Design and practice of the “BOPPPS+PAD” Blended Learning Model in Teaching of Surgical Nursing

Design and practice of the “BOPPPS+PAD” Blended Learning Model in Teaching of Surgical Nursing | 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 Design and practice of the “BOPPPS+PAD” Blended Learning Model in Teaching of Surgical Nursing Meichun Tan, Zheng Ruan, Wenjuan Xi, Yunxia Ding, Caiyu Shen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7677614/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Objective The study aimed to Design and Implementation of the “BOPPPS + PAD” blended Learning model in Surgical Nursing teaching, and evaluate Its Outcomes Methods A total of 363 undergraduate nursing students enrolled in 2021 and 2022 were selected as research subjects by using convenience sampling. The 188 students enrolled in 2021 formed the control group, while the 175 students enrolled in 2022 constituted the experimental group.For the control group students, instructors delivered surgical nursing instruction using traditional blended learning model which centered on classroom instruction supplemented by online resources. For the experimental group students, instructors implemented surgical nursing instruction through the “BOPPPS + PAD” blended teaching methodology. After completing the course, learning outcomes and course satisfaction were compared between the two groups. Results The course comprehensive grades for students in the control group and experimental group were 78.00 ± 7.41 and 83.66 ± 9.42, respectively (t = -3.03, p < 0.01); The self-directed learning ability scores were 91.53 ± 16.08 and 103.81 ± 15.48, respectively (t = -4.97, p < 0.001); The critical thinking ability scores were 344.84 ± 43.78 and 376.84 ± 72.33, respectively (t = -3.35, p = 0.001); Active collaborative learning ability scores were 16.06 ± 4.57 and 18.56 ± 3.05, respectively (t = -3.67, P < 0.001). All results showed statistically significant differences. Course satisfaction among experimental group students was higher than that of the control group (P < 0.05), indicating a statistically significant difference. Conclusion The implementation of the “BOPPPS + PAD” blended learning model in Surgical Nursing teaching enhances students' academic performance and course satisfaction, while fostering their self-directed learning abilities, critical thinking skills, and active collaborative learning capabilities. BOPPPS PAD Blended learning model Surgical Nursing Teaching effectiveness Figures Figure 1 Figure 2 Introduction The BOPPPS model((Bridge-in, Learning Objective, pre-assessment, Participatory Learning, post-assessment, and Summary)was first established by Douglas Kerr’s team at the University of British Columbia in 1978 [ 1 ].The BOPPPS teaching model is an education-goal-oriented, student-centered teaching approach which was designed to enhance classroom teaching efficiency and promote active learning.The BOPPPS model can promote students’ interaction and engagement, thus enhancing their performance and learning experience. The PAD (Presentation-Assimilation-Discussion) teaching model, formally known as the “Split-Classroom Approach,” is an original teaching methodology proposed by Professor Zhang Xuexin of the Department of Psychology at Fudan University in 2014 [ 2 ].The core concept of PAD is to divide classroom time into two parts: half allocated for teacher-led instruction, and the other half dedicated to interactive learning through student discussions(This study adheres to its core principle of allocating half the time to students and half to teachers. However, since students have already studied relevant knowledge points online before class, the implementation process begins with organizing student discussions and exchanges, followed by the teacher addressing questions and summarizing key points).This study adheres to its core principle of allocating equal time to both students and teachers. However, since students have already studied relevant knowledge points online prior to class, teachers organize student discussions during instruction. Through prior learning and discussion, students enhance their understanding and cognition of the knowledge. Finally, teachers address questions and provide summaries. The implementation process has been modified to: Discussion-Assimilation-Presentation. Surgical Nursing is a required and core course in the nursing program, serving as a vital support for cultivating students' critical thinking skills and clinical nursing practice abilities [ 3 ].Since 2018, members of the course teaching team have been continuously enhancing the resource development of the online course (online course link: https://www.xueyinonline.com/detail/254831175 ) in accordance with the standards for first-class course construction.Online resources are organized by chapter, with each chapter containing an introduction, learning objectives, key concepts, chapter assessments (pre-test and post-test), instructional videos (approximately 10 minutes each, recorded by teachers based on key concepts), and mind maps.In recent years, while continuously strengthening the development and management of online resources, the team has also been innovating teaching models. They have adopted “BOPPPS + PAD” blended learning model, as detailed below: