Setting
The study was conducted as part of simulation sessions that prepared second-year undergraduate nursing students for clinical placement in medical-surgical settings. It took place in nursing programs at a university in Southern Norway (two sites) and at a university in Western Norway (one site). At the fall semester in 2020, there were 175, 153 and 145 students enrolled at the three sites, respectively. However, about half of these students were eligible, as only those undergoing clinical placements at somatic hospitals during that period could be included, in accordance with the curriculum and learning outcomes.At all the universities, the students had been taught preoperative nursing care for surgical patients, communication between health care providers, and the ISBAR approach before the research study was launched.The simulation set-up at each site comprised one lecture room with 12 computers with headsets for virtual desktop simulation and a room for paper-based simulation (one large room or smaller group rooms). Four instructors were used to facilitate the sessions and collect data for the study.