Assessment for simulation learning outcomes: a comparison of knowledge and self-reported confidence with observed clinical performance

Nurse Educ Today. 2012 Aug;32(6):e35-9. doi: 10.1016/j.nedt.2011.10.006. Epub 2011 Nov 5.


Background: With extensive use of simulation in nursing education, researchers around the world are evaluating learning outcomes from simulation. Numerous studies reported the use of knowledge tests and self-reported measures to evaluate simulation outcomes.

Aim: To determine whether self-reported confidence and knowledge measures are indicators of clinical performance observed in a simulation-based assessment.

Method: Thirty-one third year nursing students were randomized into intervention and control group. The intervention group received a six hour simulation-based programme in care of a patient with physiological deterioration. Pre and post-tests using knowledge test, confidence scale and simulation-based assessment were conducted immediately before and after the simulation program.

Results: The intervention group had a significantly higher post-test mean score than the control group for knowledge and clinical performances. Both groups demonstrated a significant improvement on post-test scores from pre-test scores for self-confidence with no significant differences detected among the two groups. Correlation tests indicated no significant correlation between self-confidence and clinical performance, and between knowledge and clinical performance.

Conclusion: The study did not provide evidence to support the validity of the knowledge test and self-confidence measures for predicting clinical performance. Most importantly, it revealed potential danger of a simulation-based assessment that could lead toward overestimation of self-confidence.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Clinical Competence*
  • Education, Nursing / methods*
  • Educational Measurement
  • Female
  • Humans
  • Knowledge
  • Learning*
  • Male
  • Nursing Education Research
  • Nursing Evaluation Research
  • Nursing Methodology Research
  • Patient Simulation*
  • Self Efficacy*
  • Self Report
  • Students, Nursing / psychology*
  • Young Adult