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This study evaluates the impact of high-fidelity simulation on the acquisition and retention of competencies in nursing students. High-fidelity simulation provides a realistic and risk-free environment allowing students to practice, which potentially enhances the acquisition and retention of required competencies. A blinded, randomised clinical trial with three arms was conducted with a pretest and a follow-up at 6 months (post-test 1) and 12 months (post-test 2). This study was conducted with 105 s-year nursing students, divided into three groups: control (6 low-fidelity simulations), intervention 1 (3 high-fidelity and 3 low-fidelity) and intervention 2 (6 high-fidelity simulations). Competencies were assessed using the Objective Structured Clinical Examination at baseline, 6 and 12 months. Student satisfaction was measured with the Simulated Clinical Experiences Scale. Initial competency scores were similar across groups. At 6 months, both intervention groups showed significant improvements in critical thinking (6.2 and 6.0, p < 0.05), clinical skills (6.8 and 6.6, p < 0.05), communication (8.0 and 8.3, p < 0.05) and ethics (7.6 and 7.5, p < 0.05) compared with the control group. Intervention group 1 demonstrated better competency retention at 12 months. Overall satisfaction with highfidelity simulation was high (9.13/10), with particular praise for the practical dimension (8.95/10), realism (8.02/10) and the cognitive dimension (9.43/10). High-fidelity simulation has the potential to enhance nursing competencies effectively. This approach supports long-term skill retention, highlighting the importance of a well-structured curriculum that integrates different simulation levels for optimal student preparation for clinical practice.

Background Multiple surgical virtual reality (VR) simulators are currently available; however, there is lack of comparison between performance after practice on these simulators compared to bench top models. Utilizing the Intuitive Data recorder (IDR) and Objective performance indicators (OPI), we aim to objectively assess robotic surgical skills using a dry lab model. We hypothesize that practicing surgical skills will improve OPIs and that those who practice on the dry lab model will have a greater improvement in their OPIs compared to those who practice with Fundamentals of Robotic Surgery (FRS) SimNow VR. Methods The IDR was used to record kinematics as each participant went through five basic surgery tasks on a dry lab benchtop model to record baseline performance. Participants were then randomized to practice on the dry lab model or the corresponding SimNow Virtual reality (VR) tasks. The participants repeated the tasks again on the benchtop model. Statistical analysis was performed using paired samples t tests, independent samples t tests, and ANOVA tests. Results Twenty-seven surgeons participated in our study ranging from interns to attendings. Randomization to VR vs benchtop practice resulted in 11 and 13 participants in each group. For the rollercoaster, backhand suturing, railroad, and knot tying tasks, a significant improvement in kinematic profiles was observed. Bimanual dexterity, angular motion, and smoothness metrics improved most consistently across the tasks after practice. Kinematic profiles between those practicing on VR versus benchtop had no significant differences. Conclusions This study shows that OPIs can be used to benchmark surgical trainees. VR appears to be non-inferior to dry lab model for practice for trainees. We identified patterns in OPI improvement that can be tailored to specific skills depending on the trainees needs. Our study is the first step in developing a standardized training and assessment tool to assess competency in robotic surgery training.

