Comparison of the Effects of Role-Playing, Small Group Discussion, and Traditional Teaching Methods on Nursing Students’ Self-Efficacy

Comparison of the Effects of Role-Playing, Small Group Discussion, and Traditional Teaching Methods on Nursing Students’ Self-Efficacy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of the Effects of Role-Playing, Small Group Discussion, and Traditional Teaching Methods on Nursing Students’ Self-Efficacy Samaneh Fallah-Karimi, Fereshteh Ghaljaie, Zahra Khalilzadeh-Farsangi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7189556/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Oct, 2025 Read the published version in BMC Medical Education → Version 1 posted 19 You are reading this latest preprint version Abstract Background and Aim: Self-efficacy is a key component in developing professional readiness among nursing students. It plays a crucial role in enhancing clinical performance, decision-making quality, and self-confidence. Therefore, identifying and applying effective educational methods to improve this capability is one of the major challenges in nursing education systems. This study aimed to compare the effectiveness of three teaching approaches—role-playing, small group discussion, and traditional instruction—on the self-efficacy of nursing students. Methods: This study was conducted as a semi-experimental study with three groups on 90 nursing students at Zahedan University of Medical Sciences, Iran. The samples were randomly assigned to three groups by drawing a red card (role-playing), a yellow card (group discussion), and a green card (role-playing). In the traditional education group, educational content was presented through lectures and PowerPoint presentations. In the group discussion group, students were divided into groups of 6. Each subgroup was given a clinical scenario related to the topic. The groups discussed and exchanged ideas about the scenario under the guidance of the facilitator. In the role-playing group, students were divided into groups of 4. Each group took on the roles of nurse, parent, child, and supervisor, and each group was given a structured clinical scenario related to the topic, and the students played the roles and acted out the scenarios. The data collection tool in this study was a clinical self-efficacy questionnaire that was completed by all students before and three months after the intervention. Results: The present study demonstrated the decisive superiority of active learning methods, especially role-playing, over traditional teaching in increasing the self-efficacy of nursing students. Role-playing, by creating a safe environment for practice, resulted in a 55.7% increase in self-efficacy (p<0.001, d=3.55) and improved students' professional confidence. Discussion group also improved with a 50.9% improvement (p=0.02), but traditional teaching only had a negligible increase of 0.8% (p=0.78). Conclusion: The findings suggest that using active and interactive teaching methods—especially role-playing—can effectively enhance nursing students’ self-efficacy. These results can be utilized in designing student-centered and participatory educational programs. Nursing education Role-playing Group discussion Traditional method Self-efficacy Student Introduction The quality of education in medical sciences, especially nursing, plays a decisive role in empowering students to successfully enter the professional field ( 1 ). One of the key factors influencing nursing students' success is their belief in their own ability to perform clinical tasks and make professional decisions ( 2 ). This belief, known as self-efficacy , plays a central role in enhancing skills, motivation, and individual performance. Self-efficacy, as a core construct of Bandura’s social cognitive theory (1977), refers to an individual's judgment about their ability to achieve specific goals within a particular domain and serves as an important psychological foundation for the development of professional skills, attitudes, and behaviors ( 3 ). The importance of self-efficacy in medical education is particularly significant; it is regarded as an effective factor in correlating students’ knowledge and attitudes with their abilities in communication, information provision, support, and self-management( 4 ). Furthermore, self-efficacy is recognized as a strong predictor of nursing behavior, playing a vital role in nurses’ professional performance( 5 ). Nursing research has shown that nurses with higher perceived self-efficacy provide better performance, deliver higher quality care, demonstrate greater commitment, and exhibit more resilience when facing challenges( 6 ). Today, many universities worldwide seek effective teaching methods that can enhance nursing students’ clinical decision-making and self-directed learning skills, thereby improving their self-efficacy( 7 ). Implementing suitable, student-centered educational programs can significantly improve clinical communication skills as well as the self-efficacy and capabilities of nursing students( 8 ). One such approach is role-playing , an active and student-centered learning method used in medical education. Role-playing is designed to create personal experiences within a safe and supportive environment, emphasizing the understanding and development of interpersonal relationships and communication skills ( 9 , 10 ). Additionally, employing role-playing can enhance counseling quality, learning experiences, and simulation of professional competencies, thereby developing nurses’ self-efficacy( 9 , 11 ).For instance, Soltanian et al. (2019)demonstrated that role-playing, compared to traditional teaching methods, significantly improves the self-efficacy of undergraduate nursing students( 12 ). Moreover, since nursing is a performance-based profession( 13 , 14 ) and professional nursing education is primarily provided at the undergraduate level( 15 ), proper training of students is crucial. Selecting an appropriate teaching method can make learning more engaging and effective( 16 ). For example, small group discussions are among the most effective and reliable educational methods for changing attitudes and achieving cognitive, emotional, and social goals( 17 ). Participation in discussions not only is engaging but also fosters creative and critical thinking, helps identify weaknesses, and promotes behavioral changes( 18 ). As one of the most widely used discussion-based teaching methods, small group discussion aims to reach a collective conclusion. It is a collaborative approach focused on collective brainstorming, ensuring equal opportunities for students to discuss and exchange ideas( 19 ). Furthermore, the use of group discussions as an educational strategy is effective in enhancing nurses’ clinical judgment and diagnostic reasoning skills and can improve students’ self-efficacy in learning( 20 , 21 ). Jaya’s study (2017) found that group discussions can effectively increase students’ self-efficacy( 22 ). One advantage of small group discussions over larger groups is the smaller number of participants, which allows for greater involvement, more opportunities to express opinions, and deeper focus on the topic. Son et al. (2023) demonstrated that the use of a combined simulation and problem-based learning (S-PBL) approach in small groups significantly improves nursing students' clinical reasoning abilities. In this method, students have the opportunity to share diverse perspectives in a supportive environment without fear of making mistakes, which leads to the enhancement of critical thinking and collaborative problem-solving skills. Additionally, students reported high satisfaction with their learning experience using this approach( 23 ). However, small group discussions also have limitations, including being time-consuming, the possibility of less participation by shy individuals, and distractions during sessions( 18 ). Additionally, Bijani et al. (2023) reported that in Iran, the lack of specialized training for instructors and time constraints are significant barriers to implementing novel teaching methods, such as group discussions, in nursing education( 24 ). Despite considerable emphasis on applying innovative educational methods such as role-playing and small group discussions—methods that create active, interactive, and student-centered learning environments to improve self-efficacy ( 25 )—traditional lecture-based methods still dominate Iranian nursing education. Practical application of novel methods remains limited due to various factors, including time shortages, lack of instructor