Evaluation of the Effectiveness of BOPPPS Combined with Scenario-Based Simulation in the Clinical Teaching of Operating Room Nursing Interns

Evaluation of the Effectiveness of BOPPPS Combined with Scenario-Based Simulation in the Clinical Teaching of Operating Room Nursing Interns | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Effectiveness of BOPPPS Combined with Scenario-Based Simulation in the Clinical Teaching of Operating Room Nursing Interns Qing Xu¹, ZhongYu Xiong¹, ChangYan Zhong¹ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6909666/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objective To evaluate the effectiveness of integrating the BOPPPS teaching model with scenario-based simulation in the clinical training of operating room nursing interns. Methods A total of 71 undergraduate nursing students were assigned to either a control group (n = 36) or an experimental group (n = 35) based on their internship commencement dates. The control group received traditional clinical skills training, whereas the experimental group was instructed using the BOPPPS model combined with scenario-based simulation. Upon completion of their rotations, theoretical knowledge, practical skills, self-directed learning ability, and teaching satisfaction were assessed and compared between the two groups. Results The experimental group scored significantly higher in theoretical and practical assessments, demonstrated stronger self-directed learning abilities, and reported greater satisfaction with the teaching experience compared to the control group (all P < 0.05). Conclusion The integration of BOPPPS with scenario-based simulation enhances nursing interns’ mastery of theoretical and practical competencies, improves self-directed learning, and increases satisfaction with clinical teaching. This approach holds promise for broader application in clinical nursing education. BOPPPS scenario-based simulation operating room clinical teaching nursing education Introduction Clinical practice in the operating room (OR) is a crucial component of undergraduate nursing education, serving as an essential stage for developing hands-on skills and professional competence[ 1 ]. Unlike general ward placements, OR internships require student nurses to quickly adapt to highly specialized procedures and multiple clinical roles[ 2 ]. Traditional teaching methods often place students in passive learning positions, hindering their ability to engage effectively in clinical scenarios, which may negatively affect the overall internship outcome. The BOPPPS (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment, Summary) model is a student-centered teaching approach that has shown significant advantages over traditional instructional methods in various educational contexts. Studies have demonstrated its effectiveness in improving students' theoretical knowledge, practical skills, and self-learning abilities in fields such as thoracic surgery [ 3 ] and nursing education[ 4 ]. The model enhances student engagement, critical thinking, and academic achievement [ 5 ]. In thoracic surgery education, BOPPPS led to higher examination scores and improved student satisfaction, interaction, and analytical abilities compared to traditional approaches[ 3 ]. A meta-analysis of nursing education studies revealed that BOPPPS significantly improved theoretical scores, practical scores, self-learning ability, and student satisfaction with teaching effectiveness [ 4 ]. These findings suggest that the BOPPPS model is a valuable framework for enhancing teaching effectiveness across various disciplines. Scenario-based simulation has emerged as an effective pedagogical strategy in nursing education, enhancing students' clinical competence, critical thinking, and decision-making abilities. Multiple studies have demonstrated the positive impact of simulation on nursing students' skills. Sullivan-Mann et al. [ 6 ]found that increased exposure to simulation scenarios significantly improved critical thinking scores. Similarly, Görücü et al. [ 7 ] conducted a meta-analysis revealing that simulation-based education enhances clinical decision-making skills in undergraduate nursing students. Wong et al. [ 8 ]identified specific pedagogical approaches for simulation-based learning, emphasizing the importance of assigned roles and structured phases to enhance clinical competence. Woda et al. [ 9 ] compared different cohorts and found that supplementary simulation, in addition to traditional clinical experiences, led to better patient assessments. These findings collectively support the use of simulation as a valuable tool in nursing education, providing students with immersive experiences that bridge theoretical knowledge and practical skills. Although multimodal teaching strategies have been increasingly adopted in nursing education[ 10 , 11 ], the combined application of the BOPPPS model and scenario-based simulation remains underexplored in the context of OR clinical training. To address this gap, the present study investigates the implementation of an integrated BOPPPS–scenario simulation approach in the OR teaching of nursing interns, with a focus on evaluating its impact on theoretical knowledge acquisition, practical skill development, self-directed learning ability, and teaching satisfaction. Materials and methods Participants This study recruited full-time undergraduate nursing students who participated in OR clinical internships at our hospital from April to July 2024. Inclusion criteria were as follows: (1) Full-time undergraduate nursing students enrolled in an operating room internship during the study period;(2) Had not previously received instruction involving BOPPPS-based teaching methods or scenario-based simulation in surgical nursing education;(3) Provided informed consent and voluntarily participated in the study. Exclusion criteria included failure to complete the entire internship due to personal or medical leave. Participants were divided into two groups based on their internship start dates. The control group comprised 36 students (11 male, 25 female; mean age: 19.72 ± 0.74 years) who began their rotation from April to May 2024. The experimental group included 35 students (6 male, 29 female; mean age: 20.03 ± 0.62 years) who started from June to July 2024. Each group appointed a team leader to coordinate with clinical instructors. There were no statistically significant differences between the two groups in terms of age, gender distribution, or pre-internship academic performance (P > 0.05), indicating comparability. Educational intervention Both groups underwent a 6-week clinical internship based on the national curriculum and competencies required for operating room nursing. The curriculum included both theoretical instruction and technical skills training. To ensure instructional consistency, both groups were supervised by the same teaching faculty—experienced charge nurses with over five years of operating room teaching experience and formal preceptor certification. One lead instructor oversaw overall quality control throughout the teaching process. Teaching method of control group The control group received traditional teaching methods. During the first week, students attended centralized theoretical lectures for the first three days, followed by focused hands-on skills training on day four. Instructors demonstrated basic operating room techniques, which were then observed and practiced by the students. From weeks 2 to 6, instruction followed a progressive sequence based on the complexity of surgical cases: obstetrics (cesarean section), general surgery (thyroidectomy), and gynecology (laparoscopic hysterectomy). Additionally, students attended two 90-minute theory sessions per week, each consisting of: Lecture (45 min) : PowerPoint-based instruction on fundamental topics such as aseptic techniques, instrument management, and workflow. Demonstration (45 min) : Live demonstrations of standard procedures by instructors. Teaching method of experimental group The instructional content for the first week was the same as the control group. From weeks 2 to 6, however, students in the experimental group were taught using the BOPPPS teaching model integrated with scenario-based simulation. Instructional Design In accordance with the clinical internship curriculum, guided by the Operating Room Nursing Practice Guidelines, and tailored to the characteristics of operating room nursing education, the teaching approach was designed based on authentic clinical cases. Each stage of the BOPPPS model—Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment, and Summary—was combined with scenario-based simulation (see Table 1). Total time per simulation session did not exceed 2 hours. Table 2 illustrates the instructional flow using a cesarean section case as an example. Teaching Implementation Bridge-in (B) : Instructors introduced the teaching theme through context-rich clinical scenarios adapted from real cases. The scenarios were designed to match students’ cognitive level and align with their future work tasks, creating opportunities for exploration and critical engagement. Objectives (O) : Learning objectives were clearly defined and encompassed three dimensions: (1) Cognitive —understanding disease processes and nursing protocols; (2) Psychomotor —applying techniques such as surgical hand hygiene, instrument counting, and patient positioning; and (3) Affective —developing empathy, patient-centered care, and professional attitudes. Pre-assessment (P) : In preparation for the upcoming clinical scenario, foundational theoretical concepts and critical nursing issues, including key challenges, were presented to assess students’ existing knowledge, skill levels, and specific learning needs and preferences [ 12 ]. This preliminary assessment provided insights into students’ interests and prior understanding of operating room nursing, enabling educators to tailor subsequent clinical instruction in terms of depth, pacing, and content specificity, thereby optimizing the clarity and effectiveness of learning outcomes. Participatory Learning (P) : High-fidelity simulation was conducted in the actual operating room using authentic instruments, supplies, and medications [ 13 ]. Each group of five students completed simulations under the supervision of two instructors. Students role-played as the surgeon, anesthesiologist, scrub nurse, circulating nurse, and patient. The clinical scenario followed a full surgical pathway, including: patient transfer, positioning, aseptic technique, surgical safety checklist, instrument count, and intraoperative collaboration. All students actively participated and were observed and recorded by instructors. Post-assessment (P) : A five-question quiz was administered after the simulation to assess students’ retention and understanding of operating room nursing concepts. Summary (S) : Instructors facilitated structured reflection and debriefing. Students reviewed