Effect of desktop virtual patient simulation on clinical reasoning skills of nursing students: A systematic review...

To evaluate the effectiveness of desktop virtual patient simulation in improving nursing students' clinical reasoning skills, knowledge, satisfaction, self-confidence, and anxiety.

Systematic review and meta-analysis.

Desktop virtual patient simulation is an innovative teaching model in nursing education, but research on its effectiveness in improving clinical reasoning skills has yielded inconsistent results.

We searched 11 databases from inception to September 18, 2025, for randomized controlled trials and quasi-experimental studies on desktop virtual patient simulation. Meta-analysis was performed using RevMan 5.4 and Stata 15.0, and trial sequential analysis with TSA 0.9.5.10. Heterogeneity was assessed through sensitivity analysis, subgroup analysis, and meta-regression.

A total of 24 studies involving 1875 nursing students were included. Meta-analysis results indicated that desktop virtual patient simulation significantly improved clinical reasoning skills (SMD = 0.42, 95% CI: 0.24-0.60, P < 0.05), knowledge (SMD = 2.40, 95% CI: 1.22-3.59, P < 0.05), and self-confidence (SMD = 0.39, 95% CI: 0.13-0.64, P < 0.05). However, no significant effects were observed for satisfaction (SMD = 0.19, 95% CI: -0.12-0.49, P = 0.23) or anxiety (SMD = 0.16, 95% CI: -0.5-0.82, P = 0.64).

Desktop virtual patient simulation effectively enhances nursing students' clinical reasoning skills, knowledge, and self-confidence. However, its effects on satisfaction and anxiety warrant further investigation. Due to its convenience, accessibility, and proven effectiveness, this modality is likely to be widely adopted in nursing education.