Comparison of the effects of role-playing, small group discussion, and traditional teaching methods on nursing students’ self-efficacy

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 Quasi-experimental study with three groups was conducted on 90 nursing students at Zahedan University of Medical sciences, Iran. Participants were randomly assigned to groups by drawing a card: red card (role-playing), yellow card (group discussion), and green card (traditional teaching). In the traditional teaching group, the educational content was delivered through lecture and PowerPoint presentation. In the group discussion method, students were divided into subgroups of six, and each subgroup was provided with a clinical scenario related to the topic. With the guidance of a facilitator, the subgroups engaged in discussion and exchange of ideas about the scenario. In the role-playing method, students were divided into groups of four, and each member assumed one of the roles: nurse, parent, child, or observer. Each group received a structured clinical scenario related to the subject, and the students enacted the assigned roles and performed the scenarios. Data were collected using the Clinical Self-Efficacy Questionnaire, completed by all students before and three months after the intervention.

Results

The present study demonstrated the clear superiority of active learning methods, particularly role-playing, over traditional teaching in enhancing nursing students’ self-efficacy. Role-playing, by providing a safe environment for practice, led to a 55.7% improvement in self-efficacy (p < 0.001, d = 1.55) and enhanced students’ professional confidence. Group discussion was also effective, resulting in a 50.9% improvement (p = 0.02), whereas traditional teaching yielded only a negligible 0.8% increase (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.

Introduction

The quality of education in health 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 self-efficacy, a scientifically validated psychological construct reflecting an individual’s perceived capability to perform clinical tasks and make professional decisions [2]. Self-efficacy, as a core construct of Bandura’s social cognitive theory (1977), plays a central role in enhancing skills, motivation, and individual performance, and serves as an important psychological foundation for the development of professional skills, attitudes, and behaviors [3].

The importance of self-efficacy in health 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]. Role-playing is an active, student-centered learning method widely used in health education to create personal experiences within a safe and supportive environment, emphasizing the understanding and development of interpersonal relationships and communication skills [9, 10]. Importantly, role-playing can be classified as a low-fidelity simulation, one of the three main types of simulation alongside mid- and high-fidelity modalities [11]. Unlike higher-fidelity simulations, low-fidelity approaches provide realistic and interactive experiences in a simplified and controlled setting, allowing students to practice clinical skills, make professional decisions, and receive feedback without exposure to real clinical risks [12]. Framing role-playing within the simulation pedagogy not only strengthens students’ clinical skills and critical thinking but also enhances their confidence and self-efficacy. This perspective highlights the value of creating structured, experiential, and psychologically safe learning environments that support both skill development and reflective practice in nursing education [13]. In this way, role-playing effectively complements other active learning strategies, enhancing counseling quality, learning experiences, and simulation of professional competencies, thereby promoting nurses’ self-efficacy [9, 14].For instance, Soltanian et al. demonstrated that role-playing, compared to traditional teaching methods, significantly improves the self-efficacy of undergraduate nursing students [15]. Moreover, since nursing is a praxis-based profession, where practice is guided not only by clinical skills but also by reflective thinking, ethical responsibility, and commitment to social justice, and professional nursing education is primarily provided at the undergraduate level [16,17,18], proper education of students is crucial. Selecting an appropriate teaching method can make learning more engaging and effective [19]. For example, small group discussions are among the most effective and reliable educational methods for changing attitudes and achieving cognitive, emotional, and social goals [20]. Participation in discussions not only is engaging but also fosters creative and critical thinking, helps identify weaknesses, and promotes behavioral changes [21]. 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 [22].

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 [23, 24]. Jaya’s study found that group discussions can effectively increase students’ self-efficacy [25]. 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. 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 [26]. However, small group discussions also have limitations, including being time-consuming, the possibility of less participation by shy individuals, and distractions during sessions [21]. Additionally, Bijani et al. reported that in Iran, the lack of specialized education for instructors and time constraints are significant barriers to implementing novel teaching methods, such as group discussions, in nursing education [27].

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 measurable self-efficacy [28]—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 [29].

