The Effectiveness of Simulation-Based Versus Patient-Based Clinical Education in Nursing: A Systematic Review and Meta-Analysis.

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.