This paper highlights findings from a literature search to examine the effects of patient simulation on students' self-efficacy and confidence. The old teaching method of "see one, do one and teach one" which has long been used to teach nursing skills and to promote the acquisition of clinical expertise is no longer accepted as the best way to teach students. A nurse's confidence in her/his ability is essential for good patient care. Only when nursing students have confidence in their own abilities are they able to shift focus to the needs of their patients. Shifting from their own needs to that of a patient is essential to being a safe and competent practitioner. A literature review was conducted to examine the available research findings relating to self-efficacy in the education of nurses, high-fidelity patient simulation effect on nurses' self-efficacy, and the effectiveness of high-fidelity simulation and its challenges.

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The use of simulation in nursing has increased substantially in the last few decades. Most schools of nursing have incorporated simulation into their curriculum but few are using simulation to evaluate clinical competency at the end of a semester or prior to graduation. Using simulation for such high stakes evaluation is somewhat novel to nursing. Educators are now being challenged to move simulation to the next level and use it as a tool for evaluating clinical competency. Can the use of simulation for high-stakes evaluation add to or improve our current evaluation methods? Using patient simulation for evaluation in contrast to a teaching modality has important differences that must be considered. This article discusses the difficulties of evaluating clinical competency, and makes the case for using simulation based assessment as a method of high stakes evaluation. Using simulation for high-stakes evaluation has the potential for significantly impacting nursing education.