Evidence for Clinical Skills Training Using Virtual Reality in Nursing and Midwifery Education: Protocol for an Umbrella Review.

BACKGROUND: Virtual reality (VR) is increasingly used in health care training and nursing education to address clinical skills gaps and provide immersive learning experiences. While multiple systematic reviews have synthesized primary research on VR effectiveness, no umbrella review has comprehensively evaluated and integrated findings from existing systematic reviews specifically focused on nursing and midwifery education. OBJECTIVE: This umbrella review aims to systematically identify, critically appraise, and synthesize findings from published systematic reviews and meta-analyses examining the use of VR in nursing and midwifery education, with particular emphasis on clinical skills training. METHODS: This protocol will follow the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 statement and is registered with PROSPERO (CRD420261303572). Nine databases will be searched, including PubMed, CINAHL, Scopus, Web of Science, ERIC, PsycInfo, Cochrane Library, African Journals Online, and SciELO. Two independent reviewers will conduct screening, data extraction, and methodological appraisal using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, version 2). The overlap of primary studies across reviews will be calculated using the corrected covered area (CCA) method, and decision rules for managing overlap will be applied. Narrative synthesis will follow Synthesis Without Meta-Analysis guidance. Certainty of evidence will be assessed using an adapted GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach with a prespecified framework for downgrading based on AMSTAR 2 ratings, overlap, heterogeneity, imprecision, and indirectness. RESULTS: The review search and screening commenced in July 2026 and are ongoing as of August 2026. Full-text screening and data extraction are scheduled for September to October 2026, followed by methodological appraisal, overlap assessment, and evidence synthesis from October to December 2026. Manuscript preparation is planned for November to December 2026, with the review findings expected to be submitted for publication in early 2027. CONCLUSIONS: This umbrella review will provide the first comprehensive, high-level synthesis of evidence on the use of VR in nursing and midwifery clinical training. By systematically appraising and grading the certainty of existing systematic reviews, it will identify the most robust findings while exposing critical evidence gaps. The resulting evidence gap map and summary of findings will offer clinicians, policymakers, and researchers a clear roadmap for evidence-based decision-making and prioritization of future primary research.