E-gaming: An active learning pedagogy for engaging learners in a private university in Karachi, Pakistan.

There is a radical shift in teaching and learning pedagogies to engage the learners in healthcare profession. It was a tough challenge for Pakistani educators of an esteemed university to motivate and assess the learners for concept absorption and critical reasoning using creative approaches. Teaching and learning styles have changed fundamentally from conventional teacher centred to inquiry-based student-centred approach. Classroom teaching in recognised nursing and medical institutes in Pakistan have transformed to blended and entirely online methodologies with the integration of diverse active learning strategies. The educators grapple to engage the millennials and to encounter this, gaming technological platform was used to facilitate the learners for maximum integration, active participation, and create an exciting learning experience. Various e-gaming tools, such as Kahoot, Jamboard, Padlet Wall, Ed-Puzzle, Mentimeter, etc., were used in nursing and medical courses and were highly appreciated by the leaners to retain, review, and self-assess.

Putting ICAP to the test: how technology-enhanced learning activities are related to cognitive and affective-motivational learning outcomes in higher education.

Digital technology is considered to have great potential to promote learning in higher education. In line with the Interactive, Constructive, Active, Passive (ICAP) framework, this seems to be particularly true when instructors stimulate high-quality learning activities such as constructive and interactive learning activities instead of active and passive learning activities. Against the background of a lack of empirical studies in authentic, technology-enhanced instructional settings, we investigated the cognitive and affective-motivational effects of these learning activity modes in technology-enhanced higher education courses. To this end, we used 3.820 student assessments regarding 170 course sessions for which the teachers stated the learning activities students were engaged in. Results of multilevel structural equation modelling highlight the importance of technology-enhanced interactive learning activities for students' perception of learning and the potential negative consequences of passive learning activities for affective-motivational outcomes. However, the superiority of constructive and interactive learning activities compared to passive and active learning activities for cognitive and affective-motivational outcomes was not supported by the findings. Instead, the findings point to potential differential effects of the individual learning activities within one activity mode. Future research should follow up on these effects to gain a more fine-grained understanding of how technology-enhanced learning activities can be optimized to enhance students' learning outcomes.

Based case based learning and flipped classroom as a means to improve international students' active learning and critical thinking ability.

BACKGROUND: International student education has become an important part of higher education and an important symbol to measure the level of higher education. To change the traditional teaching model, here we introduced a combination of Case-Based Learning (CBL)and Flipped Classroom (FC) into the pathophysiology course for international students. This study aimed to explore whether the active learning ability and critical thinking ability of international students can be improved, based on this new teaching model, improving the innovation ability of teachers' team and students' attitude to the reform. METHODS: The two chapters of Cardiac Insufficiency and Apoptosis in Pathophysiology are designed as a CBL + FC teaching method. Distribute the Self-assessment Scale on Active Learning and Critical Thinking (SSACT) and satisfaction questionnaire to international students to evaluate teaching reform based on CBL + FC. RESULTS: Compared with the traditional classroom, the online flipped classroom based on CBL has significantly improved the learning enthusiasm, as these students are required to independently complete literature review, actively participate in classroom teaching, learn to use multiple learning strategies, and collaborate with other students to complete PowerPoint (PPT)production. At the same time, the students' ability to raise problems and solve problems has been greatly improved by analyzing clinical cases; By consulting the literature, the theoretical knowledge learned can be better applied to clinical analysis. The results of the satisfaction survey also show that international students are more likely to accept the flipped classroom teaching mode. CONCLUSIONS: This teaching mode will stimulate the learning motivation of international students, enhance teaching attraction and increase teaching interaction; At the same time, the CBL + FC teaching method can strengthen the evaluation of international students' in and out of class and online learning, enhance students' active learning ability and critical thinking ability, promote the development of personalized learning, and integrate with international medical education.

The Community Health Advocacy Initiative: A Longitudinal Experiential Curriculum in Community Engagement for Preclerkship Medical Students.

