Nursing Students' Views on the Timing of Simulation-Based Education: Before Versus During Clinical Placements

Simulation-based education is widely recognized for enhancing nursing students' clinical preparedness and confidence. However, limited research has explored how the timing of simulation, before vs. during clinical placements, affects perceived effectiveness. This study aimed to explore nursing students' perceptions of the effectiveness of simulation-based training delivered at two different time points: before and during clinical placements.

A within-subject cross-sectional survey was conducted among 125 final-year undergraduate nursing students at a university in Saudi Arabia. The survey included quantitative items and an open-ended question to capture perceptions. Descriptive statistics, paired samples t-test, and qualitative content analysis were used. The study followed Strengthening the Reporting of Observational Studies in Epidemiology cross-sectional reporting guidelines.

Although 76 students (60.8%) preferred preclinical simulation, positioning it as a critical preparatory step in clinical readiness, there was no statistically significant difference in effectiveness ratings between the two timings (mean = 6.5, p = 0.80; Cohen's d = 0). Qualitative responses showed that students valued both timings for distinct purposes: preclinical simulation reduced anxiety and built foundational skills, while in-placement simulation reinforced learning and supported real-time application. A combined simulation approach was favored by 101 students (80.8%), supporting the value of longitudinal integration.

Students perceive simulations as beneficial, regardless of timing, but recognize the unique value of each. Findings highlight the importance of strategically and flexibly embedding simulation across the curriculum. Nursing programs should adopt a developmentally sequenced simulation strategy that supports learners' progression and addresses both preparatory and reinforcing roles across the clinical education continuum.