title: Effectiveness of simulation-based nursing education depending on fidelity: a meta-analysis.
abstract: BACKGROUND
  Simulation-based nursing education is an increasingly popular pedagogical approach. It provides students with opportunities to practice their clinical and decision-making skills through various real-life situational experiences. However, simulation approaches fall along a continuum ranging from low-fidelity to high-fidelity simulation. The purpose of this study was to determine the effect size of simulation-based educational interventions in nursing and compare effect sizes according to the fidelity level of the simulators through a meta-analysis.
  
  
  METHODS
  This study explores the quantitative evidence published in the electronic databases EBSCO, Medline, ScienceDirect, ERIC, RISS, and the National Assembly Library of Korea database. Using a search strategy including the search terms "nursing," "simulation," "human patient," and "simulator," we identified 2279 potentially relevant articles. Forty studies met the inclusion criteria and were retained in the analysis.
  
  
  RESULTS
  This meta-analysis showed that simulation-based nursing education was effective in various learning domains, with a pooled random-effects standardized mean difference of 0.70. Subgroup analysis revealed that effect sizes were larger for high-fidelity simulation (0.86), medium-fidelity simulation (1.03), and standardized patients (0.86) than they were for low-fidelity and hybrid simulations. In terms of cognitive outcomes, the effect size was the largest for high-fidelity simulation (0.50). Regarding affective outcome, high-fidelity simulation (0.80) and standardized patients (0.73) had the largest effect sizes.
  
  
  CONCLUSIONS
  These results suggest that simulation-based nursing educational interventions have strong educational effects, with particularly large effects in the psychomotor domain. Since the effect is not proportional to fidelity level, it is important to use a variety of educational interventions to meet all of the educational goals.
authors.affiliation: The Catholic University of Korea 222, Banpodae-ro, Seocho-gu, Seoul, 06591, Republic of Korea.
authors.forename: Junghee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Catholic University of Daegu, 33, Duryugongwon-ro 17gil, Nam-gu, Daegu, 42472, Republic of Korea.
authors.forename: Jin-Hwa
authors.initials: JH
authors.lastname: Park
authors.affiliation: Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea. ssj1119@ewha.ac.kr.
authors.forename: Sujin
authors.initials: S
authors.lastname: Shin
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D004506:Education, Nursing / Q000379:methods* / Q000592:standards*; D006801:Humans; D016544:Patient Simulation; D000066908:Simulation Training / Q000592:standards*; D013338:Students, Nursing
keywords: Educational models; Meta-analysis; Nursing education; Patient simulation