Several studies in Iran have examined the effect of different educational methods on nursing students’ self-efficacy. However, studies have shown that active and interactive teaching methods have a significant impact on students’ professional confidence and self-efficacy scores. For example, a study by Soltanian reported that role-playing, compared to traditional teaching methods, significantly enhanced nursing students’ self-efficacy and professional confidence [15]. Similarly, Parchbafie et al. found that peer-group-based learning increased students’ clinical self-efficacy scores,, thereby contributing to improved patient care outcomes [30]. Another study by Fesharaki et al. investigated the impact of lecture-based teaching and lecture combined with problem-based learning on nursing students’ self-efficacy, and the results indicated that effective educational interventions could enhance students’ capability and confidence in performing clinical tasks [31].

However, these studies have been limited to examining one or two specific teaching methods, and no research in Iran has simultaneously compared multiple educational approaches—including role-playing, small-group discussion, and traditional teaching—regarding their effect on nursing students’ self-efficacy. Given that self-efficacy is not merely a psychological construct but also a key determinant of students’ ability to provide clinical care, make professional decisions, solve problems, interact effectively with patients, and maintain professional confidence, attention to effective educational strategies for its enhancement is particularly important [32, 33]. As demonstrated by Momeni et al., higher self-efficacy in clinical performance is associated with increased motivation for active learning and engagement in clinical settings, ultimately enhancing the quality of care provided to patients [34]. Therefore, the present study aimed to compare the effects of three educational methods—role-playing, small-group discussion, and traditional teaching—on the self-efficacy of nursing students.

Methods

This quasi-experimental study with a pretest–posttest design was conducted to examine the effects of three instructional methods—traditional teaching, group discussion, and role-playing—on the clinical self-efficacy of nursing students. The study population included all 90 fifth-semester nursing students at Zahedan University of Medical Sciences, Iran, who had enrolled in the theoretical course Pediatric Nursing. Due to the limited number of eligible students, a census method was applied, and all 90 students were recruited. Inclusion criteria were enrollment in the pediatric nursing course and willingness to participate. Exclusion criteria included absence from more than one educational session, academic transfer to another university, or withdrawal from the course.

Data collection tools

The data collection instrument consisted of two sections. The first section was a demographic form covering gender, age, marital status, interest in the nursing profession, and cumulative grade point average (GPA). The second section was the Clinical Self-Efficacy Questionnaire, comprising 37 items rated on a five-point Likert scale ranging from 0 to 100 (completely disagree to completely agree). The items were selected according to the expected clinical skills of nursing students and based on the content of The National Council Licensure Examination (NCLEX) Review for Clinical Nursestextbooks widely accepted in the United States and Canada. With the collaboration of three nursing faculty members, five case scenarios were developed across five main nursing domains, each accompanied by three Questions, yielding a total of 15 multiple-choice items. Higher scores indicated greater clinical self-efficacy. The final instrument demonstrated strong reliability, with a Cronbach’s alpha of 0.96 (range: 0.90–0.92) and test–retest reliability of r = 0.94 over two weeks. The reliability of the Clinical Nursing Performance subscale was acceptable (Cronbach’s alpha = 0.72, test–retest r = 0.81) [35].

Study procedure

After receiving ethical approval from the University Research Ethics Committee and the Education Office, eligible students were identified and invited to participate. They were informed about the study objectives, procedures, and confidentiality assurances. Written informed consent was obtained, and students were assured of their right to withdraw at any stage without academic consequences.Randomization was performed using colored cards: red (role-playing), yellow (group discussion), and green (traditional teaching). Allocation was supervised by an independent observer who was blinded to the group identities. Both the observer and the allocator were unaware of the meaning of each card color to ensure allocation concealment.

It should be noted that the full theoretical content of the Pediatric Nursing course had already been delivered using traditional teaching before the intervention. The intervention sessions were supplementary and included six 60-minute sessions at the end of the semester, designed as practice and reinforcement of previously taught content through the three different methods (Table 1). Thus, the intervention did not replace the main course instruction but served as an additional educational component.

