Virtual reality and standardized patient simulation programs in chemotherapy education for breast cancer: A comparative analysis of nursing students' knowledge, cognitive load, satisfaction and confidence

Aim: To compare the effectiveness of the Virtual Reality (VR) Simulation Program and the Standardized Patient (SP) Simulation Program in chemotherapy education for breast cancer patients among undergraduate nursing students, focusing on knowledge, cognitive load, satisfaction and self-confidence levels. Background: Effective chemotherapy education is critical for nursing students to develop the competencies to manage treatment side effects and support patient adherence, especially in breast cancer care. Simulation-based learning methods, such as the VR Simulation Program and the SP Simulation Program, offer innovative approaches to enhance nursing education; however, their comparative effectiveness remains uncertain. Methods: This two-group quasi-experimental study was conducted with 107 first-year nursing students at a university in Turkey. Participants were randomly assigned to the VR Simulation Program (n = 54) or the SP Simulation Program (n = 53). Data were collected using a semi-structured questionnaire, Chemotherapy Knowledge Assessment Test, Cognitive Load Scale and Student Satisfaction and Self-Confidence in Learning Scale. Data analysis was conducted using t-tests. Results: Both the VR Simulation Program (t = -4.30, p < 0.001) and the SP Simulation Program (t = -7.48, p < 0.001) significantly improved students' knowledge. However, the SP Simulation Program group scored higher in knowledge (t = -2.891, p = 0.005), cognitive load (t = -2.891, p = 0.005), satisfaction (t = -3.176, p = 0.002) and self-confidence (t = -2.971, p = 0.004). Conclusions: Despite imposing a higher cognitive load, the SP Simulation Program was more effective than the VR Simulation Program in enhancing nursing students' knowledge, satisfaction and self-confidence in chemotherapy education. These findings highlight the need for carefully planned educational strategies to manage cognitive demands and optimize learning outcomes in nursing education.