Mayumi Ishida

Background/Objectives: Opportunities for pre-service midwifery students to manage postpartum hemorrhage (PPH), a high-risk, infrequent emergency, are limited. Virtual reality (VR) can provide contextual decision-making practice, whereas mannequin training provides tactile psychomotor practice. Evidence on combining these modalities and their instructional sequence remains limited. This exploratory pilot study examined implementation and preliminary outcomes of a blended lecture–VR–mannequin program. Methods: Ten final-year midwifery students were allocated by drawing lots to lecture–VR–mannequin (L–VR–M; n = 5) or lecture–mannequin–VR (L–M–VR; n = 5). Performance was assessed using an Objective Structured Clinical Examination (OSCE) before and after the program; motivation was assessed using the Course Interest Survey after the program. Analyses were exploratory, with effect sizes and Hodges–Lehmann confidence intervals reported alongside p values. Results: No statistically significant between-sequence differences were found. Across all participants, the median OSCE score increased from 34.5 (IQR, 31.0–35.0) to 44.0 (IQR, 41.0–45.0); the paired median difference was 10.5 points (95% CI, 9.0–15.5; p = 0.005; r = 0.89). This change cannot be attributed solely to the program because there was no no-intervention control and the same scenario was repeated. Uterine fundal massage showed a relatively large exploratory effect favoring L–VR–M (r = 0.54), but the confidence interval included no difference. Conclusions: The program was deliverable within one approximately 4 h session and was associated with higher post-program OSCE scores in this small cohort. The design does not establish effectiveness or an optimal sequence because of the very small sample, baseline imbalance, non-blinded assessors, and possible testing and practice effects. A larger controlled study using alternate OSCE scenarios, blinded assessors, and delayed follow-up is required.