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In the traditional teaching group, content was delivered via lecture and PowerPoint, with limited opportunities for questions at the end of sessions. In the group discussion arm, students were divided into subgroups of six, each assigned a clinical scenario. Under the supervision of a facilitator, students engaged in collaborative discussion and exchange of ideas. In the role-playing arm, students were divided into groups of four, each assigned the roles of nurse, parent, child, and observer. Each group received a structured clinical scenario to perform. The observer had a structured role, using a checklist to evaluate peers’ performance and provide oral and written feedback. This role was distinct from the facilitator (the course instructor, a PhD in pediatric nursing), who supervised the overall process and provided general guidance when necessary.

All sessions were conducted at the Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences. Three months after the intervention, students in all groups completed the same questionnaire again. The three-month follow-up period was chosen based on standard protocols in educational research and previous evidence indicating its appropriateness for assessing the persistence of learning outcomes [36]. During this follow-up period, students did not participate in any additional pediatric nursing education related to the study content, attending only their routine clinical placements unrelated to the intervention.

Data analysis

Data were analyzed using SPSS version 26. Normality of quantitative variables was assessed with the Kolmogorov–Smirnov test. Since normality assumptions were met, parametric tests were applied. Group homogeneity regarding baseline demographic variables (age, gender, marital status, GPA, and interest in nursing) was evaluated using chi-square tests for categorical variables and one-way ANOVA for continuous variables. To compare pretest and posttest clinical self-efficacy scores between groups, one-way ANOVA was applied, followed by Tukey’s Post Hoc tests when significant. Within-group comparisons were conducted using paired t-tests. A p-value of < 0.05 was considered statistically significant.

Finding

Of the initial 90 eligible students, three withdrew due to unwillingness to continue, leaving 87 participants who completed the educational interventions. At baseline, the three groups were homogeneous with no significant differences in demographic variables including age, gender, marital status, cumulative GPA, and interest in the nursing profession. The majority of students were single and reported interest in nursing as a career (Table 2).

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The findings demonstrated the superiority of active learning methods over traditional teaching. Role-playing, by providing a safe environment for practicing clinical skills, had the greatest effect on nursing students’ self-efficacy (p < 0.001, d = 1.55). This method not only resulted in a 55.7% increase in self-efficacy scores but also elevated students to a clinically desirable level of professional confidence. Group discussion, though less effective than role-playing, still produced a meaningful improvement of 50.9% (p = 0.02), making it a valuable strategy. In contrast, traditional teaching led to only a negligible 0.8% increase (p = 0.78), which was not statistically significant. These findings highlight the need to reconsider nursing curricula with greater emphasis on interactive, learner-centered approaches (Tables 3 and 4).

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Discussion

This study compared the effects of three teaching methods—role-playing, small group discussion, and traditional lecture—on the clinical self-efficacy of nursing students. The results clearly demonstrate that both role-playing and small group discussion significantly improved students’ self-efficacy compared to the traditional method. Specifically, role-playing increased self-efficacy scores from 48.2 to 72.9, representing a 55.7% improvement (P < 0.001, d = 3.55, Table 4), while small group discussion improved scores by 50.9% (P = 0.02, Table 4). In contrast, the traditional lecture method produced only minimal, non-significant gains (0.8%, P = 0.78, Table 4). These findings directly reflect the statistical results and highlight the superiority of interactive, experiential learning approaches over lecture-based education.

The strong effect of role playing aligns with multiple prior studies. Brown and Chidume reported that role playing enhances communication skills, critical thinking, and confidence through safe practice environments and immediate feedback [37]. Qu et al. demonstrated a positive correlation between increased self-efficacy and the quality of nursing care following role play-based interventions [38]. Khaledi et al. found that integrating role play with gamification in CPR education improved both competence and confidence compared to traditional methods [39]. Similarly, Dorri et al. reported that role playing significantly increased students’ knowledge (63.85 vs. 46.41, p < 0.001) and patient satisfaction, further supporting the efficacy of experiential learning [40]. Additional studies, such as Bouriami et al. and Banharak et al., showed that scenario-based role playing enhances motivation, learning strategies, and clinical decision-making in health education, while Benko and Peršolja and Sartain et al. demonstrated improvements in empathy, interpersonal skills, and professional readiness through role-play workshops [41,42,43,44].