Introduction: Community partnership is a key strategy for addressing the social determinants of health and achieving health equity. There are few examples of curricula for undergraduate medical education that teach all, rather than self-selected, medical students to collaborate with community members to improve health. We describe the design and implementation of the Community Health Advocacy Initiative (CHAI) curriculum, a new yearlong educational program for medical students at Northwestern University's Feinberg School of Medicine. Methods: CHAI aimed to fill the curricular gap in social determinants of health education by providing medical students with the knowledge and skills to improve the health of patients through collaborations with community partners. This longitudinal curriculum included structured faculty mentorship and an applied community experience. Results: The CHAI curriculum was delivered to 164 second-year medical students in academic year 2021-2022. Faculty mentors rated most students as meeting expectations for application of community partnership principles and demonstration of professionalism. Qualitative analysis of faculty mentor comments demonstrated that medical students exhibited positive outcomes in engaging with community organizations, overcoming barriers, developing feasible and impactful goals, and advancing their own knowledge and skills. Discussion: Implementing a community health curriculum for all medical students is feasible and represents an important model for teaching about the importance of community partnerships in addressing the social determinants of health.

Normal Pregnancy Care and Physiology and Select Pregnancy Complications: A Flipped Classroom Case for the OB/GYN Clerkship.

Introduction: This module teaches core knowledge and skills for undergraduate medical education in reproductive health, providing instruction in the management of normal and abnormal pregnancy and labor utilizing interactive small-group flipped classroom methods and case-based instruction. Methods: Advance preparation materials were provided before the education session. The 2-hour session was facilitated by clinical educators using a faculty guide. Using voluntary surveys, we collected data to measure satisfaction among obstetrics and gynecology clerkship students and facilitators following each education session. Results: Capturing six clerkships spanning 9 months, 116 students participated, and 64 students completed the satisfaction survey, with 97% agreeing that the session was helpful in applying knowledge and principles to common clinical scenarios. Most students (96%) self-reported that they achieved the session's learning objectives utilizing prework and interactive small-group teaching. Nine clinical instructors completed the survey; all agreed the provided materials allowed them to facilitate active learning, and the majority (89%) agreed they spent less time preparing to teach this curriculum compared to traditional didactics. Discussion: This interactive flipped classroom session meets clerkship learning objectives related to the management of pregnancy and labor using standardized materials. The curriculum reduced preparation time for clinical educators as well.

A Game-Based Tool for Reducing Jargon Use by Medical Trainees.

Introduction: Physicians can be unaware that many US adults have intermediate or lower health literacy. Avoiding medical jargon in patient communication can improve poor outcomes associated with lower health literacy, but physicians may struggle to do so as health literacy education is neither standardized nor universal at US allopathic medical schools. As with other skills-based proficiencies in medical education, repeat exposure and active learning help build competency. Medical students developed the Patient Communication Challenge (PCC), an adaptation of the Hasbro game Taboo, to facilitate practice of patient-centered communication skills among medical trainees. Methods: Hour-long workshops were held for groups of preclinical medical students. Students watched a communication exemplar video, played the PCC game, and completed a postworkshop survey. To play, two teams competed to earn points by identifying medical concepts as explained by a teammate who described the term without using medical jargon. Results: Evaluations indicated that the game was enjoyable and reinforced didactic concepts through active learning, with self-reported participant satisfaction and competency gain. Overall, 59% of participants (53 of 90) completed postworkshop surveys; 91% (48 of 53) agreed they felt more proficient in avoiding jargon, 94% (50 of 53) would recommend the workshop to a classmate, and 100% (53 of 53) would play again. Discussion: The PCC can help early medical trainees develop health communication skills through gamification with utilization of adult learning principles and adequate frequency for skill retention. Future applications include longitudinal assessment and expanding to later stages of medical training and other health professions.

Online-to-offline combined with problem-based learning is an effective teaching modality in the standardized residency training of nephrology.

