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deliberate practice, nursing students, self-efficacy, simulation, virtual simulation



  1. Mabry, Jennifer PhD, RN
  2. Lee, Emily DNP, RN
  3. Roberts, Toni DNP, RN
  4. Garrett, Rebecca EdS


Background: To reduce performance anxiety and increase engagement in medical-surgical simulations, virtual simulation (VS) was introduced prior to complex high-fidelity simulation to increase students' self-efficacy.


Problem: A presimulation preparation needed to be expanded for high-fidelity simulation involving emergent clinical situations.


Approach: Combined frameworks of Ericsson's theory of deliberate practice and Bandura's self-efficacy theory were applied. Students completed VS scenarios until a specific score of mastery was obtained, and then the same scenario was repeated in the high-fidelity simulation laboratory. A modified self-efficacy scale survey was administered presimulation and postsimulation. Data were collected on 3 cohorts of students (n = 151) over an academic year.


Outcomes: VS followed by high-fidelity simulation significantly increased student perception of self-efficacy in all 3 cohorts (P = .001, P = .037, P = .005).


Conclusion: Preparation for high-fidelity simulation using VS increases self-efficacy and allows students to engage in the simulation experience, thus achieving higher levels of mastery through deliberate practice.