A meta-analysis of a thesis project entitled Virtual Patients (VPs) for Assessment of Clinical Reasoning has been performed. VPs are interactive computer simulations of real-life clinical scenarios for the purpose of healthcare education and assessment. To teach and learn clinical reasoning (CR) can be hard because its complexity and difficulty to make it visible for students. VPs have been found to improve learning and be superior to traditional teaching methods for training CR. Most VP systems have the potential to track all interactions of the user and therefore recommended for assessment. The aim of the metaanalysis, which is based on the research project’s four studies, was to reach a deeper understanding of the educational impact of using VPs in postgraduate pediatric nurse education. Data was collected during 2008-2013.The first study evaluated the applicability and students’ acceptance of VP-based exams. Through thinking aloud the second study identified how clinically experienced nurses solved complex VP cases which was a base for the third study; evaluating a new scoring model for VP-based exams. Finally the last study explored if formative VP-based assessments in connection with self-evaluations had an impact on student’s development of CR and if they could detect their progression. For the meta-analysis, concepts of challenge, skills, novice and expert have been applied. The findings shows that VP-based assessments have high educational impacts: for example even if the students were novices in the domain of Child health care, the early exposure for formative VP-based assessments gave them an insight about what is required to work at such a unit as well as a stimulation to develop CR in this field. They became aware of what to focus on in literature and clinical practice. The students reported a perceived progression of CR ability from uncertainty about the competence, to self-efficacy.