BACKGROUND: The online-to-offline (O2O) teaching method is recognized as a new educational model that integrates network learning into offline classroom education, while problem-based learning (PBL) is a teaching modality that guides students to apply acquired theoretical knowledge to solve practical problems. However, implementing O2O combined with PBL has not been extensively explored in nephrology residency training. This study aims to explore the efficacy of O2O combined with PBL in the standardized residency training of nephrology by comparing it with the traditional lecture-based teaching (LBT). METHODS: Sixty residency trainees who participated in the standardized training of internal medicine in the nephrology department of the Second Affiliated Hospital of Zhejiang University School of Medicine were equally allocated into O2O combined with PBL (O2O/PBL) or the LBT group demographically matched. Examinations of theory, practice skills, clinical thinking and teaching satisfaction surveys were utilized to assess the teaching effects of the two groups. RESULTS: Participants from the O2O/PBL group outperformed those from the LBT group in the examination of theory (81.233 ± 9.156 vs. 75.800 ± 7.009, mean ± SEM), practice skills (104.433 ± 3.569 vs.100.316 ± 4.628, mean ± SEM) and clinical thinking (88.933 ± 4.473 vs. 86.667 ± 3.844, mean ± SEM). There was no significant difference in the teaching satisfaction between the two groups. CONCLUSION: The current study shows the positive impact of O2O combined with PBL approach on standardized residency training in nephrology without reducing teaching satisfaction.

Interactive H5P content for increased student engagement in a dental hygiene program.

Background: Presently, dental hygiene education is primarily divided into classroom lectures, simulation labs, and clinical experiences. Although the recent surge of curriculum renovation in dental and medical schools centres around enhancing student engagement and active learning, classroom teaching remains teacher-focussed, involving students mainly as passive learners. H5P is an open platform for creating and sharing interactive HTML5 learning content. A large set of H5P content was created and provided to students through the learning management system as supplementary material for an oral biology course in the dental hygiene program at a Canadian university. This study was conducted to evaluate the impact of this interactive H5P content on the students' learning experiences. Methods: The third-year dental hygiene students enrolled in the oral biology course were invited to participate in the study. Anonymised student performance data from the summative exam were analysed, and a survey regarding the student experience with the supplementary H5P content was administered. Results: Students performed better on questions for which H5P supplements were provided. The results from the survey showed satisfaction and perceived benefit of using H5P as supplementary content in didactic lectures. Discussion: The H5P content allowed students to apply knowledge and reproduce understanding, promoting active learning in the didactic oral biology course. Students appreciated the content's interactive nature and expressed willingness to have similar experiences in other courses. Conclusion: Using H5P, interactive learning content can promote self-directed and personalized learning. This open learning platform has the potential to redefine didactic teaching by fostering an active learning environment.

Contexte: À l'heure actuelle, la formation en hygiène dentaire s'appuie principalement sur des exposés en classe, des simulations en laboratoire et des expériences cliniques. Bien que la récente vague de révision des programmes d'études des écoles dentaires et de médecine soit axée sur le renforcement de l'engagement des étudiants et de l'apprentissage actif, le travail en classe reste axé sur l'enseignement par un enseignant : dans ce contexte, les étudiants sont principalement des apprenants passifs. H5P est une plateforme ouverte pour la création et le partage de contenu d'apprentissage interactif au format HTML5. Un vaste ensemble de contenu H5P a été créé et fourni aux étudiants, par l'entremise du système de gestion de l'apprentissage, à titre de matériel supplémentaire pour un cours de biologie buccale dans le cadre du programme d'hygiène dentaire d'une université canadienne. Cette étude a été effectuée pour évaluer les effets de ce contenu H5P interactif sur les expériences d'apprentissage des étudiants. Méthodes: Les étudiants en hygiène dentaire de troisième année inscrits au cours de biologie buccale ont été invités à participer à l'étude. Des données anonymisées sur le rendement des étudiants provenant de l'examen sommatif ont été analysées, et un sondage sur l'expérience des étudiants avec le contenu H5P supplémentaire a été mené. Résultats: Les résultats des étudiants étaient meilleurs pour les questions pour lesquelles du contenu H5P supplémentaire a été fourni. Les résultats de l'enquête ont révélé les avantages perçus de l'utilisation du contenu H5P supplémentaire dans les cours didactiques, ainsi que la satisfaction en la matière. Discussion: Le contenu H5P a permis aux étudiants d'appliquer les connaissances et de reproduire la compréhension, favorisant ainsi l'apprentissage actif dans le cadre des cours didactiques de biologie buccale. Les étudiants ont apprécié la nature interactive du contenu et se sont dits prêts à répéter l'expérience dans le cadre d'autres cours. Conclusion: Grâce à H5P, le contenu d'apprentissage interactif peut favoriser l'apprentissage autodirigé et personnalisé. Cette plateforme d'apprentissage ouverte a le potentiel de redéfinir l'enseignement didactique en favorisant un environnement d'apprentissage actif.

