Effects of generative artificial intelligence (GenAI) patient simulation on clinical competency among global nursing undergraduates: A cross-over randomised controlled trial

Background and aims Clinical competency is paramount for nurses to ensure that patients receive safe, high-quality care. Generative artificial intelligence (GenAI) in nursing education is gaining attention, and evidence shows its suitability for real-life situations. GenAI may be an effective solution for enhancing nurses’ clinical competency. This study compared the impact of scenario-based GenAI patient simulation versus immersive 360° virtual reality (VR) simulation on educational outcomes, namely clinical competence, cultural awareness, AI readiness, and simulation effectiveness. Methods This cross-over randomised controlled study design was conducted from June 2024 to August 2024. Forty-four undergraduate nursing students in years 1, 2, and 3 were selected to participate. Subgroups were formed, each comprising three undergraduate nursing students from different years. They were randomised to receive either a GenAI patient simulation (intervention, Group B) or 360° VR simulation (control, Group A) for three separate days and with a washout period. Four self-reported questionnaires were used to measure clinical competency: the Clinical Competence Questionnaire (CCQ), Cultural Awareness Scale (CAS), Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS), and Simulation Effectiveness Tool – Modified Questionnaire (SET-M). Results The study revealed notable improvements in clinical competence and confidence among the participants. Group A demonstrated significant enhancements in the CCQ at both time points, and Group B also showed meaningful progress. Both groups experienced changes in the CAS-Total scores, although these changes were not statistically significant. In terms of the MAIRS-MS total score, Group A had a significant increase at time 1 (T1), and Group B showed an improvement from baseline to time 2 (cross-over session, T2). Regarding SET-M results, most participants (75%) felt that debriefing contributed to their learning, and 77.3% reported increased confidence in their nursing assessment skills. Conclusions The findings offer compelling evidence of its effectiveness in enhancing clinical outcomes, as assessed by the CCQ, CAS, and MAIRS-MS. Importantly, our results reveal statistically significant improvements in these measures, particularly within Group B. Both 360° VR simulation and GenAI patient simulation with real-time feedback and GenAI debriefing can serve as powerful teaching tools for improving nursing students’ clinical outcomes; however, GenAI exhibits a notably greater effect. Clinical trial registration/number Not applicable