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Toward competency-based nurse practitioner education: Evaluating clinical reasoning in virtual simulation: A multisite study
Journal article   Peer reviewed

Toward competency-based nurse practitioner education: Evaluating clinical reasoning in virtual simulation: A multisite study

Mindi Anderson, Peggy P. Hill, Jennifer Roye, Elizabeth Wells-Beede, Jacqueline LaManna, Deb O’Briant, Patti A. Parker, Frank Guido-Sanz and Desiree A. Díaz
Clinical simulation in nursing, Vol.115, 101950
2026-06

Abstract

Advanced practice Clinical reasoning Competency-based education Nurse practitioner Screen-based simulation Virtual simulation
•Virtual simulation (VS) supports competency-based education.•VS aligns with advanced practice competencies related to assessment and diagnosis.•Clinical reasoning can be evaluated using VS for NP learners. Nurse practitioner (NP) students may lack confidence in diagnostic planning skills. As programs move toward competency-based education, virtual simulation (VS) offers an opportunity to assess core competencies related to clinical reasoning (CR) in a structured, learner-centered format. The aim was to explore how VS can be used to evaluate core competencies for advanced practice nurses. This multisite study included 74 primary-care-focused NP students across three universities. Institutional review board approval at all universities was attained. Participants completed two VS scenarios. Simulations were conducted using standardized prebriefing and debriefing processes. Data collected included clinical and diagnostic reasoning, diagnostic confidence, time on task, and student perception of effectiveness. Time spent in VS was not associated with CR scores. Confidence in diagnosis remained unchanged regardless of diagnostic accuracy. Data suggests that the order in which scenarios occurred was less impactful than the content difficulty. Students perceived the VSs as effective. VS offers a reliable and scalable strategy for evaluating NP learner competencies related to CR. Simulations can align with multiple competencies.

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