Research on the influencing factors of promoting flipped classroom teaching based on the integrated UTAUT model and learning engagement theory.

With the rapid advancement of educational technology, the flipped classroom approach has garnered considerable attention owing to its potential for enhancing students' learning capabilities. This research delves into the flipped classroom teaching methodology, employing the Unified Theory of Acceptance and Use of Technology (UTAUT), learning engagement theory, and the 4C skills (comprising communication, collaboration, creativity, and critical thinking) to investigate its effects on learning capabilities. The research surveyed 413 students from three universities in Jiangxi Province, employing stratified random sampling. SPSS 24.0 and Amos were used for structural equation modeling and hypothesis testing analysis. The findings indicate that: (1) Performance expectancy, effort expectancy, and peer influence significantly enhance students' learning engagement in the flipped classroom. (2) Students' learning engagement in the flipped classroom notably promotes their learning capabilities. (3) Performance expectancy, effort expectancy, and peer influence can significantly boost learning capabilities by increasing learning engagement. (4) Personality traits significantly moderate the effect of peer influence on learning engagement, highlighting the crucial role of individual differences in learning. (5) The level of students' learning engagement is differentially influenced by performance expectancy and peer influence across various academic disciplines. Ultimately, this research provides valuable insights for educational policymakers and guides improvements in teaching practices, collectively advancing educational quality and equity.

Exploring the responses of preclinical medical students and professors to flipped learning for the development of clinical reasoning.

PURPOSE: This study developed and implemented case-based flipped learning using illness script worksheets and investigated the responses of preclinical students and professors to the intervention in terms of its effectiveness, design, and implementation. METHODS: The study was conducted at a medical school in Korea, where the "clinical reasoning method" course, originally a lecture-oriented course, was redesigned into a flipped learning. In total, 42 second-year medical students and 15 professors participated in this course. After the class, online surveys were conducted, and a focus group interview was held with seven students to explore the students' experiences in more detail. RESULTS: In total, 37 students and seven professors participated in the survey. The mean score for all items is 3.12/4 for the student survey and 3.43/4 for the professor survey. The focus group interview results were categorized as the beneficial aspects and challenges for the development of clinical reasoning. CONCLUSION: The findings indicated that their responses to the intervention were generally positive, and it is thought to be an effective instructional method for fostering clinical reasoning skills in preclinical medical students.

Adapting and applying student-centered learning in a perfusion clinical rotation.

While the process of teaching student perfusionists has been in development since the 1950s, the publication of the processes to improve perfusion clinical education has been largely lacking. Publications regarding education from other allied health and medical fields have shown the value of student-centered learning. The use of reflective practice to move perfusion students from thinking about actions after cardiopulmonary bypass (CPB) to reflecting and reacting on actions during CPB is better encouraged by moving from a teacher-centered to a student-centered clinical model. Our institution's teaching process has developed into a multi-point procedure to make our students into reflective practicing clinicians. Student preceptor evaluations were reversed to allow the students to evaluate themselves first, with feedback from the preceptor given subsequently. Additionally, a biweekly student educational session, where the student chooses a topic and reviews current evidence-based practice, was instituted. The clinical program director serves as the moderator and clinical expert to facilitate problem-based learning during the sessions. Students were also given three skill/experience levels with goals to reach and move through during the rotation. These student levels were also helpful to our preceptors in knowing what each student's skill level was throughout their rotation. Overall, moving from a teacher-centered to a student-centered clinical rotation has helped make students familiar with reflective practice, self-evaluation, evidence-based practice, and problem-based learning. The incorporation of these processes will hopefully lead students to become lifelong reflective perfusionists.

Evaluating the effects of action learning on the research competency of undergraduate nursing students: A mixed-methods study.

