To assess dietetic students' anxiety levels before and after a series of simulations and to document students' perceived sources of anxiety while completing simulation-based learning activities. A mixed-method convergent pilot study was conducted. Students enrolled in a Nutrition Assessment course that included a series of four simulations were invited to participate. Students completed an online pre-post simulation survey and engaged in individual interviews and a focus group discussion. The questionnaires included demographic questions and the French State-Trait Anxiety Inventory. Nonparametric tests and thematic analysis were used to examine data. Fourteen students participated in the study's quantitative component and seven in the qualitative component. There was a significant decrease in trait (44.5��������13.8 vs 32.0��������14.0, ���=���0.01) and state (47.0��������11.2 vs 33.0��������18.0, ���=���0.05) anxiety from pre- to post-simulations. Individual factors influencing students' anxiety levels were stress and self-confidence. External factors influencing students' anxiety levels were unknown situations, observers, patient profiles, observers' feedback, preparation level, and academic setting. Our findings suggest that ensuring the educator is not present during simulations, advance preparation, and reassurance that simulations are a learning and not an evaluation activity may be effective pedagogical strategies for dietetic educators to reduce learners' anxiety and facilitate competency development.
