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Impact of virtual simulation on nursing students’ learning outcomes: a systematic review
  1. Terri Kean
  1. Retired Faculty of Nursing, University of Prince Edward Island, Harrington, PE C1A 4P3, Canada
  1. Correspondence to Terri Kean, Retired Faculty of Nursing, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada; tkean1965{at}

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Background and purpose

  • This is a summary of Foronda C, Fernandez-Burgos M, Nadeau C, et al. Virtual simulation in nursing education: a systematic review spanning 1996 to 2018. Simulation in Healthcare. 2020;15(1):46.

  • Despite its growing use, there is limited synthesised knowledge on the effectiveness of virtual simulation (VS) as a pedagogical approach in nursing education.

  • Measuring the effectiveness of VS as a nursing pedagogy may contribute to the development of best practices for its use and enhance student learning.

  • This systematic review was undertaken to examine, appraise and synthesise research on the effectiveness of VS to impact nursing students’ learning outcomes.


Results and areas for future research

  • Eighty studies depicting the use of a wide variety of VS technology in nursing education and representing 22 years of inquiry from 15 countries qualified for review.

  • Most studies (86%) reported VS improved student learning outcomes specifically: 13/15 studies reported increased learning (knowledge); 8/13 studies reported improved skill performance; 10/12 studies reported enhanced student satisfaction; 2/5 studies reported improved critical thinking and 2/6 studies reported increased self-confidence.

  • Ten studies noted technical difficulties were common, interfered with student learning and caused anxiety, frustration and dissatisfaction among students.

  • Future research examining the impact of the integration of VS into curricula and the use of VS with manikin-based simulation is needed. More information is needed about the optimal time and dose of VS needed to impact learning outcomes and long-term knowledge retention as well as the effect of substituting limited amounts of clinical practicum for VS. This research should provide the evidence to build a framework for best practice in relation to the use of VS in nursing curricula.

Take home messages

  • The COVID-19 pandemic heightened the need for all levels of nursing curricula to be innovative, nimble and flexible to ensure seamless teaching and learning in time of crises.

  • The use of VS provides a pedagogical approach in nursing education that facilitates and enhances learning (knowledge), skill performance, learner satisfaction, critical thinking and self-confidence.

  • Further research to determine best practices and the provision of technological support for students and faculty is needed to optimise the use and impact of VS in nursing education, especially during times when access to clinical sites is limited.

Ethics statements

Patient consent for publication


  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.