title: Assessment for simulation learning outcomes: a comparison of knowledge and self-reported confidence with observed clinical performance.
abstract: 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.
  
  
  OBJECTIVE
  To determine whether self-reported confidence and knowledge measures are indicators of clinical performance observed in a simulation-based assessment.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive 117597, Singapore. nurliaw@nus.edu.sg
authors: Sok Ying
authors: SY
authors: Liaw
authors: Albert
authors: A
authors: Scherpbier
authors: Jan-Joost
authors: JJ
authors: Rethans
authors: Piyanee
authors: P
authors: Klainin-Yobas
mesh_terms: D002983:Clinical Competence; D004506:Education, Nursing / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D019359:Knowledge; D007858:Learning; D008297:Male; D015402:Nursing Education Research; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D016544:Patient Simulation; D020377:Self Efficacy; D057566:Self Report; D013338:Students, Nursing / Q000523:psychology*; D055815:Young Adult