Mediating Effects of Cognitive Load on the Relationship Between Learning Flow and Clinical Reasoning Skills in Virtual Simulation Learning.

• Learning flow and cognitive load were significant predictors of clinical reasoning skills. • Cognitive load mediated the relationship between learning flow and clinical reasoning skills. • Simulation educators should apply best-practice standards in virtual simulation learning. Although the demand for virtual simulation learning is increasing to substitute clinical practicum, there are a lack of studies that identify the relationships among learning flow, cognitive load, and clinical reasoning skills in virtual simulation learning. This study was a cross-sectional survey with 148 nursing students who completed virtual simulation learning as a substitution for clinical practicum during the COVID-19 pandemic. Participants completed a web-based self-administered questionnaire. Data were analyzed using multiple regression analysis to identify the mediating effects of cognitive load on the relationship between learning flow and clinical reasoning skills. Learning flow and cognitive load were significant predictors of clinical reasoning skills. Cognitive load mediated the relationship between learning flow and clinical reasoning skills. Simulation educators should apply best-practice standards by enhancing learning flow and cognitive load to achieve clinical reasoning skills in virtual simulation learning. [ABSTRACT FROM AUTHOR]