expertise, and resistance to change ( 26 ). Although separate studies have examined the effectiveness of each of these methods individually, there has been no comparative study investigating the simultaneous impact of role-playing, small group discussions, and traditional methods on nursing students’ self-efficacy. Therefore, identifying the most effective teaching method among these three approaches for enhancing nursing students’ self-efficacy and improving the quality of their clinical education appears necessary. The present study was conducted to compare the effects of role-playing, small group discussions, and traditional teaching on the self-efficacy of nursing students. Methods In this quasi-experimental study with a pretest-posttest design, the effect of three educational methods—traditional lecture, group discussion, and role-playing—on the clinical self-efficacy of nursing students was investigated. The statistical population in this study was all nursing students in the 5th and 6th semesters of Zahedan University of Medical Sciences for whom the theoretical unit of "sick child" was defined (n = 90). Inclusion criteria were enrollment in the pediatric nursing course and willingness to participate in the study. Exclusion criteria included absence from more than one training session, transfer to another university, or course withdrawal. Data collection tools included two parts. The first part was a demographic information form containing variables such as gender, age, marital status, interest in the nursing profession, and overall GPA. The second part was the Clinical Self-Efficacy Questionnaire consisting of 37 items rated on a five-point Likert scale (0–100). The final Cronbach’s alpha of the “Clinical Self-Efficacy” instrument was 0.96, with a range between 0.90 and 0.92, and the two-week test-retest reliability indicated acceptable stability (r = 0.94). The Cronbach’s alpha for the “Nursing Clinical Performance” tool was 0.72, and its test-retest reliability was also acceptable(r = 0.81) ( 27 , 28 ). After obtaining the necessary approvals from the Research Ethics Committee and the educational deputy of the nursing faculty, eligible students were identified and selected. Detailed information about the study, its objectives, procedures, and data confidentiality was provided to the students, and written informed consent was obtained. Students were informed that they could withdraw from the study at any time without any impact on their grades or academic progress. Participants were randomly allocated into three groups by drawing colored cards: red (role-playing), yellow (group discussion), and green (traditional lecture). In the first phase, before any educational intervention, all students in the three groups completed the demographic form and the clinical self-efficacy questionnaire. The educational content, outlined in Table 1 , were prepared based on Wong’s Pediatric Nursing textbook( 29 ) and approved by four faculty members from the School of Nursing and Midwifery at Zahedan University of Medical Sciences. In all groups, training was provided by an instructor who had a PhD in pediatric nursing. All sessions were held at the Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Iran. In the traditional education group, the educational content was presented through lectures and PowerPoint presentations. In this method, students mostly played the role of listeners and observers, with limited opportunity for questions and answers at the end of the session. In the group discussion method, students were divided into groups of six and were given a clinical scenario related to the topic. Each group discussed the scenario under the guidance of a facilitator. In the role-playing group, students were divided into groups of four and each student assumed one of the roles of nurse, parent, child, or observer. Each group received a structured clinical scenario and enacted their assigned roles. All three groups participated in six 60-minute training sessions. Three months after the final session, the self-efficacy questionnaires were re-administered to all students to assess the final outcomes of the study. Table 1 Educational content of the sessions session The title of the session Objectives of session First Fundamentals of child and family nursing in a hospital setting • Understanding the characteristics of a child's natural growth and development (physical, mental, psychosocial) at different ages (infancy, toddlerhood, early childhood, school age, and adolescence) • Understanding the impact of illness and hospitalization on the child and family • Learning the principles of effective communication with the child and family • Introducing the concept of "family-centered nursing care" and its importance in children • Ethical considerations and children's rights in the hospital Second Nursing assessment and pain management in children • Physical assessment of children based on age (differences with adults) • Introduction to pain assessment tools for different ages • Principles of non-pharmacological pain management • Nursing care before, during and after painful procedures Third Common respiratory problems in children • Anatomy and physiology of the respiratory system in children • Recognizing the signs and symptoms of respiratory distress in children • Learning about common acute respiratory diseases • Nursing care in children with respiratory distress Fourth Common pediatric digestive problems and fluid and electrolyte disturbances • Anatomy and physiology of the digestive system in children • Recognizing the causes and symptoms of diarrhea and vomiting in children • Learning about the types of dehydration and assessing its level • Principles of oral and intravenous fluid therapy in children • Nursing care in children with digestive disorders the fifth Urinary, nervous, and blood system problems in children • Anatomy and physiology of the urinary, nervous and blood systems in children • Recognizing the signs and symptoms of urinary tract infections, meningitis and anemia in children • Monitoring vital signs and state of consciousness in neurological disorders • Principles of blood sampling and blood transfusion in children the sixth Caring for a child with special needs and psychosocial issues • Familiarity with the concept of a child with special needs • Understanding the principles of caring for children with chronic illnesses • The importance of rehabilitation and family support • The role of the nurse in identifying, referring, and supporting children with psychological and social problems Finding Of the 90 initially eligible students, 3 were excluded due to their unwillingness to continue cooperation. As a result, educational interventions were conducted on 87 students. At the beginning of the study, the three groups did not differ significantly from each other in terms of all individual characteristics, including age, gender, marital status, overall grade point average, and interest in the nursing profession and were homogeneous. The study showed that most of the students were single and interested in the nursing profession ( Table 2 ) . The present study demonstrates the superiority of active learning methods over traditional teaching. Role-playing, by creating a safe environment for practical practice of skills, had an impact on nursing students' self-efficacy (p < 0.001 d = 3.55). This method not only increased scores by 55.7% but also clinically led students to a desirable level of professional confidence. Although group discussion was less effective than role playing (p = 0.02), the 50.9% improvement in self-efficacy made it a valuable option. In contrast, traditional education, with a small increase of 0.8% (p = 0.78), failed to produce significant change. These findings emphasize the need to revise the nursing education program with a focus on interactive methods ( Table 3 , 4 ). Table 2 Frequency of demographic variables in nursing students in the three control, group discussion, and role-playing groups Variable Traditional education group discussion role playing P-Value Gender of the student Girl 16(53/3%) 17 (58/6%) 14 (50%) P = 0/80 Boy 14 (46/6%) 12 (41/3%) 14 (50%) marital status single 22(73/3%) 16(55/1%) 18 (64/2%) P = 0/34 married 8(26/6%) 13(44/8%) 10 (35/7%) Interested in nursing Yes 23 (76/6%) 21 (72/4%) 19 (67/8%) P = 0/75 No 7 (23/3%) 8 (27/5%) 9 (32/1%) age 20/76 ± 1/67 21/37 ± 2/09 22/41 ± 2/59 P = 0/13 overall grade point average 16/70 ± 1/44 16/41 ± 1/45 15/75 ± 1/14 P = 0/21 Table 3 Comparison of self-efficacy scores before clinical and after intervention