Small group discussion also proved effective, though slightly less so than role playing. This improvement may stem from peer learning, collaborative problem-solving, and supportive interactions. Badge et al. and Cusimano et al. reported that group-based and near-peer learning formats enhance self-efficacy and professional skills by fostering participation and reflection [45, 46]. Germain et al. further highlighted that peer assessment within such groups increases motivation and confidence [47]. Together, these findings emphasize the value of collaborative learning environments in nursing education.

Conversely, the traditional lecture method had minimal impact, consistent with Azizi et al. and Hsu et al., who found limited gains in self-efficacy and clinical performance with passive teaching [48, 49]. However, Alamrani et al. reported no significant difference between simulation and traditional approaches, indicating that contextual factors—such as intervention design, participant characteristics, and assessment tools—can influence outcomes [50]. Nevertheless, the small improvement observed in the lecture group here reinforces the limited capacity of teacher-centered methods to foster confidence and clinical competence.

It is noteworthy that not all findings in the literature are consistent with our results. While most studies support the benefits of role playing and interactive methods, some, such as Alamrani et al. (2018), reported no significant superiority over traditional teaching. These discrepancies may reflect differences in curriculum design, duration of interventions, or cultural and institutional factors affecting student engagement. By contrast, studies consistently showing positive effects reinforce the mechanism of active learning: engaging students in realistic scenarios, providing repeated practice opportunities, and delivering immediate feedback to enhance mastery and self-efficacy.

In summary, the present findings indicate that active, experiential, and interactive teaching methods—particularly role playing—are more effective than traditional lectures in improving nursing students’ clinical self-efficacy. The alignment and occasional discrepancies with previous studies highlight the importance of context, implementation quality, and learner characteristics in determining the impact of educational interventions. Overall, these results support the integration of structured role play and collaborative group activities into nursing curricula to enhance students’ professional preparedness and confidence.

Implications

The clear superiority of active learning methods, particularly role playing and small group discussion, over traditional lecture-based education highlights the need to revise current nursing curricula to incorporate more interactive and student-centered teaching strategies. Role playing demonstrated the greatest impact on students’ self-efficacy, increasing scores by 55.7% and clinically enhancing professional confidence, while small group discussions, although slightly less effective, still produced a meaningful 50.9% improvement. These findings suggest that educators should prioritize active learning interventions in both classroom and clinical education to foster students’ confidence, clinical competence, and readiness for professional practice.

From a research perspective, this study underscores the need for further investigations into the long-term effects of active learning strategies on nursing students’ clinical performance and patient care outcomes. Exploring combinations of multiple active methods or tailoring interventions to specific student characteristics may optimize learning effectiveness. Future studies could also examine the cost-effectiveness, scalability, and feasibility of implementing such interactive programs across different educational settings. Overall, these findings provide strong justification for integrating structured role play and collaborative group activities into nursing education to enhance self-efficacy and professional preparedness.

Limitations

This study has several limitations. First, sampling was restricted to a single university, which may limit the generalizability of findings to other cultural, educational, or resource settings. Second, the short-term design did not allow for assessment of 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, and psychological state) could have affected the results. In particular, self-reported self-efficacy scores may be influenced by social desirability bias, whereby participants provide responses they perceive as favorable rather than entirely accurate [51]. This potential bias could have led to an overestimation of students’ perceived self-efficacy, highlighting the need for cautious interpretation of these findings. Future studies are encouraged to incorporate complementary objective measures, longitudinal designs, and multi-center sampling to strengthen the validity and applicability of the results.

Conclusion

The findings indicate that role-playing and small group discussion significantly improve nursing students’ clinical self-efficacy compared to traditional lectures, with role-playing 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.

Data availability

The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author (zahra khalilzadeh-Farsangi) on reasonable request.

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