Objects and methods 1.1 Research subjects 363 undergraduate nursing students enrolled in 2021 and 2022 were selected as the study subjects by Convenience sampling .The 188 students enrolled in 2021 served as the control group, comprising 33 males and 155 females with an average age of (20.78 ± 3.95) years. Their average score of completed courses was 80.95 ± 6.88;The 175 students enrolled in 2022 served as the experimental group, comprising 44 males and 131 females with an average age of (20.13 ± 2.74) years. Their average score of completed courses was 80.17 ± 7.03.There were no statistically significant differences between the two groups of students in terms of general characteristics such as gender and age, as well as completed course grades. This study adheres to the Declaration of Helsinki,all subjects signed an informed consent form before participating in the study.The study was approved by the Ethics Committee of Jiangxi University of Technology (review approval number: A099-20240915-003). This study has not been tested on humans, therefore the clinical trial number is: Not applicable. 1.2 Study Methods The curriculum was divided into two semesters.In the fourth semeter,students completed 56 credit hours of theoritical instruction and 8 credit hours of practical training.In the fifth semeter,students completed 48 credit hours of theoritical instruction and 16 credit hours of practical training.The control group's intervention period runs from February 2023 to December 2023, while the experimental group's intervention period spans from February 2024 to December 2025. The specific intervention methods are as follows: 1.2.1 Control group The control group conducted instruction primarily through offline methods, supplemented by online approaches, as detailed below: Before class, teachers assign preparatory tasks through the online platform. Students complete these preparatory tasks and target assessments on the online learning platform.In the classroom, the teacher first clearly states the learning objectives and requirements. Next, they systematically and methodically explain all content, incorporating some interaction with students as needed during instruction, though the primary focus remains on teacher-led lectures. Finally, the teacher concludes the class with a summary.After class, teachers assign homework through the online platform, and students complete chapter quizzes on the online platform.The implementation path of this teaching model is shown in Fig. 1 .This teaching model primarily utilizes the classroom as the main teaching venue and relies on teacher-led instruction as the primary teaching method. In practice, neither instructors nor students make the most of the online resources for Surgical Nursing. Instructors incorporated only pre- and post-tests into teaching management, while students lacked motivation for online learning due to unclear objectives. Multiple factors resulted in online instruction serving merely as a supplement to in-person teaching. Students remained passive recipients during the process, lacking active critical thinking. Consequently, this teaching model fails to cultivate students' Self-directed learning ability and clinical nursing thinking. 1.2.2 Experimental group From February 2023 to February 2024, the teaching team continuously refined key concepts, expanded the test question bank, case library, and assignment collection,etc.They produced several 10-minute instructional videos based on these concepts, created micro-lessons, list key points into mind maps,and summarize teaching priorities and challenges.Before the lesson begins, the teacher divides each class into 5–6 groups, with each group consisting of one group leader and 4–5 members. The teaching team members collaborate with defined roles: one clinical nursing expert is responsible for collecting and organizing teaching cases; one member is responsible for online instruction implementation and management, including assigning learning tasks, addressing student inquiries, analyzing online learning data, summarizing student learning outcomes, and promptly identifying issues in online teaching. Three members oversee in-person instruction, organizing classroom activities such as discussions and presentations around teaching cases using the PAD teaching method. The experimental group adopted “BOPPPS + PAD” blended learning model with the implementation path shown in Fig. 2 . One week prior to the course commencement, instructors released learning tasks such as case studies or instructional videos online, along with supplementary learning materials or resources which guiding students self-directed learning. Concurrently, learning objectives were published online to direct students' learning direction.Students take the pre-test online one day before the course begins. Teachers promptly summarize the pre-test results and provide timely feedback to the instructors responsible for in-person teaching.In-person classes, teachers organize students into small groups to conduct case-centered discussions. Following this, students engage in cross-group exchanges and discussions, group presentations at last. During case discussions, students are encouraged to actively participate in class, fostering their initiative to gain a deep understanding and internalize