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“Experience tells you what to do; confidence allows you to do it.”

-Stan Smith


  • Discuss the relationship between confidence and competence and how simulation can close the gap between the two.

  • Understand how simulation can be used to motivate and build confidence in clinical performance.

  • Discuss the value of simulation-based methods for acquiring and maintaining competence.

  • Describe the ways simulation can be used to build self-assessment skills.

  • Discuss instructional considerations for simulation-based methods that support the acquisition and maintenance of clinical competence and confidence.

The purpose of any instruction is to effect change in learners’ knowledge, skills, or attitudes that subsequently alters their behaviors. The underpinnings for all human learning lay in several psychological, biological, physical, and environmental constructs. For example, the learner's self-concept of his or her ability to learn (psychological), health status (biological), and any disability (physical) influence learning.

Educators may choose to make accommodations to support these individual influences, but the primary role of an educator is to create an environment that facilitates learning. The environment in which instruction takes place significantly affects learning and can have an impact on the benefits of simulation-based instruction—experiential, situated, multimodal, on-demand, safe, and so on. This is covered in more detail in Chapter 3.

The desired learning outcome of simulation-based instruction in healthcare is to change (improve) learners’ behavior in applied clinical practice. Two primary factors that influence behavior in applied practice are:

  • Confidence in one's ability to perform what is required

  • Competence to correctly perform what is required

Simulation-based instruction supports both these factors. In particular, it can significantly improve the acquisition and maintenance of competence beyond current training systems. This chapter discusses each of these factors independently and then examines the influence of their interaction on learning and instruction.


For the purpose of this discussion, confidence is defined as learners’ conscious and subconscious beliefs about their ability to successfully perform what is required to achieve a favorable outcome in a clinical context.

Conceptually, confidence is related to these theoretical constructs (among others):

These theories explore various individual state and trait characteristics that influence a learner's self-perception of ability to perform in a specific context. They examine various individual factors that contribute to the learning process; however, they are difficult to address through instruction alone. Two advantages of simulation-based methods are that they may help learners gain confidence by improving their ability to more accurately self-assess, and they motivate ...

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