Abstract Simulation provides a safe, non-threatening learning environment, which allows for the development of student self-efficacy and confidence when attempting skills in the actual clinical environment. Aim of the study: to assess the effect of simulation as a learning approach on self-efficacy and intrinsic motivation of the first year medical nursing student in Damanhour University (Egypt). Settings: Faculty of Nursing Damanhour University. Sampling all medical surgical nursing students enrolled at the first year, (n=311) at the academic year 2014-2015. Tools: Two tools were used to collect data. Tool I: General Self-Efficacy Scale (GSE) Tool II: Intrinsic Motivation Inventory (IMI); as well as demographic characteristics. Results: Confidence level and intrinsic motivation increased significantly post – simulation intervention. A significant positive weak correlation between total self- efficacy and total intrinsic motivation. There is a statistical significant difference between self-efficacy and both gender and studying hours. Conclusion Simulation is an active learning strategy that can effectively be integrated into all levels of nursing education to foster student-centered instruction. Results of this study showed that there was a significant difference in the students' self – efficacy and intrinsic motivation after using simulation. Recommendation Educators should be encouraged to use the various forms of simulation when appropriate with nursing students.