ObjectiveGamification is a non-evaluation and competition-based training methodology with high emotional involvement. The goal of this study was to evaluate gamification methodology as compared with other existing methodologies when teaching cardiopulmonary resuscitation (CPR) to secondary school students.Methods489 secondary school students from two high schools in Spain participated in this randomised-block quasi-experimental study in February 2018. The students were classified into different groups. Each group received CPR training with a different methodology: GAM (gamification-based training as a compulsory but non-tested academic activity to learn by playing in teams, with instructor and visual feedback); EVA (training based on subsequent evaluation as a motivational incentive, with instructor and visual feedback); VFC (visual feedback complementary, training based on a non-compulsory and non-tested academic activity, with instructor and visual feedback); TC (traditional complementary, training based on a non-compulsory and non-tested academic activity, with instructor feedback). After a week, each student performed a 2 min hands-only CPR test and quality of CPR was assessed. Visual feedback in training and CPR variables in test were provided by the QCPR Instructor App using a Little Anne manikin, both from Laerdal (Norway).ResultsGAM (89.56%; 95% CI 86.71 to 92.42) methodology resulted in significantly higher scores for CPR quality than VFC and TC (81.96%; 95% CI 78.04% to 85.88% and 64.11%; 95% CI 58.23 to 69.99). GAM (61.77%; 95% CI 56.09 to 67.45) methodology also resulted in significantly higher scores for correct rate than VFC and TC (48.41%; 95% CI 41.15% to 55.67% and 17.28%; 95% CI 10.94 to 23.62). 93.4% of GAM methodology participants obtained >50 mm of compression mean depth which was a significantly higher proportion than among students in VFC and TC (78.0% and 71.9%). No differences between GAM and EVA were found. A confidence level of 95% has been assigned to all values.ConclusionsGAM methodology resulted in higher CPR quality than non-tested methods of academic training with instructor feedback or visual feedback. Gamification should be considered as an alternative teaching method for Basic Life Support (BLS) in younger individuals.

PurposeTo assess the efficacy of an accelerated proficiency-based training protocol in robotic simulation practice in delivering durable proficiency compared to conventional training methods.MethodsNovice medical students (n = 16) were randomized into either the accelerated skills acquisition protocol (ASAP) or conventional training protocol (CTP). Subjects were trained to proficiency on the da Vinci Skills Simulator (dVSS) by an expert trainer. Differences in the repetitions required to achieve proficiency in two simple and two complex virtual reality (VR) training tasks were assessed as the primary outcome measure. Transfer of the acquired skills to two other non-practiced tasks was assessed immediately and prospectively followed through to 3, 6 and 12 months in the two groups. Retention of the practiced tasks was assessed along the same timeframe.ResultsSubjects in the ASAP group acquired proficiency significantly faster in three of the four training tasks: camera control (p = 0.0002), suture sponge (p < 0.0001), ring walk3 (p < 0.0001), and peg board (p = 0.6936). When assessing transfer of skills, there were no significant differences between the two groups: Ring rail 3 (p = 0.6807) and Tubes (p = 0.2240). When assessing retention of skills at 3, 6 and 12 months, for all 6 tasks, no significant differences were seen between the ASAP and CTP groups.ConclusionASAP is proven to be an efficient approach for delivering proficiency in robotic VR simulation training. The results are durable when compared to conventional simulation training methods. The findings may have significant implications in the design of robotic VR simulation curricula.

Background . Considering the importance of psychological first aid, which is the first priority when a disaster occurs, developing a web‐based simulation training program for nurses and confirming its effectiveness is necessary. Aim . This study aimed to develop an interactive simulated education program as a psychological first aid program for nurses and verify its effectiveness. Participants . Nurses working in hospitals and the community who had not participated in psychological first aid training in the last year were recruited. Methods . A web‐based interactive simulated educational program for psychological first aid was developed. To verify its effectiveness, a randomized controlled trial design was used. The experimental group participated in a web‐based educational program, while the control group was provided self‐learning data in the form of e‐books. The program’s effects on disaster response core competencies, problem‐solving abilities, and self‐leadership capacity were measured. We used descriptive statistics to analyze the general characteristics, and independent t ‐tests were used to analyze the differences before and after the intervention. Results . The core competencies for disaster response ( t  = −2.239, p < 0.05, Cohen’s d  = 0.59), problem‐solving abilities ( t  = −2.753, p < 0.01, Cohen’s d  = 0.72), and self‐leadership capacity ( t  = −2.073, p < 0.05, Cohen’s d  = 0.54) showed a statistically significant difference between groups. Conclusions . The web‐based simulation education program for psychological first aid training developed in this study effectively enhanced nurses’ ability to respond to disasters and improved their problem‐solving abilities and self‐leadership capacity. Thus, nurses can use the educational program as a tool to learn psychological first aid. This trial is registered with KCT0008965 .

