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The Pros and Cons of Different Simulation Modalities in Nursing Education Programs (Part 2)

In Part 1 of our blog series about simulation modalities, we talked about static and high fidelity manikins, plus the unique pros and cons of standardized patients. As you probably know, these are just three of the modalities you can use to simulate real nursing skills with your students. Each has its pros and cons and is appropriate for different situations. From my experience in nursing simulation labs, I’ve built my own understanding of when to use each one. This time, let’s talk about task trainers, VR, and computer-based simulations.

Nursing Simulation Pros and Cons, Part 2

If you haven't seen part 1, check it out here!

#1: Task Trainer

Task trainers are an affordable modality that allows students to repeat a skill until they master it. We’ve had success with task trainers, as the students are able to simulate most aspects of the procedures and experience a hands-on learning environment. 

When trainers are inadequate, it impacts the students' learning experience. This is why some of my most rewarding moments were spent creating task trainers to support the learning objectives we value at Sim2Grow. For example, when teaching students how to care for a pediatric patient with a Mickey-gastric tube, we were able to create a durable and reliable side trainer to use right next to the manikin. This was used for many years and provided the students with hands-on experience. We were even able to create our own task trainer for pressure injury training by producing nearly a dozen sets of custom wounds in a range of skin tones. 

While they are durable and relatively affordable, over time, task trainer replacement parts can become expensive. It is important for students to treat the task trainers with care and consider sharps safety, sterile technique, patient comfort, etc. This is not only to avoid damaging the trainer but also to develop the students’ mindset when it comes to caring for real patients. Although they have limitations, task trainers are a durable, hands-on modality that supports students in their learning and simulates realistic patient care. 

Task Trainer Pros

Task Trainer Cons

  • Task Trainers are usually more affordable and durable, allowing students to repeatedly practice psychomotor skills.
  • Task trainers can be dedicated to one or more specific skills.
  • Programs can create their own task trainers, which makes them even more affordable.
  • They allow students to practice on different body types, sizes, ages, and genders. 
  • They provide hands-on practice for students before treating real patients. 
  • Task Trainers closely simulate what actual procedures look like. 
  • Task trainer replacement parts and consumable inserts may become expensive over time.
  • Replacing the veins for older IV task trainers is difficult and time consuming… products are only now becoming more maintainable and reliable. 
  • Students must still maintain a sterile environment, use sharp safety skills, and ensure patient comfort to best simulate the procedures. 
  • Students need to account for the limitations of the task trainer, including not using betadine on the trainer’s skin and understanding needle size limitations. 

#2: Virtual and Augmented Reality

Virtual and Augmented reality are still fairly new in this market. They have a lot of potential and are beginning to be used more frequently. The immersive qualities of this technology are going to be extremely popular and useful in the future. Virtual reality is still expensive, but as more versions are put on the market, prices are becoming more affordable. This technology is being adjusted and improved as early adopters give feedback with each new iteration of a product. This will not only be a new modality on the market; it will enhance the features of other modalities to make them more immersive for the student. 

While younger generations can be quite tech savvy, it may take students time to get used to this particular technology and master the use of the headset and controllers. This, as well as learning the hygiene procedures necessary for this equipment, may end up taking time away from students learning instead of enhancing it. Because VR/AR are still in development, rolling them out for use on a large scale for students is not plausible and probably won't be for a couple more years. Check out this article for more information on how VR can enhance nursing simulations. 

VR Pros

VR cons

  • VR can enhance student experience
  • The market for VR is gradually becoming more affordable as products are introduced or improved. 
  • Younger generations (especially gamers) may be able to pick up the skills of using VR easily. 
  • VR is hard to learn and teach.
  • Hygiene procedures increase turnaround time.
  • Students often express discomfort from the weight of the VR devices.
  • Can cause headaches, dizziness, distraction, and/or nausea. 

#3: Computer-Based

Computer-based simulations are most useful in an asynchronous learning environment. They allow students to run and repeat the simulations on their own, which allows for a higher level of understanding. As a hospital nurse educator, I have found that some learners need extra practice outside of normal business hours while working nights and weekends. Computer-based simulations are most plausible for times when students don’t have other modalities available to them. 

Computer-based simulations aren’t always the best modality for students to learn from because they lack the hands-on aspect that is important for students developing their psychomotor skills. We have seen that they are helpful in a hybrid model paired with another modality, such as a task trainer. There are also often difficulties working with computer-based simulations because they can be hard to navigate. This can impact our measure of a student's intelligence in an academic setting. Computer-based simulations can be difficult to navigate, which impacts a student’s ability to showcase their true capabilities. 

Computer Based Pros

Computer based cons

  • Computer based simulations are helpful for learning in an asynchronous environment. 
  • Simulation can be run by students whenever it is convenient for them
  • Computer-based simulations can be run as often as necessary for mastery. 
  • CB simulations typically require per seat subscriptions, which could be costly if use is not maximized
  • May not allow for customization
  • Problematic software: navigation is difficult resulting in failure because the right tools are not easily accessible 
  • Unreliable measurement of learning and grading
  • No psychomotor skills practiced


Using different modalities allows students to make mistakes and grow in their learning so that when they enter the professional world, they are more adept and confident in their skills. Task trainers are an affordable option, but their maintenance costs make it important to understand their careful handling to increase their longevity. Virtual reality offers an immersive experience to students, but may lack practicality due to costs and usability. Finally, computer based simulations offer students an asynchronous modality, but they lack the hands-on aspect that is required of nursing programs. 

No simulation modality is perfect in every situation, and picking the right one isn’t an exact science.  The best modality to use is one that you have on hand. Don't feel limited just because you don’t have the most up to date features or every one of the above tools. I’m an advocate for using any of these modalities as long as the modality can support the learning objective.  There’s more than one way to achieve an objective, so take into consideration the cost in terms of your time, efforts, finances, and ease of use for the learners. Plus, learners who are excited to experience new things will be your best “marketers” to tell their peers about their cool experiences in the sim lab and get everyone eager to have a turn. Your fellow educators in the clinical practice realm will thank you for the efforts you put in to expose students to sim in their academic years!