key concepts, clarified uncertainties, and received guided feedback. Emphasis was placed on self-reflection and knowledge integration. Instructors encouraged students to verbalize their insights, guided their case analysis, and helped them organize knowledge into logical clinical frameworks to enhance surgical nursing competence. Effectiveness Assessment Theoretical and Practical Examination Scores At the end of the clinical internship, all students underwent a comprehensive assessment. Theoretical knowledge was evaluated using a written examination, designed and administered by the lead clinical instructor, with a total score of 100 points. Practical skills were assessed based on the Fundamentals of Nursing Skills Evaluation Criteria . Students were randomly assigned two out of five potential skill scenarios for the hands-on examination. Evaluation criteria included appearance and professionalism, assessment skills, equipment preparation, procedural accuracy, communication, quality of completion, and knowledge response, with a maximum score of 100 points. Self-Rating Scale of Self-Directed Learning (SRSSDL) Self-directed learning ability was measured using the Self-Rating Scale of Self-Directed Learning (SRSSDL), a validated and reliable instrument designed specifically for nursing students. Originally developed by Williamson[ 14 ], It consists of five dimensions: learning awareness, learning strategies, learning behaviors, learning evaluation, and interpersonal skills. The Cronbach’s α coefficient for the overall scale is 0.967, indicating excellent reliability. The SRSSDL uses a 5-point Likert scale, with a total score ranging from 60 to 300. Scores of 60–140 indicate low self-directed learning ability, 141–220 indicate moderate ability, and 221–300 indicate high ability. Higher scores reflect stronger self-directed learning capacity. Satisfaction Survey The satisfaction questionnaire was developed by the research team and comprised six items. It assessed students’ perceptions of the teaching approach across multiple dimensions, including: (1) whether it helped boost confidence in learning, (2) whether it promoted the development of teamwork skills, (3) whether it enhanced interpersonal communication, (4) whether it stimulated learning interest, (5) whether it improved self-directed learning ability, and (6) whether it strengthened the capacity to integrate and apply knowledge in problem-solving. Responses were rated on a three-point scale: “Satisfied,” “Neutral,” or “Dissatisfied.” The questionnaire was administered to both the control and experimental groups at the end of the internship. A total of 71 questionnaires were distributed and collected, yielding a 100% response rate. Statistical Analysis All statistical analyses were conducted using SPSS version 22.0. Measurement data were expressed as mean ± standard deviation (SD). Two-sample t-tests were used to compare differences between the control and experimental groups. A p-value of less than 0.05 was considered statistically significant. Results Theoretical and Practical Examination Scores At the end of the clinical internship, the experimental group achieved significantly higher scores in both theoretical knowledge and practical skill assessments compared to the control group (Table 3 ). The mean theoretical exam score in the experimental group was 87.03 ± 3.50, versus 81.39 ± 4.96 in the control group (t = − 5.517, p < 0.001). Similarly, the experimental group’s mean practical skill score was 89.37 ± 3.46, notably higher than the control group’s 83.36 ± 5.38 (t = − 5.618, p < 0.001). These findings indicate that students taught with the BOPPPS combined scenario simulation method performed better in both knowledge and hands-on skills assessments than those taught with traditional methods. Table 3 Comparison of theoretical and practical examination scores between the two groups (Mean ± SD) Group n Theoretical examination Practical skills examination Control group 36 81.39 ± 4.96 83.36 ± 5.38 Experimental group 35 87.03 ± 3.50 89.37 ± 3.46 t -value −5.517 −5.618 P -value < 0.001 < 0.001 Note: Significant differences were found between groups in both theoretical and practical examinations (both P < 0.001). Self-Directed Learning Ability The experimental group also demonstrated a significantly greater self-directed learning ability than the control group across all measured dimensions (Table 4 ). In particular, the mean scores for learning awareness , learning strategy , learning behavior , learning evaluation , and interpersonal skills were consistently higher in the experimental group compared to the control group, with each difference reaching statistical significance (all p < 0.001). Specifically, the experimental group scored 43.43 ± 2.72 vs. 41.14 ± 1.38 (learning awareness), 43.77 ± 2.02 vs. 40.53 ± 1.28 (learning strategy), 45.66 ± 3.05 vs. 42.08 ± 1.50 (learning behavior), 44.03 ± 3.13 vs. 39.83 ± 1.88 (learning evaluation), and 45.00 ± 3.19 vs. 40.89 ± 1.88 (interpersonal skills) in comparison to the control group (all p < 0.001 for each paired comparison). Consequently, the total self-directed learning score was significantly higher in the experimental group (221.89 ± 6.57) than in the control group (204.47 ± 3.37, t = − 14.002, p < 0.001). These results reflect an overall enhancement of the students’ self-directed learning capabilities under the BOPPPS combined with scenario simulation teaching approach. Table 4 Comparison of self-directed learning ability scores between the two groups (Mean ± SD) Group n Learning awareness Learning strategies Learning behaviors Learning evaluation Interpersonal skills Total score Control group 36 41.14 ± 1.38 40.53 ± 1.28 42.08 ± 1.50 39.83 ± 1.88 40.89 ± 1.88 204.47 ± 3.37 Experimental group 35 43.43 ± 2.72 43.77 ± 2.02 45.66 ± 3.05 44.03 ± 3.13 45.00 ± 3.19 221.89 ± 6.57 t -value −4.463 −8.076 −6.241 −6.829 −6.593 −14.002 P -value < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 Note: Experimental group scores were significantly higher than control group scores across all dimensions and the total score (all P < 0.001). Student Satisfaction with Teaching Method Student satisfaction survey results showed that the experimental group was markedly more satisfied with the teaching method than the control group on all evaluated items (Table 5 ). Notably, none of the students in the experimental group reported being “dissatisfied” with any aspect of the BOPPPS plus scenario simulation teaching, whereas a few students in the control group indicated dissatisfaction in some areas (with up to 2.8% of control students rating “not satisfied” on certain items). The proportion of students rating each aspect as “satisfactory” was substantially higher in the experimental group, ranging from 85.7–97.1% across the six satisfaction items, compared to 55.5–69.4% in the control group. For example, 85.7% of students in the experimental group were satisfied with the method’s ability to stimulate their interest in learning (versus 69.4% in the control group), and 97.1% were satisfied with how it fostered teamwork (versus 69.4% in the control group). Likewise, 91.4% of the experimental group reported being satisfied with the improvement in problem-solving ability under the new teaching model, compared to 58.3% of the control group. Overall, the experimental cohort reported a significantly higher level of satisfaction with the teaching experience, underscoring the positive reception and perceived benefits of the BOPPPS combined scenario simulation approach. Table 5 Comparison of student satisfaction between the two groups regarding teaching methods [n (%)] Items Control group (n = 36) Experimental group (n = 35) Satisfied Neutral Stimulating interest in learning 25 (69.4) 11 (30.6) Enhancing self-confidence in learning 24 (66.7) 12 (33.3) Improving interpersonal communication skills 22 (61.1) 14 (38.9) Fostering teamwork 25 (69.4) 10 (27.8) Promoting self-directed learning ability 20 (55.5) 15 (41.7) Enhancing ability to integrate knowledge for problem-solving 21 (58.3) 14 (38.9) Discussion Operating room nursing education places strong emphasis on hands-on practice. However, traditional lecture-based “spoon-feeding” teaching—where instructors unilaterally impart knowledge—makes it difficult for students to engage in realistic clinical scenarios. Under conventional methods, students remain passive learners lacking motivation and interest; they often feel fatigued by clinical assessments, which leads to unsatisfactory examination performance [ 15 , 16 ]. Contemporary nursing education paradigms call for integrating clinical practice with theoretical knowledge in training [ 17 – 20 ]. In the present study, the experimental group achieved significantly higher theoretical and practical exam scores than the control group (P < 0.05), indicating that the BOPPPS combined with scenario-based simulation approach effectively enhanced students’ mastery of operating room knowledge and skills. This outcome is consistent with the findings of Wen et al. [ 21 ]. Multiple studies have demonstrated its effectiveness in improving students' theoretical knowledge, practical skills, and self-learning abilities compared to traditional teaching methods[ 3 , 4 , 22 ]. In nursing education, the BOPPPS model has been found to enhance students' examination scores, self-learning ability, and satisfaction with teaching effectiveness [ 4 ]. Grounded in communicative and constructivist learning theory, the BOPPPS approach emphasizes active student participation, interaction, and feedback[ 23 , 24 ]. Through a collaborative, inquiry-driven learning process—where students are the principal actors and instructors serve as guides—this model actively engages students in educational activities. As students complete learning tasks, they consolidate theoretical knowledge and strengthen practical skills, ultimately achieving better learning outcomes. Furthermore, by guiding students to review the simulated clinical scenario and the entire operative process, instructors help them integrate theoretical knowledge with the case details, promoting deeper reflection, problem analysis, and the exploration of effective solutions[ 25 ]. This teaching method not only stimulates students’ interest and reinforces their theoretical understanding, but also significantly improves their clinical practical skills. At the same time, it cultivates teamwork and interpersonal communication abilities, laying a solid foundation for students’ future professional development. Beyond improving academic performance, the BOPPPS combined with scenario simulation strategy also proved beneficial in enhancing students’ self-directed learning ability. During the implementation of this teaching method, instructors introduced actual surgical cases and guided the nursing interns to perform perioperative care simulations in small groups. This approach helped students become familiar with the workflow of surgical nursing collaboration and