Bridging theory and practice: A systematic review of simulation-based education in nursing

To examine the effectiveness of Simulation-based education (SBE) compared with traditional lecture-based instruction across knowledge, clinical skills, clinical reasoning, affective outcomes and retention.

SBE has been widely adopted in nursing curricula to facilitate the integration of theoretical knowledge with clinical practice. However, evidence regarding its effectiveness across different learning domains and simulation modalities remains variable and has not been comprehensively synthesized.

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

PubMed/MEDLINE, Embase, CINAHL and Scopus (2015-2025) were searched for interventional studies evaluating SBE as a primary teaching strategy. Twenty-six studies met the inclusion criteria. Risk of bias was assessed using RoB 2, ROBINS-I and the NIH Before-After tool.

Across studies, SBE was associated with improvements in multiple learning outcomes compared with lecture-based or standard instruction, although findings varied across simulation modalities and outcome domains. Some high-fidelity, virtual and structured-debriefing approaches showed favorable effects on clinical reasoning and skill performance. Affective responses were mixed, with confidence often improving while some virtual modalities were associated with higher anxiety. Limited follow-up data suggested partial retention of knowledge and clinical reasoning over time.

SBE enhances multiple learning outcomes; however, heterogeneity in study designs and simulation approaches, together with methodological limitations and limited longitudinal evidence, indicate that findings should be interpreted cautiously and that further rigorous research is needed to clarify how simulation approaches support sustained competency development.