Learning Autonomy and Group Cohesion in Clinical Simulation: A Quasi-Experimental Comparison of Two Training...

Background/Objectives: Given the complexity of current healthcare, working in highly cohesive teams is essential. Clinical simulation can promote group cohesion among healthcare teams. There are different learning methodologies in simulated environments capable of developing group cohesion in healthcare teams. The objective of this study was to compare group cohesion outcomes between two clinical simulation learning models-self-directed (Self-Learning Methodology in Simulated Environments, MAES©) and non-self-directed (Simulation-Based Learning, SBL)-in nursing student teams. Methods: A quasi-experimental pre-post study with a control group was conducted among 311 fourth-year nursing students from two Spanish universities. The primary outcome was group cohesion, assessed using the Spanish short version of the Group Environment Questionnaire (GEQ) total score and its dimensions. The questionnaire was administered twice, before and after participation in clinical simulation sessions. The experimental group used the MAES© methodology, while the control group used SBL. Between-group differences were analyzed using analysis of covariance (ANCOVA), adjusting post-intervention scores for baseline values. Within-group pre-post changes were explored as a secondary analysis using the Wilcoxon signed-rank test. Results: No significant differences in baseline group cohesion were found. After the intervention, both methodologies were associated with improvements in group cohesion over time. Adjusted analyses (ANCOVA) showed statistically significant between-group differences favoring MAES© across all dimensions, with small-to-medium effect sizes (ηp² = 0.036-0.138). Conclusions: Both simulation methodologies were associated with improvements in group cohesion among nursing students. Adjusted between-group differences were observed across all dimensions, associated with higher adjusted scores in the MAES© group. However, given the non-randomized design these findings should be interpreted as associations rather than evidence of causality. Further randomized controlled trials are needed to confirm these results.