knowledge. The instructor addresses questions and clarifies issues revealed during discussions and presentations, providing explanations for concepts that students find challenging. At the end of the class, the instructor reviews key points once more.This study adopted the core principles of the PAD teaching method, dividing classroom time into two same segments: half allocated for teacher instruction and half for student engagement. The classroom begins with student discussion, interaction, and presentation followed by teacher-led Q&A and knowledge consolidation.To be precise, the classroom instruction follows the Discussion-Assimilation-Presentation sequence.After class, teachers assign quizzes through the online platform. Upon completing the quizzes, students can discuss learning challenges and insights with teachers and peers in the platform's discussion forum. Students can also reflect on shortcomings in their learning, summarize their experiences, and propose more effective methods.Teachers provide timely feedback, concluding with a chapter summary. This teaching model encourages and motivates students to fully utilize online resources for self-directed learning.Offline instruction is fully student-centered, stimulating students' potential through group discussions and intergroup exchanges. This teaching model cultivates students' self-directed learning abilities, clinical nursing thinking, and proactive collaborative learning capabilities with team members. 1.3 Observation indicators 1.3.1 Comprehensive Grade of Surgical Nursing Upon completing the course, students will take a final exam, after which their comprehensive course grade will be calculated. The specific components and their respective weightings are as follows: Pre-test 10% 、Course participation (including various online and offline participation forms such as group discussions, intergroup exchanges, group presentations, and online teaching resource learning)20% 、Post-test 10% and Final exam 60%. 1.3.2 Assessment Scale for Self-Directed Learning Abilities Among Nursing Students The self-directed learning ability assessment scale for nursing students developed by Professors Lin Yi and Jiang Anli of the Second Military Medical University [ 4 ] was adopted. The scale demonstrated reliability and validity coefficients of 0.835 and 0.8632 respectively.This scale comprises three dimensions with 28 items: Self-Management Competence (10 items), Learning Collaboration Competence (7 items), and Information Competence (11 items).The scale adopts a 5-point Likert scale: “Strongly Agree,” “Somewhat Agree,” “Neutral,” “Somewhat Disagree,” and “Strongly Disagree.” Positive statements are scored as follows: 5 (strongly agree), 4 (Somewhat Agree), 3 (Neutral), 2 (somewhat disagree), and 1 (Strongly Disagree). Reversed items are scored in the opposite manner. The total score ranges from 28 to 140 points.The higher the score, the better the self-directed learning ability. 1.3.3 Critical Thinking Skills Assessment Scale The critical thinking ability measurement scale adopted was developed by experts including Peng Meici and Wang Guocheng from the School of Nursing at The Hong Kong Polytechnic University, based on the Chinese adaptation of the California Critical Thinking Dispositions Inventory (CCTDI) [ 5 ].The Cronbach's alpha coefficient of the scale is 0.9,content validity index is 0.89.This scale comprises seven dimensions with 70 items: Truth-Seeking (10 items), Open-Mindedness (10 items), Analytical Ability (10 items), Systematization Ability (10 items), Confidence in Critical Thinking (10 items), Intellectual Curiosity (10 items), and Cognitive Maturity (10 items).The scale adopts Likert's six-level scoring method, the scores from high to low are 6, 5, 4, 3, 2, and 1, representing respectively"“Strongly agree,” “Somewhat agree,” “agree,” “Somewhat disagree,” and “Strongly disagree.” .The total score of this scale ranges from 70 to 420. the higher the score, the better the critical thinking ability. 1.3.4 active collaborative learning capabilities Referencing the National Survey of Student Engagement-China (NSSE-China) developed by Tsinghua University's Institute of Education, this scale encompasses five dimensions: Academic Challenge, Active Collaborative Learning, Faculty-Student Interaction, Richness of Educational Experiences, and Campus Environment Support [ 6 ]. This study employs only the dimension of Active and Collaborative Learning. This dimension has a Cronbach's α of 0.87 and consists of 6 items. Using a 4-point Likert scale, the scores from high to low are 4, 3, 2, and 1, representing respectively "Excellent, Good, Average, Poor.The total score of this scale ranges from 6 to 24.the higher the score, the stronger levels of active collaborative learning among students. 1.3.5 Course Satisfaction To evaluate the effectiveness of the blended learning model, we developed a questionnaire and conducted a survey through the Wenjuanxing platform. The questionnaire covered three dimensions (three items): satisfaction with teaching, satisfaction with learning outcomes, and overall evaluation.Each item offers four response options: Very Satisfied, Satisfied, Dissatisfied, and Very Dissatisfied. The questionnaire achieved a Cronbach's alpha coefficient of 0.742. Prior to the formal survey, researchers randomly selected 10 students for a pre-survey. Feedback indicated that the pre-survey instructions and questionnaire items were easy to understand. 