Due to resourcing constraints and the pressures from the increasing numbers of undergraduate students, implementing immersive simulation-based education (iSBE) (Al-Ghareeb and Cooper, 2016, Aldridge, 2016) poses significant challenges to simulation educators (Sim-Eds). Despite a growing evidence base (Moloney et al., 2022, Ragsdale and Schuessler, 2021) that indicates that iSBE better prepares healthcare students for professional practice, these challenges can make it prohibitive for Sim-Eds to include iSBE modalities into healthcare curricula (Haerling, 2018, Hippe et al., 2020). A situation faced by the authors when they endeavoured to implement iSBE into undergraduate nursing programmes.

The model implemented was an immersive repeated standard simulation (iRS-Sim) approach (Fig. 1) delivered over three hours with students in small teams undertaking two scenarios. The design utilised a manikin-based modality, an approach that other studies (Carpenter et al., 2021, Moloney et al., 2022) have found effective in preparing undergraduate nursing students for practice. The model was based on the definition of immersive simulation by the Society for Simulation in Healthcare (SSH), “a real-life situation that deeply involves the participants’ senses, emotions, thinking, and behaviour” (Lioce, 2020).

To provide evidence of the effectiveness of various models, Platt et al. (2021) identified there was a need to establish iSBE instructional designs that enable Sim-Eds to optimise learning while maximising their resources. If it is determined that one particular iSBE approach can accelerate participant learning over the same time period, it could provide a greater return on investment through efficient and effective use of programme time and the accelerated achievement of competence (Bukhari et al., 2017). Harris et al. (2017) highlighted Team Deliberate Practice (TDP) as a design that could improve team performance. Centred on the principles of Deliberate Practice (DP) (Ericsson, 2004), TDP combines well-defined objectives, set at an appropriate level, with opportunities for repetitive team practice, performed under the expert supervision of a coach who provides immediate feedback (Helsen et al., 1998, Lund et al., 2013). This approach has been used successfully to improve performance in various team sports (Ford et al., 2020, Machado et al., 2020). Although a number of nursing studies (Badowski and Oosterhouse, 2017, Karageorge et al., 2020) have found that iSBE incorporating DP improved team performance, there is little evidence of the efficacy of iSBE with TDP when compared to other iSBE approaches on participants over the same time.

Platt et al. (2021) reported, at a group level, the positive effects of immersive Simulation using Team Deliberate Practice (iSim-TDP) on the performance of small teams of undergraduate nursing students when compared to the effects of immersive repeated standard simulation (iRS-Sim) over the same time (Fig. 1). The original study was undertaken as part of a doctoral study completed in 2019, and was based on the key iSBE research priorities set out at the first Research Consensus Summit of the Society for Simulation in Healthcare (SSiH) (Dieckmann et al., 2011). The iSim-TDP model was developed, based on the principles of TDP, as an alternative design to enhance and optimise participants' learning within the curriculum and resourcing constraints. The study aimed to compare the effects of an iSim-TDP intervention on the observed performance of undergraduate nursing students, compared to the effects of an iRS-Sim approach, when delivered over the same time.

Since this study was published there have been increasing calls from healthcare organisations, and professional bodies, to use iSBE modalities in healthcare education, meaning that its use has grown exponentially (Aebersold, 2018, Eppich and Reedy, 2022). Globally, this has included initiatives to replace clinical placements with iSBE, including the United States of America (Bradley et al., 2019) and China (Au et al., 2016). In the United Kingdom (UK), NHS England (2023) advocated the use of iSBE to facilitate the expansion of placement capacity, which the Nursing and Midwifery Council (NMC) (2023) endorsed and increased the number of hours that can be used for simulated practice learning (SPL) from 300 to 600 (NMC, 2023).

In light of this increase, and that the identification of effective SBE designs remained a key research priority internationally (Anton et al., 2022, Society for Simulation in Healthcare, 2023), the authors believed that it was imperative to explore the effects of the two designs further. As repeated team iSBE can improve participant's knowledge (Zulkosky et al., 2021) and confidence (Generoso et al., 2016), this paper reports on the effects, at an individual level, of the two instructional designs on the self-efficacy (confidence) and knowledge of undergraduate nursing students. An individual level was chosen, as the performance of a team is dependent on an individual’s knowledge and skill (Nadler et al., 2011), and confidence is a key factor in their performance (Andreatta and Lori, 2014). It was hypothesised that when delivered over the same three-hour period, the mean self-efficacy (confidence) and knowledge scores of the iSim-TDP intervention groups would be different to the scores of the comparison groups using iRS-Sim. The data analysis for this paper took place between 2022 and 2023 as it was envisaged that exploring the initial findings further, using a mixed methods approach, would give a deeper understanding of the effects of the two models and provide an insight into their efficacy.