Author ORCID Identifier

Celeste M. Alfes

Document Type


Publication Date



Objective The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students' learning outcomes. Design A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data sources PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references. Study selection To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis. Review method Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria. Synthesis method For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen's d with a 95% CI. Results Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected. Conclusions Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students' knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students' competence and patient outcomes.


education, high fidelity simulation training, learning, nursing, students

Publication Title

BMJ Open






© Author(s) 2019

Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Included in

Nursing Commons


10.1136/bmjopen-2018-025306" data-hide-no-mentions="true">
10.1136/bmjopen-2018-025306" data-hide-zero-citations="true" data-style="small_circle">

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