The Effectiveness of Simulation‐Based Versus Patient‐Based Clinical Education in Nursing: A Systematic Review and Meta‐Analysis
Abstract
ABSTRACT Aim To compare the effectiveness of simulation‐based education (alone or in combination with patient‐based clinical teaching) in undergraduate nursing students, when measured using objectively assessed outcomes. Design Systematic review with meta‐analyses. Review Methods Comparative studies in undergraduate nurses where outcomes of externally verified exams, proficiencies or competencies for both groups were included. Citation‐checking, data‐extraction and quality‐assessment (using CASP checklists) were by two reviewers independently, and Revman (5.4) was used for meta‐analysis, using standardised mean differences (SMD). Data Sources Ten databases (platforms) were searched from January 2000 to January 2024: MEDLINE (OVID), Embase (OVID), Maternity and Childcare (OVID), CINAHL (EBSCO), PsycINFO (EBSCO), Central (Cochrane Library), Scopus, Science Citation Index (Web of Science), ERIC (EBSCO) and Assia (ProQuest). Results Forty‐two studies (5336 participants) were included: 19 randomised controlled trials, two randomised crossover trials, three cohort and 18 case–control studies. Twenty‐eight studies compared simulation‐based education to clinical teaching, 11 compared simulation‐based education plus clinical teaching to clinical teaching only, and three compared more versus less simulation‐based education in courses. Comparison 1: 21 studies (n = 2329 participants) could be meta‐analysed, giving SMD = 0.96 (95% confidence intervals = 0.63–1.30). Comparison 2: 11 studies (n = 918 participants) gave SMD = 0.82 (95% confidence intervals = 0.49–1.15). All included studies reported as good or better results for simulation education. Conclusions Simulation‐based education, alone or in combination, may be as good as patient‐based clinical teaching only to teach care skills to nursing students. Future simulation‐based education versus patient‐based clinical teaching evaluations should also measure clinical and patient‐based outcomes. Implications for the Profession and/or Patient Care More simulation‐based education of nursing students may result in fewer patients used for teaching. Impact Increased simulation‐based education may enhance undergraduate teaching, as more can be taught patient‐based clinical skills in an educational setting without apparently reducing educational performance. Patient or Public Contribution No patient or public contribution as this is a systematic review. Trial Registration PROSPERO (https://www.crd.york.ac.uk/prospero): CRD42022363205