Journal of Advances in Medical Education & Professionalism

Review article

Impacts of Unfolding Case-Study Learning on Nursing Students’ Performance Outcomes: A Scoping Review

MAYSA` KASSABRY; MAHMOUD AL-KALALDEH; AHMAD AYED; GHADA ABU-SHOSHA; BASMA SALAMEH

Volume 14, Issue 1 , January 2026, Pages 1-20

https://doi.org/10.30476/jamp.2025.108065.2234

Abstract

Introduction: The unfolding case study is an innovative teaching strategy that structures patient scenarios over time to enhance learner engagement and improve outcomes. However, its ... Read More

Review article

Applications and Challenges of Virtual Reality in Medical Sciences Education: A Systematic Review

SEDIGHE SADAT TABATABAEI FAR; MILAD AHMADI MARZALEH; RAHMATOLLAH SOLTANI; FARZANEH GHALEH GOLAB

Volume 14, Issue 1 , January 2026, Pages 21-31

https://doi.org/10.30476/jamp.2025.104655.2076

Abstract

Introduction: Virtual reality (VR) technologies are interactive multimedia environments that serve as popular educational tools for teaching various groups. This study aimed to explore ... Read More Introduction: Virtual reality (VR) technologies are interactive multimedia environments that serve as popular educational tools for teaching various groups. This study aimed to explore the applications of VR in the education of different medical science groups, including medicine, medical residents, dentistry, nursing, pharmacy, etc., in a systematic review format. This technology provides unique opportunities for learners to immerse themselves in experiences, leading to increased understanding and practical skills in the field of medical sciences. Therefore, this study was conducted in 2023 to examine the applications and challenges of VR in medical science education through a systematic review.Methods: This study systematically extracts published articles through keyword searches from 1970 until March 14, 2023, in Web of Science, Scopus, Science Direct, Cochran Library, PubMed,ProQuest and IEEE. To evaluate the methodological quality of the included studies, we used the STROBE checklist. All stages were carried out by two researchers, and the final selected articles were summarized in tables.Results: This review included 26 studies from an initial pool of 22,160 identified articles. The analysis revealed six key themes regarding the use of these technologies: their impact on learning outcomes, increased student motivation, enhanced self-confidence, improved teamwork, their role as tools for curriculum integration, and associated challenges. Collectively, the reviewed studies suggest that such technologies contribute positively to learning satisfaction, academic performance, public speaking confidence, and collaborative skills. Additionally, they serve as effective supplementary tools in educational settings. Nevertheless, several studies reported potential side effects, including dizziness, nausea, and eye strain.Conclusion: This study showed that the use of technologies like VR improved learning, motivation, and teamwork, but there were challenges in their implementation. It is recommended that thesetechnologies should be integrated into the curriculum and training workshops should be held for their effective use. Additionally, policymakers should provide financial resources and nationalguidelines to support the expansion of these technologies.

Original Article

Perceptions of Healthcare Design Course Implementation and Opportunities from a Student-Driven Multidisciplinary Collaboration

DANIEL HU; MARY LOU; AKASH NADELLA; MOHNISH NADELLA; GEOFF CAPRARO

Volume 14, Issue 1 , January 2026, Pages 32-42

https://doi.org/10.30476/jamp.2025.108162.2239

Abstract

Introduction: Design thinking is vital in medical education for addressing complex healthcare challenges, but interdisciplinary collaboration opportunities remain limited. This study ... Read More Introduction: Design thinking is vital in medical education for addressing complex healthcare challenges, but interdisciplinary collaboration opportunities remain limited. This study evaluates student-reported 1) exposure to design-thinking methods, and 2) access to healthcare-specific design opportunities (courses, projects, mentors, and networks) at Brown University, the Rhode Island School of Design (RISD), and the Warren Alpert Medical School (AMS). It also assesses a student-driven organization that fosters skill development, interdisciplinary collaboration, and project-based learning.Methods: A survey was developed with multidisciplinary student and faculty review for face and content validity. Using a cross-sectional convenience sample from a cross-institutional listserv, 77 students completed the 25-question survey covering demographics, prior experiences, interests, and perceived access to healthcare design opportunities. Responses used checkbox and Likert scale formats. We used descriptive statistics and between-group comparisons (project participants vs nonparticipants) via t-tests on Likert means (α=0.05).Results: The survey yielded 77 responses. Respondents represented Brown (61%), AMS (18%), and RISD (14%), with 6% enrolled in joint Brown-RISD programs. Institutional disparities were noted from self-reported aptitudes: RISD students excelled in design (100%), and AMS in research (79%). Brown students reported the greatest access to academic opportunities in healthcare design (68%). Common challenges included limited professional networks (average 2.4/5). Participants sought collaborations and skills from other institutions. Most respondents (94%) desired project-based opportunities, highlighting demand for practical applications. Design x Health project participants reported significantly higher self-perceived access to opportunities and understanding of design processes compared to non-participants.Conclusions: This study highlights the potential of student-driven organizations in addressing limited opportunities and networking needed to incorporate design in health solutions. By improving access to networks and integrating healthcare design into curricular and extracurricular offerings, such initiatives prepare students to tackle healthcare challenges.