encouraged them to actively identify and resolve problems during the simulation[ 26 ]. As a result, it effectively improved their understanding of the content, reduced the monotony of the class (compared to traditional lecture-based teaching), and made learning more practical and engaging [ 27 ]. Through scenario-based simulation training, students were able to reinforce their theoretical knowledge[ 28 ] and learn to proactively conduct safety checks during the simulated surgeries, recognizing the importance of the “Time-out” procedure. The instructor’s retrospective debriefing further enabled students to grasp key points of perioperative nursing: preoperative preparation, intraoperative responsibilities, surgical steps, and postoperative transfer and handover. This process helped students realize that every detail of nursing coordination is crucial to the success of an operation[ 29 ]. More importantly, this teaching method markedly improved the students’ self-directed learning ability. Under the dual influence of simulated scenarios and real surgical training, students not only mastered technical operations but also developed the capacity to independently observe changes in patient conditions and analyze potential complications. Unlike the rote memorization of standard nursing procedures, the scenario-driven educational approach encourages students to actively think and problem-solve, thereby enhancing their clinical judgment and adaptability. Scenario simulation effectively integrates theoretical instruction with practical application; it allows students to apply theoretical knowledge to future clinical practice[ 30 ]. Through continuous practice and feedback, learners can organically integrate and apply what they have learned, which in turn strengthens their self-directed learning capability and initiative[ 31 ]. Furthermore, student feedback results (Table 5 ) indicated that the combined BOPPPS and scenario simulation model greatly increased the learners’ satisfaction with the teaching experience. As shown in Table 5 , the experimental group nursing students reported a much higher level of satisfaction with the BOPPPS plus scenario-based simulation teaching compared to the control group. This high satisfaction can be attributed to the unique demands of operating room nursing work. OR practice is highly specialized and requires not only a solid foundation of theoretical knowledge but also strong practical skills from students. When confronted with a heavy and intense workload of scheduled and emergency surgeries, nursing interns often experience the dilemma of having “understood it but not remembered it, and known it but not retained firmly” [ 32 ]. Moreover, the strict requirements, complex procedures, and person-to-person variability in OR teamwork often leave students feeling perplexed and at a loss as to how to begin, placing considerable pressure on their memory and learning and thereby affecting their learning outcomes [ 33 ]. Therefore, clinical teaching in the operating room must be closely tailored to the characteristics of the OR environment, the nature of surgical nursing tasks, and the psychological profile of nursing students. In this study, the interns exposed to clinical scenario simulation showed very high satisfaction, confirming that this method had a positive effect on their learning process. Through the BOPPPS combined with scenario simulation approach, students were able to acquire necessary clinical knowledge and skills in a safe, controlled environment and apply them flexibly in real clinical situations[ 11 ]. This teaching strategy not only increased the students’ satisfaction and confidence in learning, but also effectively alleviated the anxiety and negative emotions that can arise during the learning process[ 10 , 11 , 34 ] . Conclusion The BOPPPS teaching model is a student-centered, instructor-facilitated interactive educational approach that emphasizes clear learning objectives and active student participation. When combined with scenario-based simulation, this method fosters deep engagement and interactive classroom discussions, facilitating students’ internalization of knowledge. Through scenario-based simulation, nursing interns are immersed in realistic or near-realistic clinical situations, thereby encouraging independent thinking and clinical decision-making. This integrated approach significantly enhances critical thinking, teamwork, and clinical reasoning capabilities among nursing students. Therefore, the combined BOPPPS and scenario simulation approach provides valuable insights and practical guidance for clinical teaching in the operating room and can be effectively applied in other specialized nursing internships as well. Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethical considerations All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Declaration of Helsinki and its later amendments. This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (Approval No. 2025-322-01). All participants provided written informed consent prior to participation. Participation in the study had no impact on students’ academic evaluation, and all data were collected anonymously. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author Contribution Q.X. conceived the study, conducted the research, and wrote the main manuscript. Z.X. was responsible for the preparation of tables and figures. C.Z. provided academic guidance and critical revisions. All authors reviewed and approved the final version of the manuscript. References Totur Dikmen B, Bayraktar N. Nursing students’ experiences related to operating room practice: A qualitative study. J Perianesth Nurs. 2021;36:59–64. Goliat L, Logterman FAM, Speziale C, DeSapri A, Sharpnack PA. 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Ma X, Zeng D, Wang J, Xu K, Li L. Effectiveness of bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary teaching strategy in Chinese medical education: A systematic review and meta-analysis. Front Med. 2022;9:975229. Tables Tables 1 and 5 are available in the Supplementary Files section. Table 2. BOPPPS combined with scenario-based simulation teaching procedure in the context of cesarean section nursing BOPPPS Phase Objective Teaching Content Bridge-in (B) Introduce clinical scenarios and current topics to stimulate nursing students’ interest. Clinical case scenario: Mrs. Zhang, 38 weeks pregnant, aged 35 years, height 160 cm, weight 78 kg; diagnosis: gravida 2 para 1, scarred uterus, premature rupture of membranes, marginal placenta previa; immediate emergency cesarean section required. Objective (O) Present multidimensional learning objectives clearly to help students understand their specific learning tasks. (1) Knowledge objectives: Master the cesarean section procedure and effectively assist during surgery. (2) Skill objectives: Accurately perform surgical safety checks, position patients appropriately for surgery, follow principles of instrument counting, and maintain strict aseptic techniques (surgical hand disinfection, gowning and gloving, preparation of sterile instrument tables). (3) Affective objectives: Demonstrate active patient care, alleviate patient anxiety, and maintain patient privacy during the procedure. Pre-assessment (P) Assess students’ existing knowledge base and skills. (1) Basic knowledge: Definition and classification of placenta previa? (2) Nursing skills: Preparation of instruments and materials required for cesarean section? (3) Psychological nursing: Strategies to alleviate patients’ preoperative anxiety and stress? Participatory learning (P) Enhance student engagement and motivation through immersive scenario-based simulations, promoting active participation. (1) Environmental preparation: i) Activate operating room laminar airflow system, regulate room temperature; ii) Prepare suction devices. (2) Material preparation: i) Sterile packages (including cesarean instrument set, small basin, sterile surgical gowns, cesarean dressing pack), disposable sterile gloves, size 21 scalpel blade, sterile surgical film, suction tubing, size 12 urinary catheter, 5 ml syringe, intrauterine gauze (standby). ii) Non-sterile materials: IV cannulation and catheterization equipment. iii) Medications: Oxytocin 20U. (3) Procedure details: Preoperative phase: i) Patient transfer and identification check; ii) IV access establishment, safety checks before and after anesthesia, patient positioning after anesthesia. Intraoperative phase: i) Sterile technique (surgical hand disinfection, gowning, gloving); ii) Prepare sterile instrument table; iii) Perform instrument counting accurately and timely; iv) Surgical site disinfection and sterile draping; v) Connect suction apparatus; vi) Perform “time-out” surgical safety checks before incision; vii) Monitor procedure progress actively and assist appropriately. Postoperative phase: i) Ensure patient’s dignified appearance; ii) Safely transfer patient from operating table to stretcher; iii) Perform final safety checks; iv) Postoperative disposal of medical waste, sharps, and instruments; v) Patient transfer and handover. Post-assessment (P) Evaluate whether students have met the expected clinical learning outcomes. (1) At what specific time points should surgical safety checks be performed? (2) Principles and timing of instrument counting? (3) Timing and role of oxytocin administration during surgery? (4) Categories of medical waste disposal? (5) Management strategies for massive intraoperative hemorrhage? Summary (S) Reinforce learning by reviewing key and challenging content areas with students. (1) Guided student feedback: i) What aspects were performed well during the scenario simulation? ii) What areas need improvement? iii) What were your considerations during patient positioning? (2) Review cesarean nursing process systematically: proper patient assessment, identification of primary nursing diagnoses, individualized nursing care planning, implementation of nursing interventions, and evaluation of nursing outcomes. (3) Encourage students to use mind maps to organize acquired knowledge and skills, creating a standardized nursing workflow for cesarean section patients. Table 3 Comparison of theoretical and practical examination scores between the two groups (Mean ± SD) Group n Theoretical examination Practical skills examination Control group 36 81.39 ± 4.96 83.36 ± 5.38 Experimental group 35 87.03 ± 3.50 89.37 ± 3.46 t -value −5.517 −5.618 P -value <0.001 <0.001 Note: Significant differences were found between groups in both theoretical and practical examinations (both P < 0.001). Table 4 Comparison of self-directed learning ability scores between the two groups (Mean ± SD) Group n Learning awareness Learning strategies Learning behaviors Learning evaluation Interpersonal skills Total score Control group 36 41.14 ± 1.38 40.53 ± 1.28 42.08 ± 1.50 39.83 ± 1.88 40.89 ± 1.88 204.47 ± 3.37 Experimental group 35 43.43 ± 2.72 43.77 ± 2.02 45.66 ± 3.05 44.03 ± 3.13 45.00 ± 3.19 221.89 ± 6.57 t -value −4.463 −8.076 −6.241 −6.829 −6.593 −14.002 P -value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 Note: Experimental group scores were significantly higher than control group scores across all dimensions and the total score (all P < 0.001). Additional Declarations No competing interests reported. Supplementary Files Table1StepsoftheBOPPPSteachingmodelcombinedwithscenario.docx Table5Comparisonofstudentsatisfactionbetweenthetwogroupsregardingteachingmethods.