in primiparous mothers in the three control, group discussion, and role-playing groups variable N Mean ± standard deviation P-Value Clinical self-efficacy before intervention Traditional education 30 34/13 ±4/57 P = 0/52 group discussion 29 33/37 ± 6/51 role playing 28 35/07 ± 5/49 Clinical self-efficacy/ after intervention Traditional education 30 34/40 ±4/81 P < 0/001 group discussion 29 50/34 ± 7/34 role playing 28 54/60 ± 5/76 Table 4 Tukey's Post Hoc Test Results for Pairwise Comparisons of Clinical Self-Efficacy Score Changes After Intervention Clinical self-efficacy before intervention (I)group (J)group Mean Difference (I-J) Std Error p-value Traditional education group discussion 0/75 1/45 P = 1 role playing -0/93 1/46 P = 1 group discussion Traditional education -0/75 1/45 P = 1 role playing -1/69 1/47 P = 0/76 role playing Traditional education 0/93 1/46 P = 1 group discussion 1/69 1/47 P = 0/76 Clinical self-efficacy after intervention Traditional education group discussion -15/94 1/57 P < 0/001 role playing -20/20 1/59 P < 0/001 group discussion Traditional education 15/94 1/57 P < 0/001 role playing -4/26 1/60 P = 0/02 role playing Traditional education 20/20 1/59 P < 0/001 group discussion 4/26 1/60 P = 0/02 Discussion This study aimed to compare the effectiveness of three teaching methods—role-playing, small group discussion, and traditional lecture—on the clinical selfefficacy of nursing students at Zahedan University of Medical Sciences. Findings revealed that both roleplaying and group discussion significantly outperformed the traditional method in enhancing selfefficacy (p < 0.001), with the roleplaying group experiencing the greatest improvement—the mean selfefficacy score rising from 48.2 to 72.9. These results clearly demonstrate the efficacy of active, interactive educational methods in boosting students’ self-belief and confidence, aligning well with prior empirical research. For example, Brown and Chidume (2023) showed that roleplaying, as an active learning strategy, enhances communication skills, critical thinking, and confidence through simulated practice and immediate feedback(30). Similarly, Khaledi et al. (2024) demonstrated that teaching CPR via roleplay and gamification significantly improved students’ practical competency and confidence compared to traditional methods(31). A study on clinical nurses by Qu et al. (2022) reported a strong positive correlation (r = 0.709, p < 0.0001) between increased selfefficacy and quality of nursing care following roleplay-based simulation (32). Moreover, the study by Dorri et al. (2019) indicated that implementing role-playing in nursing education—based on the Kirkpatrick evaluation model—significantly impacted students’ knowledge and patient satisfaction. Specifically, the knowledge scores of students in the role-playing group were significantly higher than those in the control group (63.85 vs. 46.41, p < 0.001), and patient satisfaction also increased significantly (33). In line with these findings, Bouriami et al. (2025) examined the effects of scenario-based role-playing on motivation and learning strategies among health sciences students. Their results showed that role-playing enhanced cognitive engagement, intrinsic motivation, and self-regulatory strategies during the learning process ( 34 ). Similarly, Banharak et al. (2024) demonstrated that using role-play in teaching clinical decision-making for older patients experiencing heart attacks led to improved ability to make rapid, accurate, and informed decisions in critical situations ( 35 ). Another relevant study by Benko and Peršolja (2023), which focused on aging-related role-play workshops, revealed that this method was highly effective in enhancing professional competencies—especially empathy, interpersonal skills, and understanding of older adults’ needs ( 36 ). Likewise, Sartain et al. (2021), in a study conducted in clinical settings, reported that engaging nursing students in complex role-playing scenarios was associated with increased professional readiness, enhanced clinical decision-making skills, and a better understanding of the real-life challenges of the nursing profession ( 37 ). The consistency between the findings of the present study and previous research can be attributed to the shared characteristics of modern educational methods, which are designed around active participation, mutual interaction, and experiential learning. In such methods, learners are placed in semi-realistic situations, face practical challenges, make decisions, and receive immediate feedback. This process not only deepens their cognitive and emotional engagement with the educational content but also boosts their sense of competence and mastery. Repeated practice in simulated environments and active involvement in group interactions gradually strengthen students’ belief in their ability to successfully perform professional tasks, ultimately enhancing their self-efficacy. Thus, the active, practice-based, and feedback-oriented nature of these approaches appears to be the primary reason for the alignment between the present findings and those of previous studies. Conversely, Azizi et al. (2022) reported that traditional teaching resulted in minimal and non-significant gains in selfefficacy and clinical performance compared to simulation—a finding consistent with our observation that the traditional lecture group showed limited improvement (38). Similarly, Hsu et al. (2015) demonstrated that scenario-based simulation significantly enhanced nurses’ communication skills and selfefficacy compared to traditional methods (39). Nevertheless, Alamrani et al. (2018) found no statistically significant difference between simulation and traditional teaching in improving students’ confidence and critical thinking—highlighting that context, intervention design, and measurement tools influence outcomes ( 40 ). While traditional methods may yield modest benefits in some cases, active, experiential strategies tend to offer superior advantages overall. Regarding small group discussion, it fosters peer learning, critical discourse, and inclusive participation—qualities linked to enhanced selfefficacy. Studies by Badge et al. (2024) and Cusimano et al. (2019) affirm that smallgroup discussions and near-peer formats can significantly enhance selfefficacy and professional skills by providing emotionally supportive, interactive learning environments (41,42). Germain et al. (2022) also highlighted the positive effect of peer assessment within such groups on students’ motivation and confidence (43). Together, the present findings align with these prior results, as both roleplaying and small group discussion engage students actively in experiential scenarios, promote immediate feedback, and reinforce belief in one’s own capabilities. This study has several limitations. First, sampling was restricted to a single university, which may limit generalizability to other cultural, educational, or resource settings. Second, the short-term design did not assess the lasting effects of these educational methods over time or their influence on actual professional performance post-graduation. Third, measurement limitations, potential response biases, and unmeasured personal factors (e.g., intrinsic motivation, personality traits, psychological state) might have affected results. Conclusion The findings indicate that roleplaying and small group discussion significantly improve nursing students’ clinical selfefficacy compared to traditional lectures, with roleplaying yielding the largest effect. These results underscore the high potential of active, student-centered, and experiential teaching methods to foster individual competence, confidence, and deeper engagement in learning. Given the study’s methodological rigor and validated measurement tools, this research contributes to advancing educational practices in nursing. Future research should explore the long-term effectiveness of these teaching strategies, ideally in real clinical environments and using mixed-method designs (both quantitative and qualitative), to provide a more comprehensive understanding of how interactive education enhances professional competence in nursing. Declarations Ethics approval and consent to participate. All methods were carried out in accordance with relevant guidelines and regulations. The study protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Approval code: IR.ZAUMS.REC.1403.334). Informed consent was obtained from all participants before they took part in the study. The project ID was 11519. Clinical Trial Number: Not applicable; this study does not require a clinical trial. Ethical approval and consent to participate: All methods were carried out in accordance with relevant guidelines and regulations. The study protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Approval code: IR.ZAUMS.REC.1403.334). Informed consent was obtained from all participants before they took part in the study. Research participants were informed of the confidentiality and voluntary nature of the information. All methods of participation in the study were conducted in accordance with relevant guidelines and regulations, consistent with the Declaration of Helsinki. Clinical Trial Number: Not applicable; this study does not require a clinical trial. Data availability The datasets generated generated during the current study are availble in the SPSS repository (https://figshare.com/account/articles/29715518?file=56726483). Competing interests: The authors report no conflict of interest in the undertaking of research. Funding: This study was funded by the research project number 11519 at Zahedan University of Medical Sciences. Author s contributions All authors have read and approved the manuscript. Study design: ZKh, FGH; data collection and analysis: SFK, FGH; manuscript preparation: ZKh and critical Review: SFK. Acknowledgments: This study was part of a research project approved by the Zahedan University of Medical Sciences (Project Code: 11519). The authors would like to thank the Research Vice Chancellor and the Community Nursing Center at Zahedan University of Medical Sciences. Consent for publication: Not applicable. References Wynne K, Mwangi F, Onifade O, Abimbola O, Jones F, Burrows J, et al. Readiness for professional practice among health professions education graduates: a systematic review. Frontiers in Medicine. 2024;11:1472834. Arianfar A, Seyf MH. A Causal Relationship Model of Self-regulated learning and future orientation: The Mediating Role of academic Self-Efficacy and task Value among Masters of Medical education (virtual) in Shahid Beheshti University of Medical Sciences. 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J Nurs Res. 2018;26(3):152-7. Badge A, Chandankhede M, Gajbe U, Bankar NJ, Bandre GR. Employment of small-group discussions to ensure the effective delivery of medical education. Cureus. 2024;16(1). Cusimano MC, Ting DK, Kwong JL, Van Melle E, MacDonald SE, Cline C. Medical students learn professionalism in near-peer led, discussion-based small groups. Teaching and Learning in Medicine. 2019;31(3):307-18. Germain LJ, Li HH, Wiqas A, Zahn L, Stewart TM, Hobart TR, et al. Can Peer Assessment Impact Self-efficacy During Small-Group Learning? PRiMER: Peer-Review Reports in Medical Education Research. 2022;6:1. Additional Declarations No competing interests reported. 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One of the key factors influencing nursing students' success is their belief in their own ability to perform clinical tasks and make professional decisions (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This belief, known as \u003cem\u003eself-efficacy\u003c/em\u003e, plays a central role in enhancing skills, motivation, and individual performance. Self-efficacy, as a core construct of Bandura’s social cognitive theory (1977), refers to an individual's judgment about their ability to achieve specific goals within a particular domain and serves as an important psychological foundation for the development of professional skills, attitudes, and behaviors (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe importance of self-efficacy in medical education is particularly significant; it is regarded as an effective factor in correlating students’ knowledge and attitudes with their abilities in communication, information provision, support, and self-management(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Furthermore, self-efficacy is recognized as a strong predictor of nursing behavior, playing a vital role in nurses’ professional performance(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Nursing research has shown that nurses with higher perceived self-efficacy provide better performance, deliver higher quality care, demonstrate greater commitment, and exhibit more resilience when facing challenges(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eToday, many universities worldwide seek effective teaching methods that can enhance nursing students’ clinical decision-making and self-directed learning skills, thereby improving their self-efficacy(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Implementing suitable, student-centered educational programs can significantly improve clinical communication skills as well as the self-efficacy and capabilities of nursing students(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). One such approach is \u003cem\u003erole-playing\u003c/em\u003e, an active and student-centered learning method used in medical education. Role-playing is designed to create personal experiences within a safe and supportive environment, emphasizing the understanding and development of interpersonal relationships and communication skills (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Additionally, employing role-playing can enhance counseling quality, learning experiences, and simulation of professional competencies, thereby developing nurses’ self-efficacy(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).For instance, Soltanian et al. (2019)demonstrated that role-playing, compared to traditional teaching methods, significantly improves the self-efficacy of undergraduate nursing students(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Moreover, since nursing is a performance-based profession(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and professional nursing education is primarily provided at the undergraduate level(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), proper training of students is crucial. Selecting an appropriate teaching method can make learning more engaging and effective(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). For example, small group discussions are among the most effective and reliable educational methods for changing attitudes and achieving cognitive, emotional, and social goals(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Participation in discussions not only is engaging but also fosters creative and critical thinking, helps identify weaknesses, and promotes behavioral changes(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). As one of the most widely used discussion-based teaching methods, small group discussion aims to reach a collective conclusion. It is a collaborative approach focused on collective brainstorming, ensuring equal opportunities for students to discuss and exchange ideas(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, the use of group discussions as an educational strategy is effective in enhancing nurses’ clinical judgment and diagnostic reasoning skills and can improve students’ self-efficacy in learning(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Jaya’s study (2017) found that group discussions can effectively increase students’ self-efficacy(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). One advantage of small group discussions over larger groups is the smaller number of participants, which allows for greater involvement, more opportunities to express opinions, and deeper focus on the topic. Son et al. (2023) demonstrated that the use of a combined simulation and problem-based learning (S-PBL) approach in small groups significantly improves nursing students' clinical reasoning abilities. In this method, students have the opportunity to share diverse perspectives in a supportive environment without fear of making mistakes, which leads to the enhancement of critical thinking and collaborative problem-solving skills. Additionally, students reported high satisfaction with their learning experience using this approach(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, small group discussions also have limitations, including being time-consuming, the possibility of less participation by shy individuals, and distractions during sessions(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Additionally, Bijani et al. (2023) reported that in Iran, the lack of specialized training for instructors and time constraints are significant barriers to implementing novel teaching methods, such as group discussions, in nursing education(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite considerable emphasis on applying innovative educational methods such as role-playing and small group discussions—methods that create active, interactive, and student-centered learning environments to improve self-efficacy (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)—traditional lecture-based methods still dominate Iranian nursing education. Practical application of novel methods remains limited due to various factors, including time shortages, lack of instructor expertise, and resistance to change (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Although separate studies have examined the effectiveness of each of these methods individually, there has been no comparative study investigating the simultaneous impact of role-playing, small group discussions, and traditional methods on nursing students’ self-efficacy.