Original Article

Assessment of the Level and Determinants of Empathy in Moroccan Medical Students: A Cross-sectional Study

SOUMAYA BENMAAMAR; IBTISSAM EL HARCH; CHARAFA MESBAHI; KARIMA EL RHAZI

Volume 14, Issue 1 , January 2026, Pages 43-51

https://doi.org/10.30476/jamp.2025.107687.2220

Abstract

Introduction: Empathy is a key element in the doctor-patient relationship. Despite its recognized importance for both patient and physician. Several studies have reported a decline ... Read More Introduction: Empathy is a key element in the doctor-patient relationship. Despite its recognized importance for both patient and physician. Several studies have reported a decline in empathyduring medical training. However, few studies have been carried out in this regard in the Arab world, particularly in Morocco. This study aimed to assess the level of empathy in Moroccan medical students and to identify the factors associated with its variation.Methods: A cross-sectional study was carried out among medical students at various Moroccan medical faculties. Data were collected using a questionnaire that included socio-demographicdata on the students and their parents, clinical and academic data and satisfaction with the relationship with parents, and the validated version of the 10 items Perceived Stress Scale (PSS 10)for stress assessment. Empathy was assessed using the Jefferson Scale of Empathy– student version (JSE-S) in its Arabic version validated in Morocco. Data were analyzed using descriptivestatistics, bivariate analysis and multivariable linear regression to determine the factors associated with empathy. The significance level was considered 0.05. All statistical analyses were performedusing SPSS Version 26.Results: A total of 565 students were enrolled. The mean JSE-S score was 106.15±13.65, with a significant drop observed during the third cycle (the 6th and 7th year) (p=0.002). Female studentsscored higher than males (p=0.003). Higher satisfaction with parental relationships was positively associated with empathy (p=0.02), while chronic disease was linked to lower scores (p=0.048).Conclusion: Empathy in Moroccan medical students appears to decline during medical training, which may affect future physician–patient interactions. These findings underscore the importance of implementing educational interventions and curricula designed to foster empathy, ultimately improving communication, patient satisfaction, and quality of care in clinical practice.

Original Article

Enhancing Physiology Learning and Practical Experimentation through Task-based Modules and PowerLab Integration in Undergraduate Medical Education: Indonesia