BACKGROUND: Research skills in nursing are crucial for guiding evidence-based practice and enhancing health care. However, undergraduate nursing students often encounter challenges in skill development because of curriculum constraints that prioritize clinical education. Bridging this skill gap is imperative for preparing students for evidence-based practice and nursing scholarship. AIM: This study aimed to investigate the impact of incorporating action learning into undergraduate nursing research classes to improve the quality of nurse education. DESIGN: A mixed-methods approach was employed using pre- and post-online surveys for quantitative analysis and reflective journals for qualitative analysis. SETTINGS: The study was conducted at a college of nursing in Seoul, South Korea. PARTICIPANTS: A convenience sample of 19 fourth-year nursing students participated in the study. METHODS: Action learning-based nursing research classes were implemented over ten sessions, integrating lectures and team activities. Pre- and post-assessment data on communication skills, critical thinking tendencies, and problem-solving abilities were analyzed using paired t-tests. The qualitative analysis involved content analysis of individual and team reflective journals. RESULTS: Participants in action learning-based nursing research classes showed significant improvements in their communication skills (t = 3.46, p = 0.002), critical thinking tendencies (t = 3.80, p = 0.001), and problem-solving abilities (t = 1.82, p = 0.043). From the analysis of reflective journals four main themes were developed: organized team projects, dynamics of learning goal achievement, extended application of learning outcomes, and recommendations for better action learning-based classes. CONCLUSIONS: This study highlights action learning as an effective educational method that integrates theory and practice in nurse education, helping students prepare for their future roles as nursing professionals. The findings underscore the effectiveness of action learning in improving undergraduate nursing students' research competency and support the need for continued development of such pedagogical approaches.

Real-world and game-based learning to enhance decision-making.

BACKGROUND: The evolving healthcare landscape necessitates highly qualified nurses equipped with a myriad of soft skills, including decision-making. Traditional teaching models have led to innovative, active methods that prioritise student participation and enhance crucial soft skill development, such as decision- making. Considering the recognised importance of improving clinical decision-making skills and the need for innovative training, a literature gap is present in assessing the effect of real world and game-based learning on decision-making abilities. OBJECTIVES: This study aimed to investigate the effect of real-world and game-based learning, specifically using case-based learning and escape room, on decision-making competence in postgraduate nursing students in academic and clinical settings. DESIGN: A descriptive, cross-sectional, quantitative intervention study was conducted, combining case-based learning and escape room methods sequentially. SETTINGS: The study was conducted among postgraduate nursing students at the University of Navarra in Spain. PARTICIPANTS: Sixty-six postgraduate nursing students, mostly women, participated in the study. METHODS: The study integrated case-based learning and escape room sequentially. Data were collected through an ad hoc online questionnaire, recorded escape times from the escape room, and academic scores. RESULTS: The study enrolled 66 participants with an average professional experience of 4.2 years. Academic results showed high scores in case resolution (average: 8.34) and knowledge tests (average: 9.21). Out of 11 groups, 81.8 % successfully escaped the escape room within 30 min, with positive questionnaire responses indicating enthusiasm, enjoyment and perceived effectiveness of the activities. CONCLUSIONS: Real-world and game-based learning significantly enhanced decision-making competence in postgraduate nursing students across academic and clinical settings, demonstrating the importance of diverse teaching methods. Further research, including comparative studies and longitudinal analyses, is needed to evaluate the educational benefits of integrating case-based learning and escape room methods in nurse education and to refine assessment tools while monitoring long-term student progress.

Nursing students' experiences of community nursing school subject classes based on the Havruta learning method: A qualitative study.

BACKGROUND: Nursing is encountering increasingly complex and unpredictable challenges, and traditional lecture-style education is inadequate for preparing future nurses to meet these societal demands. In nursing, it is important to expand the variety of student-centered educational methods that empower students to build and contemplate their own knowledge. The Havruta educational method is recognized for its effectiveness in fostering critical thinking and promoting self-directed learning skills. OBJECTIVES: This study aims to elucidate the nature and significance of experiences among nursing students who engage in community nursing classes through the Havruta learning approach. DESIGN: Qualitative research. SETTINGS: Nursing universities in Korea. PARTICIPANTS: This study was conducted on 68 nursing students who participated in the Havruta learning method. METHOD: A total of 68 third-year students enrolled in community nursing courses in the second semester of 2022 at a university participated in this qualitative study. Data were collected through the analysis of reflection journals. RESULTS: The study identified four overarching themes and 10 sub-themes relating to the application of the Havruta learning method in community nursing classes. The primary themes included: "how to increase motivation to participate in classes," "learning through communication," "Gaining insight through problem-solving," and "Regrets about the lack of time." CONCLUSIONS: The findings suggest that the Havruta learning approach allows students to broaden their intellectual scope and perspective on a more comprehensive body of knowledge. This is achieved through interactive methods that encourage self-organization and reflective thinking.

