# From curiosity to continuance: explaining nursing students’ continuance learning intention in virtual simulation using an integrated ECM-TAM

## TL;DR

This study explores why nursing students continue using virtual simulations for learning, finding that satisfaction and positive attitudes are key, while curiosity alone isn't enough.

## Contribution

The study integrates ECM, TAM, and clinical curiosity to explain nursing students' continuance learning intention in virtual simulations.

## Key findings

- Satisfaction and attitude directly predict continuance learning intention.
- Clinical curiosity does not directly influence intention but affects it through attitude.
- The integrated model explains 43.8% of the variance in continuance learning intention.

## Abstract

Virtual simulation is integral to modern nursing education, yet the “acceptance-discontinuance anomaly”—where students cease usage after initial adoption, resulting in fragmented skill acquisition—remains a challenge. Understanding the determinants of Continuance Learning Intention (CLI) is crucial for sustainable competency development. This study aims to investigate the factors influencing nursing students’ CLI toward virtual simulation by integrating the Expectation-Confirmation Model (ECM), Technology Acceptance Model (TAM), and the construct of Clinical Curiosity.

A descriptive cross-sectional study was conducted at a medical university in Shanghai, Eastern China. A total of 281 nursing students with experience in virtual simulation were recruited to complete an online survey. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to test the hypothesized relationships among confirmation, perceived clinical usefulness, satisfaction, attitude, clinical curiosity, and CLI.

The integrated model explained 43.8% of the variance in CLI. The model demonstrated good fit with a Standardized Root Mean Square Residual (SRMR) of 0.053. Confirmation significantly predicted Perceived Clinical Usefulness (PCU) and Satisfaction (p < 0.001). Satisfaction (β = 0.341, p < 0.001) and Attitude (β = 0.402, p < 0.001) were direct predictors of CLI. Notably, Clinical Curiosity did not directly predict intention (β = 0.045, p = 0.323). Instead, mediation analysis revealed that Attitude fully mediated the relationship between Clinical Curiosity and CLI (β = 0.084, p < 0.001).

Clinical relevance and user satisfaction are foundational for retention. Uniquely, intrinsic clinical curiosity alone does not guarantee continued learning in this high-stakes educational context; it must be catalyzed into a positive evaluative attitude to drive sustainable usage. Instructional designs should prioritize bridging curiosity-triggering content with attitude-reinforcing debriefings to foster long-term engagement.

The online version contains supplementary material available at 10.1186/s12912-026-04466-6.