Introduction:
Technology has improved the teaching of complex subjects such as anatomy, which is vital in healthcare and midwifery education¹. Virtual Reality (VR) is an innovative and valuable tool that can help midwives and students develop essential clinical competencies in anatomy, which are essential for providing high-quality pregnancy, birth, and postnatal care. Systematic reviews state that VR can enhance motivation for learning and preserve knowledge and in-depth learning among students in health care^1,2. There are few studies demonstrating the development of learning outcomes in anatomy within the midwifery education using VR. We therefor conducted a pilot study to investigate whether the use of VR could affect the learning and knowledge of the pelvic anatomy among midwifery students at a university college in Norway. The aim of the pilot study was to investigate whether midwifery students' knowledge of anatomy increased after they have completed teaching sessions in anatomy using immersive Virtual Reality goggles as a learning tool.

Material and Methods:
We used a pre-post-test experimental design, conducting a pilot study investigating midwifery students’ pelvic anatomy knowledge before and after the use of VR-technology as a learning tool. We compared two different midwifery student cohorts. Cohort one attended two traditional anatomy lectures, each spanning four hours, amounting to a total of eight hours of lecture time. From a teaching point of view, this was the only distinguishing factor between the two cohorts. The pre-post-test contained 11 questions about anatomical knowledge, and one open-ended question about their learning experience in VR. Intervention (VR) Within the master’s programme in Midwifery, we have established a VR-based medical simulation session focusing on the relationship between the female pelvis, foetus and uterine muscle. The use of VR goggles enables students to immerse in the environment and follow the rotation of the foetus through the birth canal simply by adopting the foetal perspective looking down from the pelvic brim and into the pelvic cavity. Working together in pairs, the students discuss and explore anatomical structures, practice on use correct anatomical terms and reflect on which procedures to initiate to promote a physiological birth.

Results:
We invited 50 midwifery students from two different classes (cohorts) at the same master’s programme in midwifery, 25 in each cohort. Both cohorts were in their first semester as a midwifery student, they had all a bachelor’s degree in nursing, and none of them had used VR as a learning tool before. Both cohorts increased their anatomical knowledge after attending the anatomical lecture using VR- goggles. We found that students from the cohort that did not participate in anatomy lectures scored significantly higher on knowledge, both before and after the lecture using VR as a learning tool for anatomy. Both cohorts experienced an increased understanding of the spatial relations between the different structures when learning in VR. They also experienced that small group activities were more helpful than working alone due to the complexity of the subject matter.

Conclusions:
Implementing VR as a learning tool, can contribute to increase spatial understanding and anatomical knowledge. By focusing on student learning in combination with learning activities and collaboration, the technology helps students gain understanding and knowledge.