An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students

•Social evaluation stress can negatively impact on clinical performance.•Stress is likely prominent amongst novice students with limited authentic exposures.•Potential patient safety implications•Early exposure to realistic clinical situations may acclimatise students.•High-fidelity simulation provides this without risk to patients.

BackgroundWhile numerous theoretical and conceptual models suggest social evaluation anxiety would likely influence performance in simulation-based learning environments, there has been surprisingly little research to investigate the extent to which this is true.MethodsFinal-year Bachelor of Science (Nursing) students (N = 70) were randomly assigned to complete one of three clinically identical simulation-based scenarios designed to elicit varying levels of social evaluation anxiety by manipulating the number of other people present with the student during the simulation (1, 2 or 3 others). Rises in acute stress were measured via continuous heart-rate and salivary cortisol. Performance scores were derived from the average of two independent raters' using a structured clinical checklist (/16).ResultsStatistically different increases were found within the first minute of the simulation between those students with one versus three other people in the room (+ 4.13 vs. + 14.01 beats-per-minute respectively, p = 0.01) and salivary cortisol measures suggested significantly different changes in anxiety between these groups (− 0.05 vs. + 0.11 μg/dL respectively, p = 0.02). Independent assessments suggested students with only one other person accompanying them in the simulation significantly outperformed those accompanied by three others (12.95 vs. 10.67 respectively, p = 0.03).DiscussionStudents accompanied by greater numbers during simulations experienced measurably greater anxiety and measurably poorer performances. These results demonstrate the ability to manipulate social evaluation anxiety within high-fidelity simulation training of undergraduates in order to help students better acclimatise to stressful events prior to practising in real clinical settings.