Comparison of educational outcomes and factors associated with clinical decision-making ability between virtual reality and simulation-based training among undergraduate nursing students

Clinical decision-making is a core competency in nursing practice, yet opportunities for direct patient care during clinical placements have become increasingly limited. Although virtual reality (VR) and simulation-based learning (SBL) are widely used in nursing education, comparative evidence regarding their educational outcomes and predictive factors remains limited. This study compared educational outcomes between VR training and simulation-based training and identified factors associated with clinical decision-making ability among undergraduate nursing students. This comparative cross-sectional study included 272 undergraduate nursing students from nursing colleges in South Korea who completed either VR training ( n = 126) or simulation-based training ( n = 146). Educational outcomes including clinical decision-making ability, learning engagement, self-efficacy, nursing performance, and nursing professional self-concept were evaluated using validated self-report questionnaires. Baseline homogeneity and outcome differences between groups were analyzed using chi-square tests and independent t-tests. Simple linear regression analyses were conducted separately for each educational modality to identify predictors of clinical decision-making ability. The VR group scored significantly higher than the simulation-based group in clinical decision-making ability (t = 3.47, p = 0.001), learning engagement ( p = 0.005), self-efficacy ( p = 0.004), nursing performance ( p = 0.020), and nursing professional self-concept ( p = 0.003). Simple linear regression analyses identified self-directed learning as the strongest predictor of clinical decision-making ability in the VR group (B = 8.40, p < 0.001, R 2 = 0.144), with class comprehension ability, living arrangement, learning engagement, self-efficacy, male gender, nursing performance, and being 23 years of age or younger also showing significant positive associations ( p < 0.05). In the simulation-based group, class comprehension ability (B = 2.40, p = 0.004, R 2 = 0.032), self-directed learning, learning engagement, and nursing professional self-concept were significant predictors ( p < 0.05). VR training was associated with significantly higher clinical decision-making ability and major educational outcomes compared to simulation-based training. Distinct predictive patterns emerged between modalities, with self-directed learning and class comprehension playing pivotal roles. These findings suggest that learner-centered VR education provides an immersive learning environment that effectively fosters clinical reasoning skills in undergraduate nursing education. Not applicable.