AMI FEBRIZA; NURMILA NURMILA; FATIMAH MAPPANYOMPA; MUH DA’I ALAMNSYAH

Volume 14, Issue 1 , January 2026, Pages 52-58

https://doi.org/10.30476/jamp.2025.107270.2195

Abstract

Introduction: Anatomy, histology, biochemistry, and physiology are essential for clinical practice. Task-based learning (TBL) offers an innovative, active learning strategy that aligns ... Read More Introduction: Anatomy, histology, biochemistry, and physiology are essential for clinical practice. Task-based learning (TBL) offers an innovative, active learning strategy that aligns with these foundational subjects. Meanwhile, the use of computer-aided data acquisition (data acquisition; DAQ) systems like PowerLab has significantly transformed physiology education through simulation-based experimentation. This study aimed to evaluate the effectiveness of combining TBL and PowerLab in enhancing undergraduate medical students’ understanding of physiology.Methods: This quasi-experimental study included 180 undergraduate medical students from the Faculty of Medicine and Health Sciences at Unismuh. Participants were selected using convenience sampling. A survey consisting of 12 validated Likert-scale questions (Cronbach’s alpha=0.84)was conducted to gather students’ insights into how PowerLab can be utilized to perform and educate physiology experiments. A task-based module was used in this study, implemented over five sessions, each lasting 120 minutes, and covering topics such as cardiovascular, respiratory, and neuromuscular physiology. Students’ cognitive abilities were measured using a pre-post-test consisting of 25 validated multiple-choice questions, a practicum exam, and the final mark of the biomedical course. Data were analyzed using SPSS version 26.0 and Microsoft Excel. Frequency and summary statistics were analyzed using descriptive statistics.Results: During experiments with PowerLab, 74.4% of the students demonstrated a good to excellent understanding of physiological concepts. The pre-post-test scores elicited a statistically significant median increase compared to the pre-test score (p<0.001). There was also a statisticallysignificant correlation (Spearman’s rho=0.82, p<0.001) between the practicum exam results and average test scores (Spearman’s rho=0.54, p<0.001) with the final marks in the biomedical course. However, 30 students (16.7%) showed decreased scores, indicating variability in response to the intervention, requiring further exploration. Additionally, students reported discrepancies between satisfaction (67% excellent) and perceived comprehension (40% average), suggesting gaps between enjoyment and conceptual understanding.Conclusion: Integrating PowerLab technology with task-based modules enhances understanding and performance in physiology education. These strategies create an engaging, hands-on learning environment that fosters critical thinking and prepares students for clinical practice applications.However, further studies are needed to investigate the reasons behind variability in students’ responses, especially those whose scores decreased, and to address observed discrepancies between students’ satisfaction and actual comprehension of the physiological concepts.

Original Article

Effect of a Supportive-Educational and a Supportive-Only Program on Novice Nurses’ Clinical Competency: A Quasi-Experimental Study in Iranian Teaching Hospitals

SAMANEH GHORBANI; MALIHEH NEKOUEI MARVI LANGARI; MOHAMMAD AMIN KARIMI; FATEMEH HESHMATI NABAVI; HAMID HEIDARIAN MIRI

Volume 14, Issue 1 , January 2026, Pages 59-69

https://doi.org/10.30476/jamp.2025.108610.2261

Abstract

Introduction: Enhancing the clinical competency of novice nurses remains a critical concern in nursing management. This study aimed to determine the effects of a supportive-educationaland ... Read More

Original Article

Concept Analysis of Knowledge Sharing in Multidisciplinary Surgical Teams: Implications for Interprofessional Education and Professional Development

ZAHRA NOURI KHANEGHAH; ZOHREH SOHRABI; HOMEIRA KHODDAM

Volume 14, Issue 1 , January 2026, Pages 70-88

https://doi.org/10.30476/jamp.2025.107599.2211

Abstract

Introduction: Understanding and clarifying key concepts such as “knowledge sharing” is essential for advancing interprofessional collaboration and education in healthcare. ... Read More Introduction: Understanding and clarifying key concepts such as “knowledge sharing” is essential for advancing interprofessional collaboration and education in healthcare. This study aimed toanalyze the concept of knowledge sharing in multidisciplinary surgical teams.Methods: This is a qualitative study performed using Schwartz-Barcott and Kim’s (2000) hybrid model of concept analysis, implemented in three stages: 1) theoretical, 2) fieldwork, and 3)final analysis. In the theoretical phase, a comprehensive literature review was analyzed through inductive content analysis. Along the fieldwork phase, semi-structured interviews were conductedwith surgical team members and analyzed deductively following Elo and Kyngäs’ approach. In the final phase, the findings from both stages were integrated to present a comprehensive definitionof knowledge sharing.Results: The final analysis phase indicated five main categories of attributes: 1) diversity of shared knowledge, 2) interactive, voluntary and multi-directional exchange, 3) purposeful process, 4) varied sharing levels, and 5) diverse sharing methods. Further, two main categories of antecedents were identified: 1) individual and knowledge factors, and 2) organizational factors. Ultimately, the analysis highlighted two main categories of consequences: 1) individual, team and therapeutic consequences, and 2) organizational consequences.Conclusion: In the present study, knowledge sharing was defined as an interactive, purposeful, and voluntary process occurring at various interpersonal and organizational levels (vertical and horizontal) through professional behaviors. It involves reciprocal (occasionally unilateral) exchange of tacit/explicit knowledge via formal, informal, and web-based channels. Since the core characteristics of knowledge sharing have remained largely consistent between the theoretical and fieldwork phases, this definition can be applied to other clinical environments.

