Simulation-Based Assessment of Vaginal Birth Competencies in Final-Year Medical Students: A Pre–Post Study

Background: Limited clinical exposure during obstetrics rotations hinders students’ ability to develop hands-on delivery skills. Simulation offers a risk-free environment for practicing procedures but also for objective evaluation of procedural competencies. This study evaluates the impact of a simulation-based training module using multiple assessment approaches, including a structured simulation-based objective checklist, pre- and post-intervention knowledge questionnaires, and self-assessment measures of perceived competence, on final-year students’ competencies in vaginal birth. Methods: A single-group prospective pre–post educational intervention study was conducted between May 2024 and June 2025 following the approval of the Ethics Committee of the University of Medicine and Pharmacy “Carol Davila”, Bucharest (approval no. 14354/2024). A total of 211 sixth-year medical students participated after completing their obstetrics–gynecology rotation. The training included a theoretical revision, a birth simulation scenario (a cephalic presentation), guided practice with faculty feedback, and a final objective evaluation. Evaluations included pre- and post-intervention knowledge questionnaires and Likert-based self-assessment of practical skills. Objective clinical competencies were assessed using a structured simulation-based checklist evaluating observable skills across key domains, including patient communication, vaginal examination, perineal support, delivery maneuvers, third-stage management, and placental assessment. Statistical analyses included paired t-tests, Wilcoxon tests, and effect size reporting. Results: Students demonstrated significant improvements in practical skills related to physiological vaginal birth (pre: 10.1; post: 19.4; Δ = +9.24; p < 0.001; d = 1.82) and mean confidence (pre: 1.95; post: 3.93; Δ = +1.99; p < 0.001; d = 1.66). Component-level analysis showed improvements in patient communication (Δ = +1.67), pelvic examination (Δ = +1.46), and controlled expulsion techniques (Δ = +1.23). Conclusions: Substantial improvements in simulated vaginal birth competencies and self-perceived confidence were observed following structured simulation-based training. These findings support the educational value of high-fidelity simulation as a complement to undergraduate obstetric training, while further research is needed to establish long-term retention and transfer to clinical practice.