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 30 Jul, 2025 Editor invited by journal 23 Jun, 2025 Editor assigned by journal 20 Jun, 2025 Submission checks completed at journal 20 Jun, 2025 First submitted to journal 16 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6909666","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494386042,"identity":"c425a6e8-cb19-493e-add9-f8983af9c0d8","order_by":0,"name":"Qing Xu¹","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Xu¹","suffix":""},{"id":494386045,"identity":"a505b1e8-fc76-430c-a0b2-f125e0640265","order_by":1,"name":"ZhongYu Xiong¹","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"ZhongYu","middleName":"","lastName":"Xiong¹","suffix":""},{"id":494386047,"identity":"04175f2c-a21a-48b5-8753-4575ffea5466","order_by":2,"name":"ChangYan Zhong¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYBACfobDBww/VEjI8ROtRbLxWEKxxBkLY8kGYrUYHD5j8IG3rSJxwwGirTl2LHGDxBmJxM3Hkzcw/KjYRlgHY8/hwwYFFRLG2848K2DsOXObsBZmiWNpBkBbZLfdyDFgZmwjQgub/BvzH7xtEoybZxCrhYfhjIEBUIviBglitUgwHEswBjoMiJ8VHCTKL/YHwFFZJ8ffnrzxwY8KIrQggQSDAySpB2shVccoGAWjYBSMEAAAXV1C1OeoJRUAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":true,"prefix":"","firstName":"ChangYan","middleName":"","lastName":"Zhong¹","suffix":""}],"badges":[],"createdAt":"2025-06-17 02:53:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6909666/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6909666/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88259304,"identity":"3031a920-a6a0-4181-9631-1944e9a4b96d","added_by":"auto","created_at":"2025-08-04 15:06:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1164692,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6909666/v1/407f0e98-67b5-465e-b782-73b98658882e.pdf"},{"id":88257740,"identity":"54c72fdb-7f7a-4032-9bfb-e3da59c42a26","added_by":"auto","created_at":"2025-08-04 14:42:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2791870,"visible":true,"origin":"","legend":"","description":"","filename":"Table1StepsoftheBOPPPSteachingmodelcombinedwithscenario.docx","url":"https://assets-eu.researchsquare.com/files/rs-6909666/v1/e8c2631aee1d273d5d834cc2.docx"},{"id":88257946,"identity":"6fcc59a8-0496-4849-9d1d-f590541b93cc","added_by":"auto","created_at":"2025-08-04 14:50:47","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15926,"visible":true,"origin":"","legend":"","description":"","filename":"Table5Comparisonofstudentsatisfactionbetweenthetwogroupsregardingteachingmethods.docx","url":"https://assets-eu.researchsquare.com/files/rs-6909666/v1/1466647beea112e1fb6ae4f9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluation of the Effectiveness of BOPPPS Combined with Scenario-Based Simulation in the Clinical Teaching of Operating Room Nursing Interns\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eClinical practice in the operating room (OR) is a crucial component of undergraduate nursing education, serving as an essential stage for developing hands-on skills and professional competence[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Unlike general ward placements, OR internships require student nurses to quickly adapt to highly specialized procedures and multiple clinical roles[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Traditional teaching methods often place students in passive learning positions, hindering their ability to engage effectively in clinical scenarios, which may negatively affect the overall internship outcome.\u003c/p\u003e\u003cp\u003eThe BOPPPS (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment, Summary) model is a student-centered teaching approach that has shown significant advantages over traditional instructional methods in various educational contexts. Studies have demonstrated its effectiveness in improving students' theoretical knowledge, practical skills, and self-learning abilities in fields such as thoracic surgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and nursing education[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The model enhances student engagement, critical thinking, and academic achievement [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In thoracic surgery education, BOPPPS led to higher examination scores and improved student satisfaction, interaction, and analytical abilities compared to traditional approaches[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A meta-analysis of nursing education studies revealed that BOPPPS significantly improved theoretical scores, practical scores, self-learning ability, and student satisfaction with teaching effectiveness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These findings suggest that the BOPPPS model is a valuable framework for enhancing teaching effectiveness across various disciplines.\u003c/p\u003e\u003cp\u003eScenario-based simulation has emerged as an effective pedagogical strategy in nursing education, enhancing students' clinical competence, critical thinking, and decision-making abilities. Multiple studies have demonstrated the positive impact of simulation on nursing students' skills. Sullivan-Mann et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]found that increased exposure to simulation scenarios significantly improved critical thinking scores. Similarly, G\u0026ouml;r\u0026uuml;c\u0026uuml; et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] conducted a meta-analysis revealing that simulation-based education enhances clinical decision-making skills in undergraduate nursing students. Wong et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]identified specific pedagogical approaches for simulation-based learning, emphasizing the importance of assigned roles and structured phases to enhance clinical competence. Woda et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] compared different cohorts and found that supplementary simulation, in addition to traditional clinical experiences, led to better patient assessments. These findings collectively support the use of simulation as a valuable tool in nursing education, providing students with immersive experiences that bridge theoretical knowledge and practical skills.\u003c/p\u003e\u003cp\u003eAlthough multimodal teaching strategies have been increasingly adopted in nursing education[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], the combined application of the BOPPPS model and scenario-based simulation remains underexplored in the context of OR clinical training. To address this gap, the present study investigates the implementation of an integrated BOPPPS\u0026ndash;scenario simulation approach in the OR teaching of nursing interns, with a focus on evaluating its impact on theoretical knowledge acquisition, practical skill development, self-directed learning ability, and teaching satisfaction.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThis study recruited full-time undergraduate nursing students who participated in OR clinical internships at our hospital from April to July 2024.\u003c/p\u003e\u003cp\u003eInclusion criteria were as follows: (1) Full-time undergraduate nursing students enrolled in an operating room internship during the study period;(2) Had not previously received instruction involving BOPPPS-based teaching methods or scenario-based simulation in surgical nursing education;(3) Provided informed consent and voluntarily participated in the study.\u003c/p\u003e\u003cp\u003e Exclusion criteria included failure to complete the entire internship due to personal or medical leave.\u003c/p\u003e\u003cp\u003eParticipants were divided into two groups based on their internship start dates. The control group comprised 36 students (11 male, 25 female; mean age: 19.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74 years) who began their rotation from April to May 2024. The experimental group included 35 students (6 male, 29 female; mean age: 20.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 years) who started from June to July 2024. Each group appointed a team leader to coordinate with clinical instructors. There were no statistically significant differences between the two groups in terms of age, gender distribution, or pre-internship academic performance (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating comparability.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEducational intervention\u003c/h3\u003e\n\u003cp\u003eBoth groups underwent a 6-week clinical internship based on the national curriculum and competencies required for operating room nursing. The curriculum included both theoretical instruction and technical skills training. To ensure instructional consistency, both groups were supervised by the same teaching faculty\u0026mdash;experienced charge nurses with over five years of operating room teaching experience and formal preceptor certification. One lead instructor oversaw overall quality control throughout the teaching process.\u003c/p\u003e\n\u003ch3\u003eTeaching method of control group\u003c/h3\u003e\n\u003cp\u003eThe control group received traditional teaching methods. During the first week, students attended centralized theoretical lectures for the first three days, followed by focused hands-on skills training on day four. Instructors demonstrated basic operating room techniques, which were then observed and practiced by the students. From weeks 2 to 6, instruction followed a progressive sequence based on the complexity of surgical cases: obstetrics (cesarean section), general surgery (thyroidectomy), and gynecology (laparoscopic hysterectomy).\u003c/p\u003e\u003cp\u003eAdditionally, students attended two 90-minute theory sessions per week, each consisting of:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eLecture (45 min)\u003c/b\u003e: PowerPoint-based instruction on fundamental topics such as aseptic techniques, instrument management, and workflow.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eDemonstration (45 min)\u003c/b\u003e: Live demonstrations of standard procedures by instructors.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eTeaching method of experimental group\u003c/h3\u003e\n\u003cp\u003eThe instructional content for the first week was the same as the control group. From weeks 2 to 6, however, students in the experimental group were taught using the BOPPPS teaching model integrated with scenario-based simulation.