(HPS) was more effective than the use of interactive case studies (ICS) with respect to knowledge gain and critical thinking abilities, and assessed the learner's perspective related to the experiences. A quantitative

quasi-experimental two group pre-test and post-test design was utilized

with nursing students (N = 49) from two different nursing programs

at a simulation center. Nursing students were pre-tested using an electronic, Evolve Reach (formerly HESI) custom exam based upon ICS and HPS content. They were randomly assigned to either the ICS or HPS group, administered the educational intervention, and concluded the experience with post-testing using another version of the custom exam that was based upon the same test blueprint. Students also completed a researcher-developed ICS / HPS evaluation form to assess their perspectives on the teaching strategies.

Analysis of covariance (ANCOVA) revealed a significant difference in knowledge gain (p=.037), and a mildly significant difference in critical thinking ability using the Critical Thinking exam score (p=.051), with the HPS group scoring significantly higher on the post-test than the ICS group. Descriptive statistics revealed that the student perspective of the HPS experience was more positive when compared to the case study group with respect to the stimulation of critical thinking abilities (p=.070), perceived value (p=.001), the ability to transfer learning to the clinical setting (p=.059), need for inclusion in undergraduate education (p=.010), understanding of concepts (p=.010), invoking nervousness (p=.001), decreasing anxiety in the clinical setting (p=.074), and substitution for clinical experiences (p=.027).

The results demonstrate the effectiveness of simulation as an innovative teaching strategy in undergraduate nursing education, validate the nursing students' positive experience with respect to simulation, and confirm the cost-benefit ratio related to the resources needed to integrate simulation into a nursing curriculum.