Original Article

White Coats and Billboards: An Ethical Analysis of Surgeons’ Attitudes towards Physicians' Advertisements in a Middle-Income Settings

LEILA MASOUDIYEKTA; PARNIAN REZAEIAMJAD; FARIBA ASGHARI; EHSAN SHAMSI-GOOSHKI; AYAT AHMADI; ALIREZA PARSAPOUR

Volume 14, Issue 1 , January 2026, Pages 89-98

https://doi.org/10.30476/jamp.2025.107709.2219

Abstract

Introduction: Physician advertising is an important topic in the medical field. It is an important tool for attracting new patients, increasing awareness of medical services, and promoting ... Read More Introduction: Physician advertising is an important topic in the medical field. It is an important tool for attracting new patients, increasing awareness of medical services, and promoting the brand of physicians and medical centers. Therefore, this study investigated the surgeons’ attitudes toward physician advertising.Methods: This cross-sectional descriptive-analytical study was conducted on 136 surgeons selected from four teaching hospitals and two private hospitals in Tehran using convenience sampling. A researcher-made questionnaire was used to measure the surgeons’ attitudes towards physician advertising. The survey included scales validated by a group of experts, and questionnaire validation methods were performed using a 5-point Likert scale. Data were analyzed using SPSS 18 software. Descriptive statistics were used to summarize the data, and inferential statistical tests, including chi-square, Fisher’s exact test, and independent t-tests, were used to examine the associations.Results: The mean age of the study physicians was 36.99±0.9 years. Regarding the physicians’ perceptions of advertising, 89% fully concurred that physician advertising enhanced their revenue.Conversely, 76.5% of physicians contended that advertising did not foster increased competition or enhance services. Most participants (84.6%) entirely refuted the assertion that advertising undermined the reputation of physicians. Furthermore, 86% expressed complete dissent about the prohibition of advertising by physicians. Seventy-five percent of surgeons said that paying the media to invite physicians to educational seminars was the most improper way for doctors to advertise. Conversely, 88.2 percent of them said that posting instructional information on theirvirtual profiles was the best approach. Statistical testing demonstrated that the judgment of the positive attitude toward physician advertising strongly correlated with age (p=0.002). The status of physician advertising in the community was deemed entirely proper for those under 30 years old, whereas it was deemed wholly inappropriate for those aged 30 to 45 and above.Conclusion: The results of this study showed that physicians’ attitudes towards advertisements by physicians in society were evaluated favorably in terms of ethical aspects and the dignity of the medical profession.

Commentary

Instances of Moral Distress in Medical Education: Recognition and Approaches

PAMELA JOFRÉ; RODRIGO VERGARA

Volume 14, Issue 1 , January 2026, Pages 99-102

https://doi.org/10.30476/jamp.2025.105629.2118

Abstract

The care of sick people is a moral issue. In a highly technological era, it risks becoming a matter of repairing unhealthy bodies by means of evidence-based strategies, neglecting the ... Read More

Letter to Editor

Can Serious Games be Used in Teaching Clinical Reasoning to Nursing Students?

NASRIN KHAJEALI; MOTAHAREH MOUSAVI GHAHFAROKHI; MITRA AMINI; FATEME JAVAHERI

Volume 14, Issue 1 , January 2026, Pages 103-104

https://doi.org/10.30476/jamp.2025.106055.2142

Abstract

Various teaching methods are used in medical education. While Card games are effective for education, supported by educational theory, and generally well accepted by learners, there ... Read More

Analyzing the Trends and Drivers Influencing Future Leadership in Medical Education in Iran