\u003c/p\u003e\n\u003ch3\u003eInstructional Design\u003c/h3\u003e\n\u003cp\u003e In accordance with the clinical internship curriculum, guided by the Operating Room Nursing Practice Guidelines, and tailored to the characteristics of operating room nursing education, the teaching approach was designed based on authentic clinical cases. Each stage of the BOPPPS model\u0026mdash;Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment, and Summary\u0026mdash;was combined with scenario-based simulation (see Table\u0026nbsp;1). Total time per simulation session did not exceed 2 hours. Table\u0026nbsp;2 illustrates the instructional flow using a cesarean section case as an example.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eTeaching Implementation\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eBridge-in (B)\u003c/b\u003e: Instructors introduced the teaching theme through context-rich clinical scenarios adapted from real cases. The scenarios were designed to match students\u0026rsquo; cognitive level and align with their future work tasks, creating opportunities for exploration and critical engagement.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eObjectives (O)\u003c/b\u003e: Learning objectives were clearly defined and encompassed three dimensions: (1) \u003cb\u003eCognitive\u003c/b\u003e\u0026mdash;understanding disease processes and nursing protocols; (2) \u003cb\u003ePsychomotor\u003c/b\u003e\u0026mdash;applying techniques such as surgical hand hygiene, instrument counting, and patient positioning; and (3) \u003cb\u003eAffective\u003c/b\u003e\u0026mdash;developing empathy, patient-centered care, and professional attitudes.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePre-assessment (P)\u003c/b\u003e: In preparation for the upcoming clinical scenario, foundational theoretical concepts and critical nursing issues, including key challenges, were presented to assess students\u0026rsquo; existing knowledge, skill levels, and specific learning needs and preferences [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This preliminary assessment provided insights into students\u0026rsquo; interests and prior understanding of operating room nursing, enabling educators to tailor subsequent clinical instruction in terms of depth, pacing, and content specificity, thereby optimizing the clarity and effectiveness of learning outcomes.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eParticipatory Learning (P)\u003c/b\u003e: High-fidelity simulation was conducted in the actual operating room using authentic instruments, supplies, and medications [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Each group of five students completed simulations under the supervision of two instructors. Students role-played as the surgeon, anesthesiologist, scrub nurse, circulating nurse, and patient. The clinical scenario followed a full surgical pathway, including: patient transfer, positioning, aseptic technique, surgical safety checklist, instrument count, and intraoperative collaboration. All students actively participated and were observed and recorded by instructors.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePost-assessment (P)\u003c/b\u003e: A five-question quiz was administered after the simulation to assess students\u0026rsquo; retention and understanding of operating room nursing concepts.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSummary (S)\u003c/b\u003e: Instructors facilitated structured reflection and debriefing. Students reviewed key concepts, clarified uncertainties, and received guided feedback. Emphasis was placed on self-reflection and knowledge integration. Instructors encouraged students to verbalize their insights, guided their case analysis, and helped them organize knowledge into logical clinical frameworks to enhance surgical nursing competence.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEffectiveness Assessment\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eTheoretical and Practical Examination Scores\u003c/h2\u003e\u003cp\u003eAt the end of the clinical internship, all students underwent a comprehensive assessment. Theoretical knowledge was evaluated using a written examination, designed and administered by the lead clinical instructor, with a total score of 100 points.\u003c/p\u003e\u003cp\u003ePractical skills were assessed based on the \u003cem\u003eFundamentals of Nursing Skills Evaluation Criteria\u003c/em\u003e. Students were randomly assigned two out of five potential skill scenarios for the hands-on examination. Evaluation criteria included appearance and professionalism, assessment skills, equipment preparation, procedural accuracy, communication, quality of completion, and knowledge response, with a maximum score of 100 points.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSelf-Rating Scale of Self-Directed Learning (SRSSDL)\u003c/h2\u003e\u003cp\u003eSelf-directed learning ability was measured using the Self-Rating Scale of Self-Directed Learning (SRSSDL), a validated and reliable instrument designed specifically for nursing students. Originally developed by Williamson[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], It consists of five dimensions: learning awareness, learning strategies, learning behaviors, learning evaluation, and interpersonal skills. The Cronbach\u0026rsquo;s α coefficient for the overall scale is 0.967, indicating excellent reliability.\u003c/p\u003e\u003cp\u003eThe SRSSDL uses a 5-point Likert scale, with a total score ranging from 60 to 300. Scores of 60\u0026ndash;140 indicate low self-directed learning ability, 141\u0026ndash;220 indicate moderate ability, and 221\u0026ndash;300 indicate high ability. Higher scores reflect stronger self-directed learning capacity.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSatisfaction Survey\u003c/h2\u003e\u003cp\u003eThe satisfaction questionnaire was developed by the research team and comprised six items. It assessed students\u0026rsquo; perceptions of the teaching approach across multiple dimensions, including:\u003c/p\u003e\u003cp\u003e(1) whether it helped boost confidence in learning,\u003c/p\u003e\u003cp\u003e(2) whether it promoted the development of teamwork skills,\u003c/p\u003e\u003cp\u003e(3) whether it enhanced interpersonal communication,\u003c/p\u003e\u003cp\u003e(4) whether it stimulated learning interest,\u003c/p\u003e\u003cp\u003e(5) whether it improved self-directed learning ability, and\u003c/p\u003e\u003cp\u003e(6) whether it strengthened the capacity to integrate and apply knowledge in problem-solving.\u003c/p\u003e\u003cp\u003eResponses were rated on a three-point scale: \u0026ldquo;Satisfied,\u0026rdquo; \u0026ldquo;Neutral,\u0026rdquo; or \u0026ldquo;Dissatisfied.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThe questionnaire was administered to both the control and experimental groups at the end of the internship. A total of 71 questionnaires were distributed and collected, yielding a 100% response rate.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were conducted using SPSS version 22.0. Measurement data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Two-sample t-tests were used to compare differences between the control and experimental groups. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eTheoretical and Practical Examination Scores\u003c/h2\u003e\u003cp\u003eAt the end of the clinical internship, the experimental group achieved significantly higher scores in both theoretical knowledge and practical skill assessments compared to the control group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The mean theoretical exam score in the experimental group was 87.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50, versus 81.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96 in the control group (t = \u0026minus;\u0026thinsp;5.517, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, the experimental group\u0026rsquo;s mean practical skill score was 89.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46, notably higher than the control group\u0026rsquo;s 83.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38 (t = \u0026minus;\u0026thinsp;5.618, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings indicate that students taught with the BOPPPS combined scenario simulation method performed better in both knowledge and hands-on skills assessments than those taught with traditional methods.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of theoretical and practical examination scores between the two groups (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTheoretical examination\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePractical skills examination\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e83.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExperimental group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e89.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;5.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;5.618\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: Significant differences were found between groups in both theoretical and practical examinations (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSelf-Directed Learning Ability\u003c/h2\u003e\u003cp\u003eThe experimental group also demonstrated a significantly greater self-directed learning ability than the control group across all measured dimensions (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In particular, the mean scores for \u003cb\u003elearning awareness\u003c/b\u003e, \u003cb\u003elearning strategy\u003c/b\u003e, \u003cb\u003elearning behavior\u003c/b\u003e, \u003cb\u003elearning evaluation\u003c/b\u003e, and \u003cb\u003einterpersonal skills\u003c/b\u003e were consistently higher in the experimental group compared to the control group, with each difference reaching statistical significance (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Specifically, the experimental group scored \u003cb\u003e43.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/b\u003e vs. \u003cb\u003e41.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/b\u003e (learning awareness), \u003cb\u003e43.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/b\u003e vs. \u003cb\u003e40.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/b\u003e (learning strategy), \u003cb\u003e45.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003c/b\u003e vs. \u003cb\u003e42.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/b\u003e (learning behavior), \u003cb\u003e44.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/b\u003e vs. \u003cb\u003e39.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/b\u003e (learning evaluation), and \u003cb\u003e45.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/b\u003e vs. \u003cb\u003e40.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/b\u003e (interpersonal skills) in comparison to the control group (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for each paired comparison). Consequently, the \u003cb\u003etotal self-directed learning score\u003c/b\u003e was significantly higher in the experimental group (221.89\u0026thinsp;\u0026plusmn;\u0026thinsp;6.57) than in the control group (204.