Debriefing is essential after virtual patient simulations; however, optimal approaches remain limited. To evaluate three different debriefing methods used with nursing students following virtual patient simulations, focusing on debriefing experience, simulation effectiveness, satisfaction and self-confidence. A blinded, randomized controlled, parallel group with pre- and post-test trial. 109 nursing students in their final-year were randomly assigned to three groups by an independent educator: Group A (n = 36), applied the Diamond, Group B (n = 36) applied Debriefing with Meaningful Learning (DML) and the Control Group (n = 37) applied Self-debriefing methods. Participants and the data analyst were blinded. The “Demographic Questionnaire”, “Debriefing Experience Scale (DES)”, “Simulation Effectiveness Tool-Modified (SET-M)”, “Student Satisfaction and Self-confidence in Learning Scale (SCLS)” were used to obtain data. Baseline measurements were similar between all groups. The DES showed differences within groups (p < 0.05, d> 0.8) and between groups across all subscales and total scores (p < 0.05). In the SET-M, within-group comparisons revealed significant differences in all groups. In contrast, an important difference was only revealed in the debriefing subscale between groups (p < 0.05). The largest effects in “debriefing” were between Group A versus Control and Group B versus Control (d>0.8). The SCLS revealed significant differences in all groups in within-group comparisons (p < 0.05). The results indicate that all debriefing methods are effective regarding DES, SET-M and SCLS scores. DML method yielded the highest gains. Findings offer evidence-based guidance for selecting debriefing strategies to enhance engagement and learning in virtual patient simulations. •Debriefing is essential in simulation-based education.•Evidence for post-VPS debriefing is limited.•All debriefing methods showed positive outcomes in experience, effectiveness, satisfaction, and self-confidence.•DML method yielded the highest gains.

This study developed and evaluated a mixed reality (MR) simulation program for dyspnoea care (D-MRSim) to enhance new nurses’ competency. Managing dyspnoea requires advanced skills, which many new nurses lack. Innovative training, such as MR simulation, may bridge this gap. This study used a mixed-methods design combining a randomized controlled trial and focus group interviews (FGIs). A total of 59 new nurses at a university hospital in South Korea participated, with random assignment to the experimental (n = 30) or control group (n = 29). The experimental group received D-MRSim (three 2-hour sessions over 6 weeks), while controls received equivalent traditional training. D-MRSim, developed using the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model, was evaluated through surveys, performance assessments and FGIs. The experimental group demonstrated significant improvements over time in confidence (χ² = 82.27, p < 0.001), problem-solving ability (χ² = 23.06, p < 0.001) and knowledge (χ² = 33.34, p < 0.001). The experimental group showed significantly greater knowledge (F = 10.17, p = 0.002) and higher clinical performance both immediately (Z = -6.12, p < 0.001) and 3 months after the program (Z = -5.55, p < 0.001). FGIs identified four themes: (1) Realistic learning environment, (2) Effective learning approach, (3) Clinical competency enhancement and (4) Limitations and need for improvement. D-MRSim effectively enhanced new nurses' clinical competency by providing an immersive learning environment with repeated practice opportunities, serving as a valuable educational tool for improving clinical skills and adaptability. •A mixed reality simulation significantly enhanced new nurses' knowledge and clinical performance for dyspnea management.•Immersive mixed reality provided realistic scenarios, enhancing nursing competency in respiratory distress management.•Mixed reality improved clinical judgment, skills, and confidence of new nurses managing complex respiratory conditions.•Mixed reality showed potential as an innovative tool bridging theory-practice gaps in critical care nursing education.

