Effects of artificial intelligence: Generated patient voices on student outcomes in prelicensure nursing simulation

Background: Simulation-based education supports clinical judgment development in prelicensure nursing students, yet patient voice remains an underexplored design feature influencing realism and presence. Methods: Eighty-four first-year prelicensure nursing students were randomly assigned to either an AI-generated or live human-voiced high-fidelity simulation. Outcomes included the Modified Presence Questionnaire and Lasater Clinical Judgment Rubric. Results: Presence scores were significantly higher in the AI-generated voice group than the human voice group, while clinical judgment scores did not differ significantly between groups. Conclusions: AI-generated patient voices enhanced learner presence while maintaining equivalent clinical judgment outcomes. Findings suggest auditory fidelity is a modifiable simulation design element that may improve immersion without compromising learning.