Volume 13, Issue 2 , April 2025, , Pages 134-148

https://doi.org/10.30476/jamp.2025.103897.2029

Abstract

Introduction: A key challenge for policymakers in medical education lies in grasping the future landscape of leadership. Without insights into emerging trends, they may face unforeseen ... Read More Introduction: A key challenge for policymakers in medical education lies in grasping the future landscape of leadership. Without insights into emerging trends, they may face unforeseen issues, leading to expensive and inefficient decision-making. This study aimed at analyzing the trends and drivers influencing future leadership in medical education in Iran.Methods: In this research, we employed a descriptiveexploratory approach This study consists of systematic reviews and interviews that have been analyzed using Structural Equation Modeling with the help of MicMac software (version 6.1.2, 2003/2004: 3IE/EPITA, France). We conducted a systematic review according to PRISMA. A literature search was performed using databases including Medline, Web of Science, ProQuest Dissertation & Theses, Scopus Embase, and Persian studies from SID, and Magiran. The inclusion criteria for the study were the articles which needed to contain one or more listed keywords, were published in a scientific journal, were written in English or Persian, were published between 2004 and 2024, had the full text available, and focused on educational leadership in medical schools. Additionally, interviews were conducted with 14 Iranian experts to pinpoint influential components. To be included, experts possessed relevant education in medical education, health policy, or higher education management; occupied an executive or managerial position in higher health education or health policy; had more than 15 years of work experience, and were willing to participate in the study. Afterward, the codes were presented in a focus group discussion of experts to define how extracted drivers would affect leadership in medical education in Iran.Results: We identified 6081 articles in the initial literature search; 17 met inclusion criteria for final review. The study identified 37 drivers in medical education management and leadership. Thesedrivers were categorized into four types: effective drivers (3), impressionable drivers (3), autonomous drivers (16), and bimodal drivers (15). Among these, the components of meritocracyin selecting managers and international relations within the education sector had the most significant impact.Conclusion: By understanding and planning around these influential and susceptible components, managers, and policymakers can gain foresight. This foresight can enhance the effectiveness of current decisions and activities, enabling a more desirable future. This can be achieved by systematically improving decision-making processes, revising procedures, and developing appropriate strategies in medical education leadership.

Integrating Artificial Intelligence in Medical Education: A Meta-Synthesis of Potentials and Pitfalls of ChatGPT

Volume 13, Issue 3 , July 2025, , Pages 155-172

https://doi.org/10.30476/jamp.2024.104617.2071

Abstract

Introduction: ChatGPT serves as a double-edged sword in education, offering either constructive information or potential challenges. Its impact ranges from being a transformative tool ... Read More Introduction: ChatGPT serves as a double-edged sword in education, offering either constructive information or potential challenges. Its impact ranges from being a transformative tool to a disruptive force, making it difficult to evaluate its educational efficacy comprehensively. In light of this complexity, the primary aim of this research was to investigate the opportunities and challenges associated with the integration of ChatGPT into the domain of medical education.Methods: The study utilized the Interaction Equivalency Theorem as its conceptual framework to guide the investigation. To achieve the research objectives, a meta-synthesis of the literature wasconducted to systematically integrate the findings of selected studies. Data collection involved comprehensive searches across specialized academic databases, including Science Direct, Springer, ERIC, Emerald, SAGE, Wiley Online Library, PubMed, and Google Scholar, focusing on publications from 2022 to 2024. 88 articles were meticulously selected based on their relevanceto the research topic. The data were then subjected to thematic analysis, facilitating the extraction of key insights and patterns to address the study objectives.Results: The findings were organized into four primary subthemes highlighting the opportunities presented by ChatGPT in medical education. These sub-themes encompassed benefits for educators, learners, curriculum development, and the learning process. Similarly, the challenges related to the integration of ChatGPT were categorized into four primary sub-themes: addressing the difficulties experienced by educators, learners, curriculum development, and the learning process. Together, these challenges were further delineated into 11 secondary sub-themes,offering a comprehensive analysis of the complexities involved.Conclusion: The findings suggest that improving educational efficiency, assisting with self-development, enhancing communication skills, creating and expanding curriculum, and improving the learning environment are opportunities for utilizing ChatGPT. The study outcomes also reveal that lack of technological knowledge, negative attitudes, reduction in education quality, diminishing students’ capabilities, reducing learning quality, flaws in learning development, difficulties in designing educational content, and bias in learning evaluation are challenges of applying ChatGPT in medical education.

