How Roleplay Boosts Nursing Students’ Clinical Self-Efficacy

 As nursing programs prepare graduates for real clinical environments, one recurring challenge in curriculum reviews is that students can recall pediatric facts but do not trust their judgment at the bedside. The gap in self-belief can shape performance, retention, and quality of patient care. 

Lectures vs. active learning methods

In this context, self-efficacy is a learner's belief that they can carry out specific clinical tasks, from managing a child in respiratory distress to counseling a family. Higher self-efficacy predicts stronger performance, better decision-making, and greater resilience in practice, as summarized in a systematic review of 47 nursing education studies (Abusubhiah et al., 2023). 

Active methods like roleplay and small-group discussion build nursing self-efficacy more effectively than lectures because learners practice clinical decisions, receive feedback, and see themselves succeed. A 2025 study of 87 students found that roleplay raised self-efficacy by more than half, while traditional lectures barely moved the needle. 

Yet, many undergraduate nursing programs still rely on lectures plus slides as the primary teaching method for pediatric content. In the Zahedan study, baseline self-efficacy across groups hovered in the mid-30s on a 0-100 scale, which is far from the confidence level most educators want for learners who are only semesters away from professional roles.

Comparing three teaching methods

The Zahedan research team set out a straightforward question: which teaching method actually builds clinical self-efficacy in pediatric nursing: lecture, group discussion, or roleplay? Ninety fifth-semester students enrolled in a pediatric nursing theory course were invited to participate in the study, and 87 students completed the full intervention and 3-month follow-up (Fallah-Karimi et al., 2025). 

Students were randomly assigned by drawing colored cards into three groups: traditional lecture, small group discussion, or roleplay. All three groups covered the same six units of pediatric content, including respiratory problems, digestive disorders, fluid and electrolyte balance, and caring for children with special needs. Each groups participated in six 60-minute reinforcement sessions. 

To measure impact, the researchers used a validated 37-item Clinical Self-Efficacy Questionnaire. Students completed it before the sessions and again three months later. The tool showed strong internal consistency (Cronbach's alpha around 0.96), giving educators confidence that any score changes reflected real shifts in perceived capability, not measuring noise. 

What made roleplay outperform discussion and lecture

The results were clear. In the roleplay group, average self-efficacy scores increased from about 35 to 55 on the 0-100 scale, an improvement of 55.7% with a very large effect size. Group discussion improved scores by 50.9%, while lecture produced only a 0.8% change that was not statistically significant.

The study found that roleplay was a huge success because it combined several powerful learning mechanisms: realistic scenarios, repeated practice, and structured feedback in a safe environment.

How group discussion still boosts self-efficacy

Although roleplay delivered the strongest gains, small group discussion also substantially improved students' self-efficacy. In the Zahedan study, learners in discussion groups saw their scores rise from roughly 33 to 50 over three months, a 50.9% increase that moved them into a clearly more confident range. 

Group discussions appear to work through peer exchange and shared reasoning rather than performance. Learners hear how others frame decisions, test their own thinking against alternatives, and gain reassurance that uncertainty is normal.

How to adapt roleplay assessments for self-efficacy in your program

Roleplay assessments that boost self-efficacy can be applied to many programs. However, designing high-quality virtual scenarios and collecting feedback can feel daunting. That is where structured roleplay assessments and authoring tools can help.

For example, our Author platform helps instructional designers build, deliver, and scale roleplay assessments for many programs and course areas in higher education. Similar to the researchers in the Zahedan study, instructional design teams build real-world scenarios, create learning objectives, and deliver meaningful feedback to learners in a safe environment. 

In a 30-minute demo, we can walk you through how Author can seamlessly turn your course materials into a full roleplay assessment with pedagogically sound content and scenarios that can boost self-efficacy and prepare your learners for careers after graduation. 

Overall, the core message remains simple: self-efficacy is built by doing, not just by hearing. When curricula prioritize realistic decisions, repeated practice, and personalized feedback, programs can make a positive impact on learners' critical thinking, problem-solving, and belief that they can get the job done well.