ABSTRACT Objectives: to compare the effectiveness of highand medium-fidelity clinical simulation on nursing students’ knowledge and clinical skills for pressure injury assessment and treatment. Methods: assessor-blinded randomized controlled trial. Thirty-two nursing students were assigned to an experimental group (n=17) or a control group (n=15). The intervention comprised a theoretical component and a simulation-high fidelity for the experimental group and medium fidelity for the control group. Data were collected with a sociodemographic questionnaire, a theoretical test, a skills checklist, and a Debriefing Assessment Scale. Statistical analysis included the chi-square test, the Mann-Whitney U test, ANOVA, and effect size, at a 5% significance level (α=0.05). Results: both groups showed significant improvement in theoretical knowledge (p<0.05). The groups did not differ significantly in skills (p=0.853). The debriefing experience was positive and similar in both groups. Conclusions: simulation improved knowledge and skills, with no differences by simulation fidelity level. RESUMEN Objetivos: comparar la eficacia de la simulación clínica de alta y media fidelidad en el desarrollo de conocimientos y habilidades de estudiantes de enfermería para la valoración y tratamiento de lesiones por presión. Métodos: ensayo clínico aleatorizado con cegamiento del evaluador. Se asignó aleatoriamente a 32 estudiantes a grupo experimental (n=17) o control (n=15). Intervención: componente teórico más simulación de alta fidelidad (experimental) o media fidelidad (control). Recogida de datos mediante cuestionario sociodemográfico, prueba teórica, lista de verificación de habilidades y Escala de Evaluación del Debriefing Asociado a la Simulación. Análisis: chi-cuadrado, U de Mann-Whitney, ANOVA y tamaño del efecto; α=0,05. Resultados: hubo mejora significativa del conocimiento teórico en ambos grupos (p<0,05). No hubo diferencias entre grupos en habilidades (p=0,853). La experiencia de debriefing fue positiva y similar. Conclusiones: la simulación mejoró conocimiento y habilidades, sin diferencias por nivel de fidelidad. RESUMO Objetivos: comparar a eficácia da simulação clínica de alta e média fidelidade no desenvolvimento de conhecimentos e habilidades de estudantes de Enfermagem para avaliação e tratamento de lesões por pressão. Métodos: ensaio clínico randomizado, com cegamento do avaliador. Alocaram-se 32 estudantes em grupo experimental (n=17) e controle (n=15). A intervenção envolveu abordagem teórica, simulação de alta fidelidade (grupo experimental) e média fidelidade (grupo-controle). Coletaram-se os dados usando questionário sociodemográfico, teste teórico, checklist de habilidades e Escala de Avaliação do Debriefing. A análise dos dados incluiu qui-quadrado, Mann-Whitney, Anova e tamanho de efeito, com significância de 5%. Resultados: houve melhora significante no conhecimento teórico dos dois grupos (p<0,05). Os grupos não diferiram significantemente nas habilidades (p=0,853). A experiência com debriefing foi positiva e semelhante em ambos. Conclusões: a simulação melhorou o conhecimento e as habilidades, sem diferenças no grau de fidelidade da simulação.

To determine the effect of visual impairment simulation training based on Data-Information-Knowledge-Wisdom (DIKW) model on professional identity and humanistic practice ability of new ophthalmic nurses. Cultivating new ophthalmic nurses’ professional identity and humanistic practice ability is the key to improving the quality of future ophthalmic services. Traditional training focuses on skills and neglects humanistic practice and teaching methods are imperfect and single. Therefore, it is necessary to innovate training strategies. A randomized controlled trial. A total of 77 new nurses from the eye hospital participated and were randomly assigned to the experimental (n = 39) and control groups (n = 38). The experimental group received the DIKW-based visual impairment simulation training and the control group received traditional training. Research tools (Nurse Professional Identity Scale, Nurses Humanistic Practice Ability Scale) were used to test at baseline and after intervention. Statistical analysis was performed by SPSS26.0. This report adheres to the CONSORT. After interventions, the nurses’ professional identity (Z = -4.854, p < 0.001) and humanistic practice ability (Z = -2.568, p < 0.05) in the experimental group improved. Compared with the control group, the scores of nurses' professional identity (Z = -5.222, p < 0.001) and humanistic practice ability (t = 3.132, p < 0.05) in the experimental group were significantly different. The DIKW-based visual impairment simulation training is helpful to improve the professional identity and humanistic practice abilities of newly recruited ophthalmic nurses. The results may contribute to the improvement of future training programs.

While previous simulation studies demonstrated comparable retention of skills for DL versus VL in normal manikins [4, 5], it is unknown if VL training among physician trainees would lead to ineffective DL use for difficult intubation scenarios. Ethical approval was sought from the National Healthcare Group Domain Specific Review Board (DSRB 2015/00937). Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due as the local approval authority does not permit data sets to be placed publicly but are available from the corresponding author on reasonable request.