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

Background: While 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. Methods: Final-year Bachelor of Science (Nursing) students (N = 70) were randomly assigned to complete one of three clinicallyidentical 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). Results: Statistically 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 mu g/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). Discussion: Students 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. (C) 2016 Elsevier Ltd. All rights reserved.