\u003c/p\u003e\u003cp\u003eTherefore, identifying the most effective teaching method among these three approaches for enhancing nursing students’ self-efficacy and improving the quality of their clinical education appears necessary. The present study was conducted to compare the effects of role-playing, small group discussions, and traditional teaching on the self-efficacy of nursing students.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this quasi-experimental study with a pretest-posttest design, the effect of three educational methods—traditional lecture, group discussion, and role-playing—on the clinical self-efficacy of nursing students was investigated. The statistical population in this study was all nursing students in the 5th and 6th semesters of Zahedan University of Medical Sciences for whom the theoretical unit of \"sick child\" was defined (n = 90). Inclusion criteria were enrollment in the pediatric nursing course and willingness to participate in the study. Exclusion criteria included absence from more than one training session, transfer to another university, or course withdrawal.\u003c/p\u003e\u003cp\u003eData collection tools included two parts. The first part was a demographic information form containing variables such as gender, age, marital status, interest in the nursing profession, and overall GPA. The second part was the Clinical Self-Efficacy Questionnaire consisting of 37 items rated on a five-point Likert scale (0–100). The final Cronbach’s alpha of the “Clinical Self-Efficacy” instrument was 0.96, with a range between 0.90 and 0.92, and the two-week test-retest reliability indicated acceptable stability (r = 0.94). The Cronbach’s alpha for the “Nursing Clinical Performance” tool was 0.72, and its test-retest reliability was also acceptable(r = 0.81) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAfter obtaining the necessary approvals from the Research Ethics Committee and the educational deputy of the nursing faculty, eligible students were identified and selected. Detailed information about the study, its objectives, procedures, and data confidentiality was provided to the students, and written informed consent was obtained. Students were informed that they could withdraw from the study at any time without any impact on their grades or academic progress.\u003c/p\u003e\u003cp\u003eParticipants were randomly allocated into three groups by drawing colored cards: red (role-playing), yellow (group discussion), and green (traditional lecture). In the first phase, before any educational intervention, all students in the three groups completed the demographic form and the clinical self-efficacy questionnaire. The educational content, outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, were prepared based on Wong’s Pediatric Nursing textbook(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) and approved by four faculty members from the School of Nursing and Midwifery at Zahedan University of Medical Sciences.\u003c/p\u003e\u003cp\u003eIn all groups, training was provided by an instructor who had a PhD in pediatric nursing. All sessions were held at the Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Iran. In the traditional education group, the educational content was presented through lectures and PowerPoint presentations. In this method, students mostly played the role of listeners and observers, with limited opportunity for questions and answers at the end of the session. In the group discussion method, students were divided into groups of six and were given a clinical scenario related to the topic. Each group discussed the scenario under the guidance of a facilitator. In the role-playing group, students were divided into groups of four and each student assumed one of the roles of nurse, parent, child, or observer. Each group received a structured clinical scenario and enacted their assigned roles.\u003c/p\u003e\u003cp\u003eAll three groups participated in six 60-minute training sessions. Three months after the final session, the self-efficacy questionnaires were re-administered to all students to assess the final outcomes of the study.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEducational content of the sessions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003esession\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe title of the session\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eObjectives of session\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFundamentals of child and family nursing in a hospital setting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Understanding the characteristics of a child's natural growth and development (physical, mental, psychosocial) at different ages (infancy, toddlerhood, early childhood, school age, and adolescence)\u003c/p\u003e\u003cp\u003e• Understanding the impact of illness and hospitalization on the child and family\u003c/p\u003e\u003cp\u003e• Learning the principles of effective communication with the child and family\u003c/p\u003e\u003cp\u003e• Introducing the concept of \"family-centered nursing care\" and its importance in children\u003c/p\u003e\u003cp\u003e• Ethical considerations and children's rights in the hospital\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecond\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNursing assessment and pain management in children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Physical assessment of children based on age (differences with adults)\u003c/p\u003e\u003cp\u003e• Introduction to pain assessment tools for different ages\u003c/p\u003e\u003cp\u003e• Principles of non-pharmacological pain management\u003c/p\u003e\u003cp\u003e• Nursing care before, during and after painful procedures\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThird\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommon respiratory problems in children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Anatomy and physiology of the respiratory system in children\u003c/p\u003e\u003cp\u003e• Recognizing the signs and symptoms of respiratory distress in children\u003c/p\u003e\u003cp\u003e• Learning about common acute respiratory diseases\u003c/p\u003e\u003cp\u003e• Nursing care in children with respiratory distress\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFourth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommon pediatric digestive problems and fluid and electrolyte disturbances\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Anatomy and physiology of the digestive system in children\u003c/p\u003e\u003cp\u003e• Recognizing the causes and symptoms of diarrhea and vomiting in children\u003c/p\u003e\u003cp\u003e• Learning about the types of dehydration and assessing its level\u003c/p\u003e\u003cp\u003e• Principles of oral and intravenous fluid therapy in children\u003c/p\u003e\u003cp\u003e• Nursing care in children with digestive disorders\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ethe fifth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrinary, nervous, and blood system problems in children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Anatomy and physiology of the urinary, nervous and blood systems in children\u003c/p\u003e\u003cp\u003e• Recognizing the signs and symptoms of urinary tract infections, meningitis and anemia in children\u003c/p\u003e\u003cp\u003e• Monitoring vital signs and state of consciousness in neurological disorders\u003c/p\u003e\u003cp\u003e• Principles of blood sampling and blood transfusion in children\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ethe sixth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaring for a child with special needs and psychosocial issues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Familiarity