The Impact of Scenario-Based Simulation Learning on Clinical Self-Efficacy among Pre-licensure Nursing and Midwifery Students: A Systematic Review of Design Features and Educational Outcomes

Aim To systematically review how scenario-based simulation learning (SBSL) shapes clinical self-efficacy among pre-licensure nursing and midwifery students and how simulation design, context and assessment timing influence educational and clinical translation. Background Scenario-based simulation learning (SBSL) is widely used in nursing and midwifery education, yet evidence on its effect on clinical self-efficacy and how simulation design moderate outcomes remains fragmented. Design A systematic review following PRISMA 2020 guidelines. Methods A PRISMA 2020-compliant review searched eight databases. Eligible studies measured task-specific clinical self-efficacy via validated tools in pre-licensure cohorts. Two reviewers independently screened records, extracted data on scenario complexity, theoretical integration, debriefing structure and outcome timing and appraised risk of bias. Results Fifty-two studies (N=4,774; 46 nursing, 6 midwifery) were included. SBSL broadly correlated with self-efficacy gains, yet only 55.8% (n=29) demonstrated statistically significant between-group superiority. Psychomotor skill (54.1%), knowledge (61.9%) and cognitive reasoning (62.5%) improvements were documented. Studies embedding explicit theoretical frameworks, calibrated scenario difficulty (“Goldilocks Zone”) and structured debriefing showed the most consistent benefits. Immediate post-simulation assessments were frequently distorted by acute simulation anxiety; self-efficacy crystallized only after cognitive consolidation. Conclusion SBSL shows promise for building clinical self-efficacy, but effects are inconsistently captured and methodologically constrained by reliance on subjective self-report. Pedagogical architecture—progressive scaffolding, discipline-sensitive scenario design and rigorous debriefing—matters more than technical fidelity. Sustained efficacy requires longitudinal follow-up beyond immediate post-intervention windows. Faculty pedagogical preparedness, rather than equipment investment, is the decisive lever for translational impact. Registration A Systematic Review. PROSPERO 2024 Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD42024622757 (CRD42024622757, registered 16 Dec 2024).