Learning Autonomy and Group Cohesion in Clinical Simulation: A Quasi-Experimental Comparison of Two Training Approaches.

Background/Objectives: Given the complexity of current healthcare, working in highly cohesive teams is essential. Clinical simulation can promote group cohesion among healthcare teams. There are different learning methodologies in simulated environments capable of developing group cohesion in health...

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Published in:Nursing Reports Vol. 16; no. 6; pp. 199 - 215
Main Authors: García-Álvarez, José Manuel, García-Sánchez, Alfonso, Díaz-Agea, José Luis
Format: clinical trial questionnaire/scale research tables/charts Journal Article
Published: MDPI Jun2026
Online Access:View this record in EBSCOhost
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      dt: Jun2026
      vid: 16
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      pid: 97109
      pub: MDPI
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        atl: Learning Autonomy and Group Cohesion in Clinical Simulation: A Quasi-Experimental Comparison of Two Training Approaches.
      aug:
        au:
          García-Álvarez, José Manuel
          García-Sánchez, Alfonso
          Díaz-Agea, José Luis
        affil: Health Sciences PhD Program, Catholic University of Murcia (UCAM), Campus de los Jerónimos nº 135, 30107 Murcia, Spain
      sug:
        subj:
          Learning Methods
          Autonomy
          Social Cohesion
          Simulations
          Students, Nursing
          Teamwork
          Outcomes of Education
          Human
          Quasi-Experimental Studies
          Pretest-Posttest Design
          Colleges and Universities Spain
          Spain
          Questionnaires
          Analysis of Covariance
          Wilcoxon Signed Rank Test
          Clinical Competence
          Educational Measurement
          Clinical Trials
      ab: Background/Objectives: Given the complexity of current healthcare, working in highly cohesive teams is essential. Clinical simulation can promote group cohesion among healthcare teams. There are different learning methodologies in simulated environments capable of developing group cohesion in healthcare teams. The objective of this study was to compare group cohesion outcomes between two clinical simulation learning models—self-directed (Self-Learning Methodology in Simulated Environments, MAES©) and non-self-directed (Simulation-Based Learning, SBL)—in nursing student teams. Methods: A quasi-experimental pre–post study with a control group was conducted among 311 fourth-year nursing students from two Spanish universities. The primary outcome was group cohesion, assessed using the Spanish short version of the Group Environment Questionnaire (GEQ) total score and its dimensions. The questionnaire was administered twice, before and after participation in clinical simulation sessions. The experimental group used the MAES© methodology, while the control group used SBL. Between-group differences were analyzed using analysis of covariance (ANCOVA), adjusting post-intervention scores for baseline values. Within-group pre-post changes were explored as a secondary analysis using the Wilcoxon signed-rank test. Results: No significant differences in baseline group cohesion were found. After the intervention, both methodologies were associated with improvements in group cohesion over time. Adjusted analyses (ANCOVA) showed statistically significant between-group differences favoring MAES© across all dimensions, with small-to-medium effect sizes (ηp2 = 0.036–0.138). Conclusions: Both simulation methodologies were associated with improvements in group cohesion among nursing students. Adjusted between-group differences were observed across all dimensions, associated with higher adjusted scores in the MAES© group. However, given the non-randomized design these findings should be interpreted as associations rather than evidence of causality. Further randomized controlled trials are needed to confirm these results.
      pubtype: Academic Journal
      doctype:
        clinical trial
        questionnaire/scale
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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