with the concept of a child with special needs\u003c/p\u003e\u003cp\u003e• Understanding the principles of caring for children with chronic illnesses\u003c/p\u003e\u003cp\u003e• The importance of rehabilitation and family support\u003c/p\u003e\u003cp\u003e• The role of the nurse in identifying, referring, and supporting children with psychological and social problems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Finding","content":"\u003cp\u003eOf the 90 initially eligible students, 3 were excluded due to their unwillingness to continue cooperation. As a result, educational interventions were conducted on 87 students. At the beginning of the study, the three groups did not differ significantly from each other in terms of all individual characteristics, including age, gender, marital status, overall grade point average, and interest in the nursing profession and were homogeneous. The study showed that most of the students were single and interested in the nursing profession \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eThe present study demonstrates the superiority of active learning methods over traditional teaching. Role-playing, by creating a safe environment for practical practice of skills, had an impact on nursing students' self-efficacy (p \u0026lt; 0.001 d = 3.55). This method not only increased scores by 55.7% but also clinically led students to a desirable level of professional confidence. Although group discussion was less effective than role playing (p = 0.02), the 50.9% improvement in self-efficacy made it a valuable option. In contrast, traditional education, with a small increase of 0.8% (p = 0.78), failed to produce significant change. These findings emphasize the need to revise the nursing education program with a focus on interactive methods \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of demographic variables in nursing students in the three control, group discussion, and role-playing groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender of the student\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGirl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(53/3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (58/6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP = 0/80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBoy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (46/6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (41/3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003emarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003esingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(73/3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(55/1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18 (64/2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP = 0/34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(26/6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(44/8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (35/7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInterested in nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (76/6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (72/4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (67/8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP = 0/75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (23/3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (27/5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (32/1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20/76 ± 1/67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21/37 ± 2/09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22/41 ± 2/59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 0/13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eoverall grade point average\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16/70 ± 1/44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16/41 ± 1/45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15/75 ± 1/14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 0/21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of self-efficacy scores before clinical and after intervention in primiparous mothers in the three control, group discussion, and role-playing groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean ± standard deviation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eClinical self-efficacy before intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34/13 \u003cb\u003e±4/57\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eP = 0/52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33/37 ± 6/51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35/07 ± 5/49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eClinical self-efficacy/ after intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34/40 ±4/81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eP \u0026lt; 0/001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50/34 ± 7/34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54/60 ± 5/76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTukey's Post Hoc Test Results for Pairwise Comparisons of Clinical Self-Efficacy Score Changes After Intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eClinical self-efficacy before intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(I)group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(J)group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean Difference (I-J)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStd Error\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0/75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0/93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0/75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1/69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 0/76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0/93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1/69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 0/76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eClinical self-efficacy after intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-15/94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP \u0026lt; 0/001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-20/20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP \u0026lt; 0/001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15/94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP \u0026lt; 0/001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-4/26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 0/02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003erole playing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraditional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20/20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP \u0026lt; 0/001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003egroup discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4/26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP = 0/02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to compare the effectiveness of three teaching methods\u0026mdash;role-playing, small group discussion, and traditional lecture\u0026mdash;on the clinical selfefficacy of nursing students at Zahedan University of Medical Sciences. Findings revealed that both roleplaying and group discussion significantly outperformed the traditional method in enhancing selfefficacy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the roleplaying group experiencing the greatest improvement\u0026mdash;the mean selfefficacy score rising from 48.2 to 72.9. These results clearly demonstrate the efficacy of active, interactive educational methods in boosting students\u0026rsquo; self-belief and confidence, aligning well with prior empirical research.\u003c/p\u003e\u003cp\u003eFor example, Brown and Chidume (2023) showed that roleplaying, as an active learning strategy, enhances communication skills, critical thinking, and confidence through simulated practice and immediate feedback(30). Similarly, Khaledi et al. (2024) demonstrated that teaching CPR via roleplay and gamification significantly improved students\u0026rsquo; practical competency and confidence compared to traditional methods(31). A study on clinical nurses by Qu et al. (2022) reported a strong positive correlation (r\u0026thinsp;=\u0026thinsp;0.709, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) between increased selfefficacy and quality of nursing care following roleplay-based simulation (32). Moreover, the study by Dorri et al. (2019) indicated that implementing role-playing in nursing education\u0026mdash;based on the Kirkpatrick evaluation model\u0026mdash;significantly impacted students\u0026rsquo; knowledge and patient satisfaction. Specifically, the knowledge scores of students in the role-playing group were significantly higher than those in the control group (63.85 vs. 46.