NURSING STUDENTS The effectiveness of simulation activities on the cognitive abilities of undergraduate third-year nursing students: a randomised control trial Jacinta Secomb, Lisa McKenna and Colleen Smith Aims and objectives. To provide evidence on the effectiveness of simulation activities on the clinical decision-making abilities of undergraduate nursing students. Based on previous research, it was hypothesised that the higher the cognitive score, the greater the ability a nursing student would have to make informed valid decisions in their clinical practice. Background. Globally, simulation is being espoused as an education method that increases the competence of health profes- sionals. At present, there is very little evidence to support current investment in time and resources. Methods. Following ethical approval, fifty-eight third-year undergraduate nursing students were randomised in a pre- test–post-test group-parallel controlled trial. The learning environment preferences (LEP) inventory was used to test cognitive abilities in order to refute the null hypothesis that activities in computer-based simulated learning environ -ments have a negative effect on cognitive abilities when compared with activities in skills laboratory simulated learning environments. Results. There was no significant difference in cognitive development following two cycles of simulation activities. Therefore, it is reasonable to assume that two simulation tasks, either computer-based or laboratory-based, have no effect on an undergraduate student’s ability to make clinical decisions in practice. However, there was a significant finding for non-English first-language students, which requires further investigation. Conclusions. More longitudinal studies that quantify the education effects of simulation on the cognitive, affective and psychomotor attributes of health science students and professionals from both English-speaking and non-English-speaking backgrounds are urgently required. It is also recommended that to achieve increased participant numbers and prevent non-participation owing to absenteeism, further studies need to be imbedded directly into curricula. Relevance to clinical practice. This investigation confirms the effect of simulation activities on real-life clinical practice, and the comparative learning benefits with traditional clinical practice and university education remain unknown. Key words: clinical decision-making, cognitive, computer, LEP, simulated learning environments, undergraduate nurses Accepted for publication: 12 May 2012 Introduction Safety and quality of healthcare provision is reliant on the competence of healthcare professionals. Increasing demands for graduates with appropriate skills, together with difficul- ties in obtaining clinical training placements during their preservice education, have prompted a global move towards the use of simulation technology (Bradley 2006, Flanagan et al. 2007, McKenna et al. 2007, in press). Despite this, there is little empirical evidence to support its use (Issenberg et al. 2005, Jones & Sheppard 2011, Secomb 2011). Background Improving education of healthcare professionals can contrib- ute to improved patient care and outcomes (Flanagan et al. Authors: Jacinta Secomb, PhD, Freelancer, Melbourne, Vic.; Lisa McKenna, PhD, Associate Professor, Monash University, Clayton, Vic.; Colleen Smith, PhD, University of South Australia, Adelaide, SA, Australia Correspondence: Jacinta Secomb, Freelancer, Melbourne, Vic., Australia. E-mail: jmsecomb@tpg.com.au Ó 2012 Blackwell Publishing Ltd Journal of Clinical Nursing, 21, 3475–3484, doi: 10.1111/j.1365-2702.2012.04257.x 3475