William D. TaalaFahad M. AlthobaitiRino S. De SagunRock P. CorderoJake CanapiJon Jon Martinez2026-01-232026-01-232026-01https://doi.org/10.1016/j.profnurs.2025.11.010https://rims.khazar.org/handle/123456789/514Purpose: In this meta-analysis, researchers examined the impact of high-fidelity simulation (HFS) and low-fidelity simulation (LFS) on the development of psychomotor skills, cognitive outcomes, and self-efficacy among nursing students, emphasizing pediatric and medical-surgical nursing. Methods: In total, 18 studies involving over 4000 nursing students were systematically reviewed. Studies that focused on simulation-based education were included. The effect size for each simulation type was calculated for psychomotor skills, cognitive outcomes, and self-efficacy using the standardized mean difference. Results: Compared with LFS, which exhibited a moderate effect size of 0.56, HFS significantly improved clinical skills, cognitive outcomes, and self-efficacy, with a pooled effect size of 0.86. Pediatric nursing students demonstrated the highest improvement (effect size, 0.82), followed by medical-surgical nursing students (effect size, 0.65), thereby indicating that HFS simulation was more effective for pediatric and medical-surgical specialties. Conclusion: HFS and LFS instructional techniques can significantly improve the clinical decision-making, skill, and confidence levels of students. These findings provide insights into the incorporation of HFS in the nursing education curriculum, especially in pediatric and medical-surgical nursing, where clinical judgment is vital.en-USHigh-fidelity simulation Low-fidelity simulation Psychomotor skills Cognitive outcomes Self-efficacyjournal-article