Assessment for simulation learning outcomes: a comparison of knowledge and self-reported confidence with observed clinical performance

Sok Ying Liaw*, Albert Scherpbier, Jan-Joost Rethans, Piyanee Klainin-Yobas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

AIM: To determine whether self-reported confidence and knowledge measures are indicators of clinical performance observed in a simulation-based assessment.

METHOD: 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.

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)e35-9
JournalNurse Education Today
Issue number6
Publication statusPublished - Aug 2012


  • Clinical Competence
  • Education, Nursing
  • Educational Measurement
  • Female
  • Humans
  • Knowledge
  • Learning
  • Male
  • Nursing Education Research
  • Nursing Evaluation Research
  • Nursing Methodology Research
  • Patient Simulation
  • Self Efficacy
  • Self Report
  • Students, Nursing
  • Young Adult
  • Comparative Study
  • Journal Article
  • Randomized Controlled Trial


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