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and patient satisfaction also increased significantly (33).\u003c/p\u003e\u003cp\u003eIn line with these findings, Bouriami et al. (2025) examined the effects of scenario-based role-playing on motivation and learning strategies among health sciences students. Their results showed that role-playing enhanced cognitive engagement, intrinsic motivation, and self-regulatory strategies during the learning process (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Similarly, Banharak et al. (2024) demonstrated that using role-play in teaching clinical decision-making for older patients experiencing heart attacks led to improved ability to make rapid, accurate, and informed decisions in critical situations (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother relevant study by Benko and Peršolja (2023), which focused on aging-related role-play workshops, revealed that this method was highly effective in enhancing professional competencies\u0026mdash;especially empathy, interpersonal skills, and understanding of older adults\u0026rsquo; needs (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Likewise, Sartain et al. (2021), in a study conducted in clinical settings, reported that engaging nursing students in complex role-playing scenarios was associated with increased professional readiness, enhanced clinical decision-making skills, and a better understanding of the real-life challenges of the nursing profession (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The consistency between the findings of the present study and previous research can be attributed to the shared characteristics of modern educational methods, which are designed around active participation, mutual interaction, and experiential learning. In such methods, learners are placed in semi-realistic situations, face practical challenges, make decisions, and receive immediate feedback. This process not only deepens their cognitive and emotional engagement with the educational content but also boosts their sense of competence and mastery. Repeated practice in simulated environments and active involvement in group interactions gradually strengthen students\u0026rsquo; belief in their ability to successfully perform professional tasks, ultimately enhancing their self-efficacy. Thus, the active, practice-based, and feedback-oriented nature of these approaches appears to be the primary reason for the alignment between the present findings and those of previous studies.\u003c/p\u003e\u003cp\u003eConversely, Azizi et al. (2022) reported that traditional teaching resulted in minimal and non-significant gains in selfefficacy and clinical performance compared to simulation\u0026mdash;a finding consistent with our observation that the traditional lecture group showed limited improvement (38). Similarly, Hsu et al. (2015) demonstrated that scenario-based simulation significantly enhanced nurses\u0026rsquo; communication skills and selfefficacy compared to traditional methods (39).\u003c/p\u003e\u003cp\u003eNevertheless, Alamrani et al. (2018) found no statistically significant difference between simulation and traditional teaching in improving students\u0026rsquo; confidence and critical thinking\u0026mdash;highlighting that context, intervention design, and measurement tools influence outcomes (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). While traditional methods may yield modest benefits in some cases, active, experiential strategies tend to offer superior advantages overall.\u003c/p\u003e\u003cp\u003eRegarding small group discussion, it fosters peer learning, critical discourse, and inclusive participation\u0026mdash;qualities linked to enhanced selfefficacy. Studies by Badge et al. (2024) and Cusimano et al. (2019) affirm that smallgroup discussions and near-peer formats can significantly enhance selfefficacy and professional skills by providing emotionally supportive, interactive learning environments (41,42). Germain et al. (2022) also highlighted the positive effect of peer assessment within such groups on students\u0026rsquo; motivation and confidence (43). Together, the present findings align with these prior results, as both roleplaying and small group discussion engage students actively in experiential scenarios, promote immediate feedback, and reinforce belief in one\u0026rsquo;s own capabilities.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, sampling was restricted to a single university, which may limit generalizability to other cultural, educational, or resource settings. Second, the short-term design did not assess the lasting effects of these educational methods over time or their influence on actual professional performance post-graduation. Third, measurement limitations, potential response biases, and unmeasured personal factors (e.g., intrinsic motivation, personality traits, psychological state) might have affected results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings indicate that roleplaying and small group discussion significantly improve nursing students\u0026rsquo; clinical selfefficacy compared to traditional lectures, with roleplaying yielding the largest effect. These results underscore the high potential of active, student-centered, and experiential teaching methods to foster individual competence, confidence, and deeper engagement in learning. Given the study\u0026rsquo;s methodological rigor and validated measurement tools, this research contributes to advancing educational practices in nursing.\u003c/p\u003e\u003cp\u003eFuture research should explore the long-term effectiveness of these teaching strategies, ideally in real clinical environments and using mixed-method designs (both quantitative and qualitative), to provide a more comprehensive understanding of how interactive education enhances professional competence in nursing.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate. All methods were carried out in accordance with relevant guidelines and regulations. The study protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Approval code: IR.ZAUMS.REC.1403.334). Informed consent was obtained from all participants before they took part in the study. The project ID was 11519. Clinical Trial Number: Not applicable; this study does not require a clinical trial.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations. The study protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Approval code: IR.ZAUMS.REC.1403.334). Informed consent was obtained from all participants before they took part in the study. \u0026nbsp;Research participants were informed of the confidentiality and voluntary nature of the information. All methods of participation in the study were conducted in accordance with relevant guidelines and regulations, consistent with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable; this study does not require a clinical trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated generated during the current study are availble in the SPSS repository \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(https://figshare.com/account/articles/29715518?file=56726483).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflict of interest in the undertaking of research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the research project number 11519 at Zahedan University of Medical\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor s contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the manuscript. Study design: ZKh, FGH; data collection and analysis: SFK, FGH; manuscript preparation: ZKh and critical Review: SFK.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was part of a research project approved by the Zahedan University of Medical Sciences (Project Code: 11519). The authors would like to thank the Research Vice Chancellor and the Community Nursing Center at Zahedan University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWynne K, Mwangi F, Onifade O, Abimbola O, Jones F, Burrows J, et al. Readiness for professional practice among health professions education graduates: a systematic review. Frontiers in Medicine. 2024;11:1472834.\u003c/li\u003e\n\u003cli\u003eArianfar A, Seyf MH. 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Don\u0026apos;t forget about role play: An enduring active teaching strategy. Teaching and Learning in Nursing. 