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37, t = \u0026minus;\u0026thinsp;14.002, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results reflect an overall enhancement of the students\u0026rsquo; self-directed learning capabilities under the BOPPPS combined with scenario simulation teaching approach.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of self-directed learning ability scores between the two groups (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLearning awareness\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLearning strategies\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLearning behaviors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLearning evaluation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eInterpersonal skills\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTotal score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e204.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExperimental group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e44.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e221.89\u0026thinsp;\u0026plusmn;\u0026thinsp;6.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;4.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;8.076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;6.241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;6.829\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;6.593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;14.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: Experimental group scores were significantly higher than control group scores across all dimensions and the total score (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eStudent Satisfaction with Teaching Method\u003c/h2\u003e\u003cp\u003eStudent satisfaction survey results showed that the experimental group was markedly more satisfied with the teaching method than the control group on all evaluated items (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Notably, none of the students in the experimental group reported being \u0026ldquo;dissatisfied\u0026rdquo; with any aspect of the BOPPPS plus scenario simulation teaching, whereas a few students in the control group indicated dissatisfaction in some areas (with up to 2.8% of control students rating \u0026ldquo;not satisfied\u0026rdquo; on certain items). The proportion of students rating each aspect as \u0026ldquo;satisfactory\u0026rdquo; was substantially higher in the experimental group, ranging from \u003cb\u003e85.7\u0026ndash;97.1%\u003c/b\u003e across the six satisfaction items, compared to \u003cb\u003e55.5\u0026ndash;69.4%\u003c/b\u003e in the control group. For example, \u003cb\u003e85.7%\u003c/b\u003e of students in the experimental group were satisfied with the method\u0026rsquo;s ability to stimulate their interest in learning (versus \u003cb\u003e69.4%\u003c/b\u003e in the control group), and \u003cb\u003e97.1%\u003c/b\u003e were satisfied with how it fostered teamwork (versus \u003cb\u003e69.4%\u003c/b\u003e in the control group). Likewise, \u003cb\u003e91.4%\u003c/b\u003e of the experimental group reported being satisfied with the improvement in problem-solving ability under the new teaching model, compared to \u003cb\u003e58.3%\u003c/b\u003e of the control group. Overall, the experimental cohort reported a significantly higher level of satisfaction with the teaching experience, underscoring the positive reception and perceived benefits of the BOPPPS combined scenario simulation approach.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of student satisfaction between the two groups regarding teaching methods [n (%)]\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperimental group (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSatisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStimulating interest in learning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (69.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11 (30.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnhancing self-confidence in learning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (66.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImproving interpersonal communication skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (61.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14 (38.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFostering teamwork\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabi\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (69.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (27.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePromoting self-directed learning ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabj\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (55.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabk\" border=\"1\"\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15 (41.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnhancing ability to integrate knowledge for problem-solving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabl\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (58.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabm\" border=\"1\"\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14 (38.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003c/p\u003e\u003cp\u003eOperating room nursing education places strong emphasis on hands-on practice. However, traditional lecture-based \u0026ldquo;spoon-feeding\u0026rdquo; teaching\u0026mdash;where instructors unilaterally impart knowledge\u0026mdash;makes it difficult for students to engage in realistic clinical scenarios. Under conventional methods, students remain passive learners lacking motivation and interest; they often feel fatigued by clinical assessments, which leads to unsatisfactory examination performance [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Contemporary nursing education paradigms call for integrating clinical practice with theoretical knowledge in training [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In the present study, the experimental group achieved significantly higher theoretical and practical exam scores than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that the BOPPPS combined with scenario-based simulation approach effectively enhanced students\u0026rsquo; mastery of operating room knowledge and skills. This outcome is consistent with the findings of Wen et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Multiple studies have demonstrated its effectiveness in improving students' theoretical knowledge, practical skills, and self-learning abilities compared to traditional teaching methods[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In nursing education, the BOPPPS model has been found to enhance students' examination scores, self-learning ability, and satisfaction with teaching effectiveness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Grounded in communicative and constructivist learning theory, the BOPPPS approach emphasizes active student participation, interaction, and feedback[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Through a collaborative, inquiry-driven learning process\u0026mdash;where students are the principal actors and instructors serve as guides\u0026mdash;this model actively engages students in educational activities. As students complete learning tasks, they consolidate theoretical knowledge and strengthen practical skills, ultimately achieving better learning outcomes. Furthermore, by guiding students to review the simulated clinical scenario and the entire operative process, instructors help them integrate theoretical knowledge with the case details, promoting deeper reflection, problem analysis, and the exploration of effective solutions[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This teaching method not only stimulates students\u0026rsquo; interest and reinforces their theoretical understanding, but also significantly improves their clinical practical skills. At the same time, it cultivates teamwork and interpersonal communication abilities, laying a solid foundation for students\u0026rsquo; future professional development.\u003c/p\u003e\u003cp\u003eBeyond improving academic performance, the BOPPPS combined with scenario simulation strategy also proved beneficial in enhancing students\u0026rsquo; self-directed learning ability. During the implementation of this teaching method, instructors introduced actual surgical cases and guided the nursing interns to perform perioperative care simulations in small groups. This approach helped students become familiar with the workflow of surgical nursing collaboration and encouraged them to actively identify and resolve problems during the simulation[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. As a result, it effectively improved their understanding of the content, reduced the monotony of the class (compared to traditional lecture-based teaching), and made learning more practical and engaging [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Through scenario-based simulation training, students were able to reinforce their theoretical knowledge[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and learn to proactively conduct safety checks during the simulated surgeries, recognizing the importance of the \u0026ldquo;Time-out\u0026rdquo; procedure. The instructor\u0026rsquo;s retrospective debriefing further enabled students to grasp key points of perioperative nursing: preoperative preparation, intraoperative responsibilities, surgical steps, and postoperative transfer and handover. This process helped students realize that every detail of nursing coordination is crucial to the success of an operation[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. More importantly, this teaching method markedly improved the students\u0026rsquo; self-directed learning ability. Under the dual influence of simulated scenarios and real surgical training, students not only mastered technical operations but also developed the capacity to independently observe changes in patient conditions and analyze potential complications. Unlike the rote memorization of standard nursing procedures, the scenario-driven educational approach encourages students to actively think and problem-solve, thereby enhancing their clinical judgment and adaptability. Scenario simulation effectively integrates theoretical instruction with practical application; it allows students to apply theoretical knowledge to future clinical practice[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Through continuous practice and feedback, learners can organically integrate and apply what they have learned, which in turn strengthens their self-directed learning capability and initiative[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, student feedback results (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e5\u003c/span\u003e) indicated that the combined BOPPPS and scenario simulation model greatly increased the learners\u0026rsquo; satisfaction with the teaching experience. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the experimental group nursing students reported a much higher level of satisfaction with the BOPPPS plus scenario-based simulation teaching compared to the control group. This high satisfaction can be attributed to the unique demands of operating room nursing work. OR practice is highly specialized and requires not only a solid foundation of theoretical knowledge but also strong practical skills from students. When confronted with a heavy and intense workload of scheduled and emergency surgeries, nursing interns often experience the dilemma of having \u0026ldquo;understood it but not remembered it, and known it but not retained firmly\u0026rdquo; [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Moreover, the strict requirements, complex procedures, and person-to-person variability in OR teamwork often leave students feeling perplexed and at a loss as to how to begin, placing considerable pressure on their memory and learning and thereby affecting their learning outcomes [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Therefore, clinical teaching in the operating room must be closely tailored to the characteristics of the OR environment, the nature of surgical nursing tasks, and the psychological profile of nursing students. In this study, the interns exposed to clinical scenario simulation showed very high satisfaction, confirming that this method had a positive effect on their learning process. Through the BOPPPS combined with scenario simulation approach, students were able to acquire necessary clinical knowledge and skills in a safe, controlled environment and apply them flexibly in real clinical situations[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This teaching strategy not only increased the students\u0026rsquo; satisfaction and confidence in learning, but also effectively alleviated the anxiety and negative emotions that can arise during the learning process[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] .\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe BOPPPS teaching model is a student-centered, instructor-facilitated interactive educational approach that emphasizes clear learning objectives and active student participation. When combined with scenario-based simulation, this method fosters deep engagement and interactive classroom discussions, facilitating students\u0026rsquo; internalization of knowledge. Through scenario-based simulation, nursing interns are immersed in realistic or near-realistic clinical situations, thereby encouraging independent thinking and clinical decision-making. This integrated approach significantly enhances critical thinking, teamwork, and clinical reasoning capabilities among nursing students. Therefore, the combined BOPPPS and scenario simulation approach provides valuable insights and practical guidance for clinical teaching in the operating room and can be effectively applied in other specialized nursing internships as well.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eEthical considerations\u003c/h2\u003e\n\u003cp\u003eAll procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Declaration of Helsinki and its later amendments. This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (Approval No. 2025-322-01). All participants provided written informed consent prior to participation. Participation in the study had no impact on students\u0026rsquo; academic evaluation, and all data were collected anonymously.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eQ.X. conceived the study, conducted the research, and wrote the main manuscript. Z.X. was responsible for the preparation of tables and figures. C.Z. provided academic guidance and critical revisions. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eTotur Dikmen B, Bayraktar N. Nursing students\u0026rsquo; experiences related to operating room practice: A qualitative study. J Perianesth Nurs. 2021;36:59\u0026ndash;64.\u003c/li\u003e\n \u003cli\u003eGoliat L, Logterman FAM, Speziale C, DeSapri A, Sharpnack PA. Partnerships, succession, and student engagement: A perioperative immersion program. J Radiol Nurs. 2021;40:364\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eHu K, Ma R-J, Ma C, Zheng Q-K, Sun Z-G. Comparison of the BOPPPS model and traditional instructional approaches in thoracic surgery education. BMC Med Educ. 2022;22:447.\u003c/li\u003e\n \u003cli\u003eLi Y, Li X, Liu Y, Li Y. Application effect of BOPPPS teaching model on fundamentals of nursing education: A meta-analysis of randomized controlled studies. Front Med. 2024;11:1319711.\u003c/li\u003e\n \u003cli\u003eWang Z. Application of the BOPPPS model in college English teaching: Promoting the integration and innovation of english discipline core literacy and strategies. Int J Acad Res Progress Educ Dev. 2024;13:Pages 3256-3260.\u003c/li\u003e\n \u003cli\u003eSullivan-Mann J, Perron CA, Fellner AN. The effects of simulation on nursing students\u0026rsquo; critical thinking scores: A quantitative study. Newborn Infant Nurs Rev. 2009;9:111\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eG\u0026ouml;r\u0026uuml;c\u0026uuml; S, T\u0026uuml;rk G, Kara\u0026ccedil;am Z. The effect of simulation-based learning on nursing students\u0026rsquo; clinical decision-making skills: Systematic review and meta-analysis. Nurse Educ Today. 2024;140:106270.\u003c/li\u003e\n \u003cli\u003eWong SL, Wu CST, Suen LKP. Pedagogical strategies with simulation technology to enhance clinical competence in nursing education. In: Li KC, Tsang EYM, Wong BTM, editors. Innovating Education in Technology-supported Environments. Singapore: Springer Nature Singapore; 2020. p. 301\u0026ndash;17.\u003c/li\u003e\n \u003cli\u003eWoda A, Schnable T, Alt-Gehrman P, Bratt MM, Garnier-Villarreal M. Innovation in clinical course delivery and impact on students\u0026rsquo; clinical decision-making and competence. Nurs Educ Perspect. 2019;40:241\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eChen X, Li B, Wang L, Zhang C, Xiu L. Application of BOPPPS combined with dynamic scenarios simulation in ICU clinical nursing teaching. Chin J Integr Nurs. 2022;8:309\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003eLiu Y, Lian X, Chen X, Zeng M, Yin Y, Lin J. Practical exploration of BOPPPS model combined with situational teaching method in clinical training of intensive medicine: Novel pedagogy and perception. Front Med. 2024;11:1442099.\u003c/li\u003e\n \u003cli\u003eFan D, Wang C, Qin X, Qiu S, Xu Y, Wang Y, et al. Evaluation of the BOPPPS model on otolaryngologic education for five-year undergraduates. BMC Med Educ. 2024;24:860.\u003c/li\u003e\n \u003cli\u003eGuerrero JG, Hafiz AH, Eltohamy NAE, Gomma N, Jarrah IA. Repeated exposure to high-fidelity simulation and nursing interns\u0026rsquo; clinical performance: Impact on practice readiness. Clin Simul Nurs. 2021;60:18\u0026ndash;24.\u003c/li\u003e\n \u003cli\u003eWilliamson SN. Development of a self-rating scale of self-directed learning. Nurse Res. 2007;14:66\u0026ndash;83.\u003c/li\u003e\n \u003cli\u003eHan SP, Wang X, Kiruparan P, Loo YH, Khoo S, Cleland J, et al. Preparation for practice: what are students learning for? Clin Teach. 2024;21:e13796.\u003c/li\u003e\n \u003cli\u003eKusurkar RA, Orsini C, Somra S, Artino AR, Daelmans HEM, Schoonmade LJ, et al. The effect of assessments on student motivation for learning and its outcomes in health professions education: a review and realist synthesis. Acad Med. 2023;98:1083\u0026ndash;92.\u003c/li\u003e\n \u003cli\u003eBerndtsson I, Dahlborg E, Pennbrant S. Work-integrated learning as a pedagogical tool to integrate theory and practice in nursing education \u0026ndash; an integrative literature review. Nurse Educ Pract. 2020;42:102685.\u003c/li\u003e\n \u003cli\u003eByrne M, Root S, Culbertson L. Integrating perioperative content in nursing curricula: A case study approach. AORN J. 2016;103:597\u0026ndash;604.\u003c/li\u003e\n \u003cli\u003eG\u0026uuml;nay U, Kılın\u0026ccedil; G. The transfer of theoretical knowledge to clinical practice by nursing students and the difficulties they experience: a qualitative study. Nurse Educ Today. 2018;65:81\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003ePaunović V. Healthcare from the classroom to clinical practice. Ann Nurs. 2023. https://doi.org/10.58424/annnurs.xmp.6jk.cy8.\u003c/li\u003e\n \u003cli\u003eWen H, Xu W, Chen F, Jiang X, Zhang R, Zeng J, et al. Application of the BOPPPS-CBL model in electrocardiogram teaching for nursing students: A randomized comparison. BMC Med Educ. 2023;23:987.\u003c/li\u003e\n \u003cli\u003eShen Y. The application of the BOPPPS model in the ward rounds of nurses\u0026rsquo; standardized training in southwest China: a mixed methods study. Front Med. 2024;11:1276652.\u003c/li\u003e\n \u003cli\u003eHe H, Zhang G, He Y. Design courses based on BOPPPS teaching mode. SHS Web Conf. 2022;145:1020.\u003c/li\u003e\n \u003cli\u003eZhang L. Teaching design and practice of intensive reading course based on BOPPPS. J Lang Teach Res. 2020;11:503.\u003c/li\u003e\n \u003cli\u003eEl Hussein MT, Cuncannon A. Nursing students\u0026rsquo; transfer of learning from simulated clinical experiences into clinical practice: a scoping review. Nurse Educ Today. 2022;116:105449.\u003c/li\u003e\n \u003cli\u003eParvis K, Badowski D, Martin D. A simulated perioperative clinical day for prelicensure nursing students. J Nurs Educ. 2021;60:386\u0026ndash;90.\u003c/li\u003e\n \u003cli\u003eChen C-Y, Shi X-W, Yin S-Y, Fan N-Y, Zhang T-Y, Zhang X-N, et al. Application of the online teaching model based on BOPPPS virtual simulation platform in preventive medicine undergraduate experiment. BMC Med Educ. 2024;24:1255.\u003c/li\u003e\n \u003cli\u003eSaragih ID, Tarihoran DETAU, Lin W-T, Lee B-O. Outcomes of scenario-based simulation courses in nursing education: a systematic review and meta-analysis. Nurse Educ Today. 2024;136:106145.\u003c/li\u003e\n \u003cli\u003eDoerner M, Seibert SA. Student perioperative experience supports recognition of safety concepts. J Perianesth Nurs. 2022;37:528\u0026ndash;32.\u003c/li\u003e\n \u003cli\u003eKoukourikos K, Tsaloglidou A, Kourkouta L, Papathanasiou I, Iliadis C, Fratzana A, et al. Simulation in clinical nursing education. Acta Inform Med. 2021;29:15.\u003c/li\u003e\n \u003cli\u003ePeng W-S, Wang L, Zhang H, Zhang Z, Wu Y-M, Sang X, et al. Application of virtual scenario simulation combined with problem-based learning for paediatric medical students. J Int Med Res. 2021;49:300060520979210.\u003c/li\u003e\n \u003cli\u003eQian W, Qian L, Xu Q, Lu L. The effects of roy\u0026rsquo;s adaptation model and the forgetting curve in the clinical instruction of operating room nursing interns. Am J Transl Res. 2021;13:8214\u0026ndash;20.