Is virtual simulation as effective as clinical simulation: a mixed methods study comparing knowledge acquisition, self-confidence, anxiety, and cost effectiveness

<h2>Abstract</h2><h3>Introduction</h3> Desktop Virtual Reality Simulation (dVRS) is a growing trend in healthcare education. The evidence base supporting this initiative is expanding yet there is limited evidence on how dVRS compares to clinical simulation (CS). The objectives of this study were to compare dVRS to CS with knowledge acquisition, self-confidence, anxiety as primary outcomes and cost effectiveness and students' perception of dVRS as secondary outcomes. <h3>Methods</h3> A two-stage sequential mixed methods approach was conducted to meet the objectives. In Stage 1, a two-armed randomized controlled trial was conducted with 67 nursing students. The experimental group (n = 34) were assigned to dVRS and control group (n = 33) to CS. In Stage 2, qualitative interviews with Stage 1 participants (n = 17) explored their perceptions of dVRS. <h3>Results</h3> In Stage 1, mean pre and post knowledge acquisition scores were high (>80 %) across both groups but significantly higher in the control group (Mean difference (MD) = −1.6, 95 % CI (−2.5, −0.6), p = 0.02. Anxiety decreased and self-confidence increased in both groups but statistically significant differences in confidence and anxiety were observed only in the control group (MD = −0.88, 95 % CI (−1.1, −0.6), p < 0.01) and (MD = 0.55, 95 % CI (0.3, 0.7), p < 0.01) respectively. Analysis of secondary outcomes estimated difference in cost when the experimental and control groups were compared (£893 vs £2036/participant, respectively). Thematic analysis of Stage 2 qualitative data generated three themes: decision making, alignment to real-world learning, and improving the dVRS experience. Additionally, participants perceived improvements in knowledge and confidence, reported the value of the immersive aspects of dVRS, and suggested areas for improvement regarding pre-brief and debrief. <h3>Conclusions</h3> Across all primary outcome measures (knowledge acquisition, self-confidence and anxiety) CS was more effective, but less cost-effective, than dVRS. Moreover, dVRS was perceived to be useful and applicable as an adjunct to CS to enhance confidence, knowledge, and decision-making skills.