2023;18(1):238-41.\u003c/li\u003e\n\u003cli\u003eKhaledi A, Ghafouri R, Anboohi SZ, Nasiri M, Ta\u0026rsquo;atizadeh M. Comparison of gamification and role-playing education on nursing students\u0026rsquo; cardiopulmonary resuscitation self-efficacy. BMC Medical Education. 2024;24(1):231.\u003c/li\u003e\n\u003cli\u003eQu M, Wang X, Jin Q, Yan Y, Ren B. Effects of roleplay simulation on improving quality management of nursing service. American Journal of Translational Research. 2022;14(10):7443.\u003c/li\u003e\n\u003cli\u003eDorri S, Farahani MA, Maserat E, Haghani H. Effect of role-playing on learning outcome of nursing students based on the Kirkpatrick evaluation model. Journal of Education and Health Promotion. 2019;8(1):197.\u003c/li\u003e\n\u003cli\u003eBouriami A, Boussaa S, El Adib AR. Effects of Role-Play Simulation-Based Case Studies on Motivation and Learning Strategies in Healthcare Sciences: A Randomized Controlled Trial. Simulation \u0026amp; Gaming. 2025;56(2):192-209.\u003c/li\u003e\n\u003cli\u003eBanharak S, Threeranut A, Metprommarat A. Effects of health education applying role play on decision making in acute myocardial infarction situation among older adults in community. Scientific Reports. 2024;14(1):19627.\u003c/li\u003e\n\u003cli\u003eBenko E, Per\u0026scaron;olja M. Nursing students\u0026rsquo; views of the impact of geriatric role-play workshops on professional competencies: survey. BMC nursing. 2023;22(1):203.\u003c/li\u003e\n\u003cli\u003eSartain AF, Welch TD, Strickland HP. Utilizing nursing students for a complex role-play simulation. Clinical Simulation in Nursing. 2021;60:74-7.\u003c/li\u003e\n\u003cli\u003eAzizi M, Ramezani G, Karimi E, Hayat AA, Faghihi SA, Keshavarzi MH. A comparison of the effects of teaching through simulation and the traditional method on nursing students\u0026apos; self-efficacy skills and clinical performance: a quasi-experimental study. BMC nursing. 2022;21(1):283.\u003c/li\u003e\n\u003cli\u003eHsu LL, Chang WH, Hsieh SI. The effects of scenario-based simulation course training on nurses\u0026apos; communication competence and self-efficacy: a randomized controlled trial. J Prof Nurs. 2015;31(1):37-49.\u003c/li\u003e\n\u003cli\u003eAlamrani MH, Alammar KA, Alqahtani SS, Salem OA. Comparing the Effects of Simulation-Based and Traditional Teaching Methods on the Critical Thinking Abilities and Self-Confidence of Nursing Students. J Nurs Res. 2018;26(3):152-7.\u003c/li\u003e\n\u003cli\u003eBadge A, Chandankhede M, Gajbe U, Bankar NJ, Bandre GR. Employment of small-group discussions to ensure the effective delivery of medical education. Cureus. 2024;16(1).\u003c/li\u003e\n\u003cli\u003eCusimano MC, Ting DK, Kwong JL, Van Melle E, MacDonald SE, Cline C. Medical students learn professionalism in near-peer led, discussion-based small groups. Teaching and Learning in Medicine. 2019;31(3):307-18.\u003c/li\u003e\n\u003cli\u003eGermain LJ, Li HH, Wiqas A, Zahn L, Stewart TM, Hobart TR, et al. Can Peer Assessment Impact Self-efficacy During Small-Group Learning? PRiMER: Peer-Review Reports in Medical Education Research. 2022;6:1.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nursing education, Role-playing, Group discussion, Traditional method, Self-efficacy, Student","lastPublishedDoi":"10.21203/rs.3.rs-7189556/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7189556/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Aim: \u003c/strong\u003eSelf-efficacy is a key component in developing professional readiness among nursing students. It plays a crucial role in enhancing clinical performance, decision-making quality, and self-confidence. Therefore, identifying and applying effective educational methods to improve this capability is one of the major challenges in nursing education systems. This study aimed to compare the effectiveness of three teaching approaches—role-playing, small group discussion, and traditional instruction—on the self-efficacy of nursing students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study was conducted as a semi-experimental study with three groups on 90 nursing students at Zahedan University of Medical Sciences, Iran. The samples were randomly assigned to three groups by drawing a red card (role-playing), a yellow card (group discussion), and a green card (role-playing). In the traditional education group, educational content was presented through lectures and PowerPoint presentations. In the group discussion group, students were divided into groups of 6. Each subgroup was given a clinical scenario related to the topic. The groups discussed and exchanged ideas about the scenario under the guidance of the facilitator. In the role-playing group, students were divided into groups of 4. Each group took on the roles of nurse, parent, child, and supervisor, and each group was given a structured clinical scenario related to the topic, and the students played the roles and acted out the scenarios. The data collection tool in this study was a clinical self-efficacy questionnaire that was completed by all students before and three months after the intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The present study demonstrated the decisive superiority of active learning methods, especially role-playing, over traditional teaching in increasing the self-efficacy of nursing students. Role-playing, by creating a safe environment for practice, resulted in a 55.7% increase in self-efficacy (p\u0026lt;0.001, d=3.55) and improved students' professional confidence. Discussion group also improved with a 50.9% improvement (p=0.02), but traditional teaching only had a negligible increase of 0.8% (p=0.78).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe findings suggest that using active and interactive teaching methods—especially role-playing—can effectively enhance nursing students’ self-efficacy. These results can be utilized in designing student-centered and participatory educational programs.\u003c/p\u003e","manuscriptTitle":"Comparison of the Effects of Role-Playing, Small Group Discussion, and Traditional Teaching Methods on Nursing Students’ Self-Efficacy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 09:19:08","doi":"10.21203/rs.3.rs-7189556/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-18T07:13:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T14:02:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-12T14:46:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191685079720404154732725430565706726650","date":"2025-08-12T12:23:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-11T19:50:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211215351695521593319590185918517303941","date":"2025-08-11T19:03:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-09T03:35:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-06T14:04:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50870431754157994787840198972194417699","date":"2025-08-04T17:59:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-04T12:48:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265597148577453517772624124832878571875","date":"2025-08-04T12:11:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278380597898645090331077992118758230762","date":"2025-08-03T19:57:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312862367296831758772284067275336904148","date":"2025-08-03T17:06:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282623664839364122849288365440011031385","date":"2025-08-03T16:26:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-03T16:10:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-02T06:47:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-01T04:43:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-31T19:38:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-07-31T19:34:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc1981f6-41bb-4d78-af01-4e7fa7e8d846","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:02:58+00:00","versionOfRecord":{"articleIdentity":"rs-7189556","link":"https://doi.org/10.1186/s12909-025-07996-w","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-10-06 15:58:16","publishedOnDateReadable":"October 6th, 2025"},"versionCreatedAt":"2025-08-07 09:19:08","video":"","vorDoi":"10.1186/s12909-025-07996-w","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07996-w","workflowStages":[]},"version":"v1","identity":"rs-7189556","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7189556","identity":"rs-7189556","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}