\u003c/li\u003e\n \u003cli\u003eJennings KM. The roy adaptation model: A theoretical framework for nurses providing care to individuals with anorexia nervosa. ANS Adv Nurs Sci. 2017;40:370\u0026ndash;83.\u003c/li\u003e\n \u003cli\u003eMa X, Zeng D, Wang J, Xu K, Li L. Effectiveness of bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary teaching strategy in Chinese medical education: A systematic review and meta-analysis. Front Med. 2022;9:975229.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTables 1 and 5 are available in the Supplementary Files section.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. \u0026nbsp; BOPPPS combined with scenario-based simulation teaching procedure in the context of cesarean section nursing\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBOPPPS Phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eObjective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTeaching Content\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBridge-in (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntroduce clinical scenarios and current topics to stimulate nursing students\u0026rsquo; interest.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eClinical case scenario: Mrs. Zhang, 38 weeks pregnant, aged 35 years, height 160 cm, weight 78 kg; diagnosis: gravida 2 para 1, scarred uterus, premature rupture of membranes, marginal placenta previa; immediate emergency cesarean section required.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eObjective (O)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePresent multidimensional learning objectives clearly to help students understand their specific learning tasks.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1) Knowledge objectives: Master the cesarean section procedure and effectively assist during surgery. (2) Skill objectives: Accurately perform surgical safety checks, position patients appropriately for surgery, follow principles of instrument counting, and maintain strict aseptic techniques (surgical hand disinfection, gowning and gloving, preparation of sterile instrument tables). (3) Affective objectives: Demonstrate active patient care, alleviate patient anxiety, and maintain patient privacy during the procedure.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePre-assessment (P)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAssess students\u0026rsquo; existing knowledge base and skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1) Basic knowledge: Definition and classification of placenta previa? (2) Nursing skills: Preparation of instruments and materials required for cesarean section? (3) Psychological nursing: Strategies to alleviate patients\u0026rsquo; preoperative anxiety and stress?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eParticipatory learning (P)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEnhance student engagement and motivation through immersive scenario-based simulations, promoting active participation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1) Environmental preparation: i) Activate operating room laminar airflow system, regulate room temperature; ii) Prepare suction devices. (2) Material preparation: i) Sterile packages (including cesarean instrument set, small basin, sterile surgical gowns, cesarean dressing pack), disposable sterile gloves, size 21 scalpel blade, sterile surgical film, suction tubing, size 12 urinary catheter, 5 ml syringe, intrauterine gauze (standby). ii) Non-sterile materials: IV cannulation and catheterization equipment. iii) Medications: Oxytocin 20U. (3) Procedure details: Preoperative phase: i) Patient transfer and identification check; ii) IV access establishment, safety checks before and after anesthesia, patient positioning after anesthesia. Intraoperative phase: i) Sterile technique (surgical hand disinfection, gowning, gloving); ii) Prepare sterile instrument table; iii) Perform instrument counting accurately and timely; iv) Surgical site disinfection and sterile draping; v) Connect suction apparatus; vi) Perform \u0026ldquo;time-out\u0026rdquo; surgical safety checks before incision; vii) Monitor procedure progress actively and assist appropriately. Postoperative phase: i) Ensure patient\u0026rsquo;s dignified appearance; ii) Safely transfer patient from operating table to stretcher; iii) Perform final safety checks; iv) Postoperative disposal of medical waste, sharps, and instruments; v) Patient transfer and handover.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePost-assessment (P)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEvaluate whether students have met the expected clinical learning outcomes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1) At what specific time points should surgical safety checks be performed? (2) Principles and timing of instrument counting? (3) Timing and role of oxytocin administration during surgery? (4) Categories of medical waste disposal? (5) Management strategies for massive intraoperative hemorrhage?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSummary (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eReinforce learning by reviewing key and challenging content areas with students.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1) Guided student feedback: i) What aspects were performed well during the scenario simulation? ii) What areas need improvement? iii) What were your considerations during patient positioning? (2) Review cesarean nursing process systematically: proper patient assessment, identification of primary nursing diagnoses, individualized nursing care planning, implementation of nursing interventions, and evaluation of nursing outcomes. (3) Encourage students to use mind maps to organize acquired knowledge and skills, creating a standardized nursing workflow for cesarean section patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Comparison of theoretical and practical examination scores between the two groups (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTheoretical examination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePractical skills examination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e89.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;5.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;5.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Significant differences were found between groups in both theoretical and practical examinations (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 \u0026nbsp; \u0026nbsp; Comparison of self-directed learning ability scores between the two groups (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eLearning awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eLearning strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eLearning behaviors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eLearning evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eInterpersonal skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e41.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e40.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e42.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e39.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e40.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e204.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e43.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e43.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e45.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e44.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e45.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e221.89\u0026thinsp;\u0026plusmn;\u0026thinsp;6.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026minus;4.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026minus;8.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026minus;6.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026minus;6.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026minus;6.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026minus;14.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Experimental group scores were significantly higher than control group scores across all dimensions and the total score (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"BOPPPS, scenario-based simulation, operating room, clinical teaching, nursing education","lastPublishedDoi":"10.21203/rs.3.rs-6909666/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6909666/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate the effectiveness of integrating the BOPPPS teaching model with scenario-based simulation in the clinical training of operating room nursing interns.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 71 undergraduate nursing students were assigned to either a control group (n\u0026thinsp;=\u0026thinsp;36) or an experimental group (n\u0026thinsp;=\u0026thinsp;35) based on their internship commencement dates. The control group received traditional clinical skills training, whereas the experimental group was instructed using the BOPPPS model combined with scenario-based simulation. Upon completion of their rotations, theoretical knowledge, practical skills, self-directed learning ability, and teaching satisfaction were assessed and compared between the two groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe experimental group scored significantly higher in theoretical and practical assessments, demonstrated stronger self-directed learning abilities, and reported greater satisfaction with the teaching experience compared to the control group (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe integration of BOPPPS with scenario-based simulation enhances nursing interns\u0026rsquo; mastery of theoretical and practical competencies, improves self-directed learning, and increases satisfaction with clinical teaching. This approach holds promise for broader application in clinical nursing education.\u003c/p\u003e","manuscriptTitle":"Evaluation of the Effectiveness of BOPPPS Combined with Scenario-Based Simulation in the Clinical Teaching of Operating Room Nursing Interns","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 14:42:41","doi":"10.21203/rs.3.rs-6909666/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-07-30T14:19:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-23T07:23:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-20T06:18:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-20T06:16:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-06-17T02:49:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"17704744-1236-409e-90aa-45648a589aad","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T14:42:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-04 14:42:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6909666","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6909666","identity":"rs-6909666","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}