Posted: February 11, 2026
• Study Start: September 1, 2021
• Primary Completion: December 31, 2021
• Study Completion: December 31, 2021
• Last Updated: February 11, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

ZA (1)