Simulated Learning, Real Emotions: The Impact of Simulation-Based Education on Nursing Students' Stress Levels During Objective Structured Clinical Examination: A Longitudinal Observational Cohort Study.

Background: Simulation-based education (SBE) is a key component of nursing training. It enables students to apply theoretical knowledge in practice, expand their clinical understanding, develop critical thinking, improve communication skills, and build self-confidence. Increasing the number of simulation hours in nursing curricula may enhance students' ability to manage stress in clinical settings. Methods: This was a cross-sectional comparative study involving 113 nursing students during a practical exam. Participants graduated in three consecutive years: 2020, 2021, and 2022. SBE was introduced into the curriculum in 2020, resulting in varying levels of simulation experience. Stress and anxiety markers were measured during the exam and compared across groups. Results: Greater simulation experience was associated with lower heart rate (p = 0.007), lower diastolic blood pressure (p < 0.001), and lower cortisol levels (p < 0.001). Students with two years of simulation training reported the lowest perceived stress (p = 0.031). However, anxiety levels remained high across all groups and did not differ significantly. Conclusions: The study showed that OSCEs are associated with elevated stress in nursing students. Students with greater exposure to simulation-based education had significantly lower stress and anxiety indicators. SBE appears to reduce stress and improve students' preparedness for clinical assessments.