Unveiling CPR training challenges in nursing education: Pedagogical strategies for success.

AIM: This study explored the challenges nursing students face while learning CPR and identified experiential learning strategies to address these challenges. BACKGROUND: Nursing students often experience challenges and anxiety during clinical learning, including CPR training. Given the experimental nature of CPR training, experiential learning models like mARC can significantly enhance the learning experience by addressing these prevalent challenges. DESIGN: This study adopts an interpretivist approach within a qualitative methodology and uses a phenomenological design. METHOD: Semi-structured interviews and the Delphi method were used to gather firsthand experiences from 37 educational supervisors, nursing professors and nursing students undergoing CPR clinical training at five public medical universities. RESULTS: Four main challenges and eighteen sub-challenges of CPR training were identified, elaborated and modeled. Additionally, thirteen experiential learning strategies, based on the mARC experiential learning model (more Authentic, Reflective, Collaborative), were mapped to address these challenges. CONCLUSIONS: Among the four main challenges of CPR training identified by this study, the lack of pedagogy appears to be the underlying cause of the other three. This underscores the significance of integrating effective pedagogical approaches into nurse education strategies and initiatives.

The use of role-play in the learning of medical terminology for online and face-to-face courses.

Student engagement while learning a new, unfamiliar vocabulary is challenging in health science courses. A group role-play activity was created to teach students medical terminology and learn why its correct usage is important. This activity brought engagement and relevance to a topic traditionally taught through lecture and rote memorization and led to the development of an undergraduate and a stand-alone introductory course to teach students medical terminology. The undergraduate course was designed to be a fully online medical terminology course for health science students and a face-to-face course for first-year dental students founded in active learning and group work. The course's centerpiece learning activity focused on using published case studies with role-play. In this group activity, students are challenged to interpret a published patient case study as one of the members of a healthcare team. This course models the group work inherent in modern health care to practice building community and practicing professional skills. This approach gives students the capacity to work asynchronously in a team-based approach using our learning management system's wiki tool and requires students to take responsibility for their learning and group dynamics. Students practice identification, writing, analyzing, and speaking medical terms while rotating through the roles. Students in both classes self-reported a 92% to 99% strong or somewhat agreement using a five-point Likert scale that the course pedagogy was valued and helpful in their learning of medical terminology. Overall, this method has proven to be an engaging way for students to learn medical terminology.NEW & NOTEWORTHY Role-play can engage students and encourage learning in identification, pronouncing, writing, and understanding medical terminology in multiple course formats.

Development and implementation of a case-based collaborative learning flipped classroom preclinical neurology course.

This paper describes the development, content, structure, and implementation of a case-based collaborative learning, flipped classroom, integrated preclinical neurology, neuroanatomy, and neuroscience course for first year medical students at Harvard Medical School. We report the methods for pre-class preparation, in-class instruction, and evaluation; student feedback with respect to content, teaching method, and learning environment; and several lessons learned regarding how to optimize preparatory and in-class learning in a case-based flipped classroom course.

The impact of applying unfolding case-study learning on critical care nursing students' knowledge, critical thinking, and self-efficacy; a quasi-experimental study.