Transforming Education: Case-Based Integrated Learning Development and Implementation – A Mixed Methods Study at a Private Medical College

Volume 13, Issue 1 , January 2025, , Pages 49-58

https://doi.org/10.30476/jamp.2024.104285.2048

Abstract

Introduction: Case-based learning (CBL) is widely used in medical education to bridge theory and practice, but traditional methods often struggle to sustain student engagement and promote ... Read More Introduction: Case-based learning (CBL) is widely used in medical education to bridge theory and practice, but traditional methods often struggle to sustain student engagement and promote critical thinking. To address these challenges, Case-Based Integrated Learning (CBIL) was developed as a novel approach combining immersive and interactive learning techniques. This study aimed to evaluate the effectiveness of CBIL in enhancing engagement, critical thinking, and clinical reasoning among medical students, and explore faculty experiences regarding the pedagogy.Methods: An explanatory-sequential mixed-methods study was conducted in a private medical college in Pakistan. Quantitative data were collected through faculty (n=35) and student (n=122) evaluation surveys, and analyzed using descriptive statistics (mean, standard deviation, frequencies, and percentages). Qualitative data from focused group discussions (FGD) with faculty were analyzed thematically. A committee of clinical faculty and medical educationists developedfour CBIL prototypes. Faculty from various clinical specialties were trained on CBIL concepts and lesson planning, and the prototypes were used to develop engaging cases for subsequent sessions. Participants included faculty from diverse disciplines and students intheir third and fourth years of medical school.Results: The faculty considered the training very effective (overall satisfaction: 5.17±0.89 out of 6), with a vast majority being very satisfied with its relevance (86%, n=30) and structure (91%, n=32).Among students, 95% (n=116) were satisfied with the developed cases. Most of them were also satisfied with the clarity (92%, n=112) and applicability of the cases (96%, n=117). In FGD, facilitators expressed satisfaction with CBIL formats as it provided opportunities for engagement, in-depth analyses, and discussions.Conclusion: Interactive formats like CBIL can engage students by allowing opportunities for interaction, discussion, and peer-learning. This promotes improved understanding and critical thinking. Further exploration of the effectiveness and impacts on the learning of various interactive formats of case-based learning is essential.

The Advantages and Challenges of Electronic Exams: A Qualitative Research based on Shannon Entropy Technique

Volume 13, Issue 1 , January 2025, , Pages 1-11

https://doi.org/10.30476/jamp.2024.102951.1987

Abstract

Introduction: The electronic exam is one of the foremost imperative instruments for evaluating students’ execution. Accordingly, this study aimed to identify the advantages and ... Read More

Nursing Students’ Perspectives on the Relationship between Virtual Reality Simulation and Clinical Decision-Making, Confidence, and Anxiety: A Cross-Sectional Study

Volume 13, Issue 3 , July 2025, , Pages 191-197

https://doi.org/10.30476/jamp.2025.105619.2115

Abstract

Introduction: This study addresses this gap by assessing the relationship of VR simulation with improving clinical decisionmaking, confidence, and anxiety reduction among nursing students. ... Read More Introduction: This study addresses this gap by assessing the relationship of VR simulation with improving clinical decisionmaking, confidence, and anxiety reduction among nursing students. The aim of this study is the relationship between virtual reality simulation and their clinical decision-making, confidence, and anxiety reduction using a cross-sectional study from the perspectives of nursing students.Methods: This cross-sectional study surveyed 200 nursing students enrolled in clinical courses utilizing virtual reality (VR) simulation for educational purposes. A structured questionnairewas used to assess their clinical decision-making, confidence, and anxiety reduction following the VR simulation course. The survey included scales validated through a panel of experts andquestionnaire validation methodologies, using a 5-point Likert scale. Descriptive statistics were used to summarize the data, and inferential statistical tests, including Pearson’s correlation and independent-sample t-tests, were conducted to examine the associations. Multiple linear regression analysis was performed to assess the predictive value of confidence and anxiety on clinical decision-making while controlling demographic variables.Results: A total of 200 nursing students participated in the study. The mean (SD) clinical decision-making score was 3.16 (1.23) out of 5, while confidence and anxiety reduction scores were 2.64 (1.34) and 2.49 (1.32), respectively. No significant correlation was found between decision-making and confidence (r=-0.079, p=0.264) or anxiety scores (r=0.121, p=0.088), but confidence and anxiety scores showed a weak direct correlation (r=0.180, p=0.011). Multiple linear regression analysis revealed that confidence and anxiety were not significant predictors of decision-making, but gender was a significant predictor, with males scoring higher (β=0.19, p=0.041).Conclusions: While VR directly influences decision-making, it has a limited association with changes in nursing students’ confidence and anxiety levels. These findings suggest that VRsimulation alone may not be sufficient for enhancing confidence and reducing anxiety and should be integrated with other instructional strategies to maximize its effectiveness in nursing education. Future studies should explore complementary training methods to improve clinical preparedness.