Simulation-Based Education Versus Traditional Teaching for Nursing Students: A Systematic Review

Simulation-based education is increasingly used in nursing programs to enhance clinical competence, yet its effectiveness compared with traditional teaching methods remains uncertain. This study aims to evaluate the effectiveness of simulation-based education compared with traditional teaching methods in improving knowledge, clinical skills, and related outcomes among prelicensure nursing students through a systematic review.

Following PRISMA guidelines, PubMed, the Cochrane Library, and ClinicalTrials.gov were searched on August 18, 2025, for studies published. Eligible studies included prelicensure nursing students who compared SBE (high/low fidelity manikins, standardised patients, virtual/augmented reality, or serious games) to traditional education. The outcomes included knowledge acquisition, clinical skills, OSCE performance, satisfaction, confidence, and retention. We considered randomised controlled, quasi-experimental, and controlled before-and-after trials.

Thirty studies met the inclusion criteria (16 non-randomised, 14 randomised controlled trials). SBE was generally associated with improved knowledge acquisition and retention compared with traditional methods, with notable gains in CPR, vital signs, cardiac auscultation, and paediatric nursing, particularly in randomised studies. SBE groups also demonstrated superior clinical and procedural performance, including suctioning, nasogastric tube feeding, transfusion tasks, and OSCE scores, with some effects sustained at 1 to 3 months. Learner satisfaction and self-efficacy outcomes were variable; results generally favoured SBE in higher-quality studies, although several reported no significant difference. GPA outcomes showed no meaningful improvement.

The available evidence, predominantly from quasi-experimental studies, suggests that SBE may offer advantages over traditional teaching in knowledge acquisition, clinical skills, and OSCE performance among prelicensure nursing students, though these findings should be interpreted in light of the methodological heterogeneity of included studies. Benefits on satisfaction and confidence were inconsistent. These findings support the considered integration of well-designed simulation into nursing curricula to advance competency-based education and patient safety.