BACKGROUND: The unfolding case-study learning approach is a growing modernized learning strategy implemented in different health disciplines. However, there is a lack of existing research that examines the effects of unfolding case studies in advanced nursing courses. AIM: To examine the impact of applying an unfolding case-study learning approach on critical care nursing students' knowledge, critical thinking, and self-efficacy. METHODS: This posttest-only, quasi-experimental study was conducted at XXX University in Palestine. A single-stage cluster sampling was used to assign nursing students enrolled in the critical care nursing course into experiment and conventional groups. The intervention group (n= 91) underwent unfolding case-study learning for selected cardiovascular topics, whereas the conventional group (n= 78) was taught using the traditional teaching methods. The posttest assessment was conducted using Knowledge Acquisition tests, Yoon`s Critical Thinking Disposition Instrument (YCTD), and the Self-Efficacy for Learning and Performance instruments. The Social Constructivist Theoretical Framework was integrated into the study. RESULTS: Homogeneity was achieved between both groups concerning Age, Gender, and GPA. The experiment group scored significantly higher than the conventional group regarding the posttest knowledge acquisition tests (7.12 vs. 5.49, respectively, t=-12.7, P<0.001, CI: -1.89 to -1.38), critical thinking (4.32 vs. 3.63 respectively, t=17.390, p<0.001, CI: -77 to -61) and self-efficacy (6.12 vs. 4.4 respectively, t=-30.897, p<0.001, CI: -1.82 to -1.60). Multivariate analysis revealed that 69 % of the variations of posttest scores were influenced by critical thinking scores (Adjusted R Squared=0.690, F=3.47, P=0002, η2=0.969). Similarly, self-efficacy has been shown to contribute by 74 % to the variations of scores after conducting the study program (Adjusted R Squared=0.743, F=4.21, P=0001, η2=0.974). However, the variations of both critical thinking and self-efficacy scores were not significantly influenced by the contribution of knowledge acquisition (p=0.772 and 0.857, respectively) and students' GPA (p=0.305 and 0.956, respectively). CONCLUSIONS: Irrespective of knowledge level and GPA, the unfolding case-study learning approach can enhance the critical thinking and self-efficacy of students enrolling in advanced nursing courses.

Development of clinical decision-making among undergraduate nursing students: the effect of unfolding case-based learning.

OBJECTIVES: This prospective cohort study evaluated the effect of unfolding case-based learning on undergraduate nursing students' self-perceived clinical decision-making ability. METHODS: Students' self-reported responses to Jenkins's Clinical Decision Making in Nursing Scale were compared between the unfolding case-based learning cohort (n=140) and the comparison cohort (n=126) at a school of nursing in the United States. RESULTS: The results revealed similar students' responses between the two study cohorts. However, unfolding case-based learning significantly increased students' perceived proficiency in "search for information and unbiased assimilation of new information". CONCLUSIONS: Findings from the present study highlight possibilities presented by unfolding case-based learning in undergraduate nursing education. The study supports that unfolding case studies can be introduced early on, and then nurtured throughout the undergraduate program to influence the development of nursing students' clinical decision-making skills.

Comparison of blended learning and traditional lecture method on learning outcomes in the evidence-based medicine course: a comparative study.

BACKGROUND: Blended learning comprised with flipped classroom (FC) and "internet plus" is a new learning strategy that reverses the position of teacher and students in class, and provides abundant learning resources before and after class. This study aimed to assess the impact of blended learning on learning outcomes in evidence-based medicine course, and compare with traditional learning method. METHODS: The participants of the two groups were from two difference cohorts in Air force medical university in China. The two groups toke the same pre-test before class and then were given the teaching of same chapters of evidence-based medicine with two different learning strategy. In the blended learning group, the participants were required to create a debriefing slide about their learning outcomes and the answers of questions given in advance after study the learning material sent by teacher a week before class, and the teacher gave a detailed summary based on the common problems, and distributed multimedia resources for review. After the experiment was carried out, learning outcomes including mastering knowledge, learning satisfaction, and self-evaluation were compared. RESULTS: 37 and 39 participants were enrolled to blended learning and traditional learning groups, respectively, and no statistically significant difference were found in baseline information and pre-test grades. Statistically significant differences were found in learning outcomes including post-test score (t = 2.90, p = 0.005), changes of scores between pre-test and post-test (t = 2.49, p = 0.022), learning satisfaction (t = 12.41, p = 0.001), and self-evaluation of the two groups (t = 7.82, p = 0.001). Especially, the changes of scores between pre-test and post-test of blended learning and traditional learning groups were 4.05 (4.26), and 2.00 (2.85), respectively. CONCLUSIONS: This study showed that compared with traditional learning strategy, blended learning can effectively enhanced participants' acquisition of knowledge, learning satisfaction, and self-evaluation in evidence-based medicine. Using blended learning method including "internet plus" and flipped classroom is recommended in the teaching of evidence-based medicine course.