Self-Efficacy, Anxiety, and Cognitive Load in a Two-Stage Episiotomy Repair Simulation Program: Sponge Training Followed by Randomized Chicken-Tissue Practice or Non-Interactive Immersive Video Instruction

Episiotomy repair is a technically demanding clinical skill with limited opportunities for supervised practice in midwifery education. This randomized comparative educational intervention examined changes in midwifery students’ self-efficacy, anxiety, and cognitive load during sequential simulation-based training. Fifty-one third-year students completed standardized sponge-based instruction and were then randomized to chicken tissue–based hands-on practice (n = 25) or non-interactive immersive VR video instruction (n = 26). Outcomes were assessed before sponge training, immediately afterward, and after the randomized interventions. From baseline to the post-sponge assessment, self-efficacy and total cognitive load scores increased significantly, whereas state and trait anxiety scores did not change. Because this phase did not include a concurrent control group, these within-participant changes cannot be attributed specifically to the sponge model. Final outcomes were analyzed using models adjusted for the corresponding post-sponge score and previous episiotomy observation. Unadjusted analyses indicated a group difference in trait anxiety and group-by-covariate interactions for cognitive load and state anxiety; however, none of the four outcome-level tests remained significant after Holm correction. Accordingly, there was no clear evidence that either advanced instructional approach was superior. Findings should be considered exploratory because of the small fixed cohort, absence of an a priori power analysis, retrospective registration, unequal intervention exposure, and lack of objective performance assessment. The study was retrospectively registered at ClinicalTrials.gov (NCT07582302).