1.4 Data analysis SPSS version 26.0 is used to analyze the date. General information use descriptive analysis.Quantitative datas that follow normal distribution are described by “mean ± standard deviation”, and the comparison between groups is made by two independent samples T-test.Count data were described using frequency and proportion. Comparisons between groups of ordered categorical data were performed using the Mann-Whitney U test ( Wilcoxon Signed-Rank Test).A p value of < 0.05 is considered statistically significant. Results 2.1 Demographics Participant characteristics are presented in Table 1 .There are a total of 363 research subjects.There is no statistical difference between the two groups in Demographic information such as gender and age, as well as average score of completed courses (P > 0.05). Table 1 Participant demographic data(N = 363) Group Gender Age Average score of completed courses Male Female Control group(n = 188) 33 155 20.78 ± 3.95 80.95 ± 6.88 Experimental group(n = 175) 44 131 20.13 ± 2.74 80.17 ± 7.03 T/χ 2 0.59 1) 0.73 2) 063 2) p > 0.05 > 0.05 > 0.05 1): χ 2): T 2.2 Course comprehensive Grades The composition and weighting of the course's comprehensive score are as follows: final exam score 60%, pre-test 10%, post-test 10%, and course participation 20%. Students took the final exam immediately after completing the course. Their comprehensive scores were calculated based on the final exam combined with pre-test, post-test, and course participation scores throughout the teaching process. A statistically significant difference was found between the comprehensive scores of the two groups, as detailed in Table 2 . Results indicate that the experimental group achieved significantly higher comprehensive scores in the Surgical Nursing course compared to the control group (t = -3.03, p < 0.01). Table 2 Comparison of Course comprehensive Grades in 2 groups (score, x̅ ±S) Group Pre-test (10) course participation (20) post-test(10) final exam score (60) Course comprehensive Grades(100) Control group 7.48 ± 1.82 15.48 ± 2.62 6.67 ± 1.13 46.81 ± 8.66 78.00 ± 7.41 Experimental group 7.85 ± 1.39 18.12 ± 1.79 7.84 ± 0.92 50.12 ± 6.20 83.66 ± 9.42 t −1.28 −7.23 −6.68 −2.60 −3.03 p 0.20 < 0.001 < 0.001 0.01 0.003 2.3 Self-directed learning ability After completing the course, an online survey was distributed through the Wenjuanxing platform to assess students' self-directed learning abilities. The scores for the two groups of students are detailed in Table 3 . Results indicate that the experimental group achieved significantly higher scores in self-directed learning abilities than the control group (t = -4.97, p < 0.001),. Table 3 Comparison of Self-directed learning ability in 2 groups (score, x̅ ±S) Group Self-management skills (10 ~ 50) Collaborative Learning Skills(7 ~ 35) Information Literacy Skills(11 ~ 55) Total capacity(28 ~ 140) Control group 32.58 ± 7.87 20.92 ± 8.38 41.37 ± 7.83 91.53 ± 16.08 Experimental group 39.21 ± 9.83 23.08 ± 9.05 47.26 ± 9.86 103.81 ± 15.48 t −4.48 −3.68 −4.78 −4.97 p < 0.05 < 0.05 < 0.05 < 0.001 2.4 Critical Thinking Skills After completing the course, an online survey was distributed through the Wenjuanxing platform to assess students' Critical Thinking Skills. The scores for the two groups of students are detailed in Table 4 . Results indicate that the experimental group achieved significantly higher scores than the control group(t=-3.35 p = 0.001). Table 4 Comparison of Critical Thinking Skills in 2 groups (score, x̅ ±S) Group Seeking Truth(10 ~ 60) Open-Mindedness(10 ~ 60) Analytical skills(10 ~ 60) Systematic Capability(10 ~ 60) CT Self-Confidence(10 ~ 60) Curiosity (10 ~ 60) Cognitive Maturity(10 ~ 60) Total Score (70 ~ 420) Control group 36.39± 9.23 37.13± 9.79 41.92± 9.68 36.94± 11.67 45.84± 11.28 37.71± 8.59 42.48± 11.35 344.84± 43.78 Experimental group 41.47± 11.82 40.26± 9.78 49.29± 8.48 39.56± 12.82 45.84± 11.28 44.38± 10.37 48.84± 13.56 376.84± 72.33 t −3.08 −2.03 −5.18 −2.67 −4.36 −2.86 −4.79 −3.35 p 0.002 0.04 < 0.001 0.03 0.005 0.004 0.003 0.001 2.5 Active Collaborative Learning Ability After completing the course, an online survey was distributed through the Wenjuanxing platform to assess students' Active Collaborative Learning Ability. The scores for the two groups of students are detailed in Table 5 . Results indicate that the experimental group achieved significantly higher scores than the control group(t=-3.67 p < 0.001)。 Table 5 Comparison of Active Collaborative Learning Ability in 2 groups(score, x̅ ±S) Indicator Control group Experimental group Active Collaborative Learning Ability 16.06 ± 4.57 18.56 ± 3.05 t −3.67 P < 0.001 2.6 Course Satisfaction After completing the course, an online survey was distributed through the Wenjuanxing platform to assess students' evaluations of teaching methods, learning outcomes, and overall evaluations.The specific evaluations are detailed in Table 6 .The results showed that the evaluation scores of the experimental group students were all higher than those of the control group(P < 0.05). Table 6 Comparison of Course Satisfaction in 2 groups(Frequency, composition ratio) Item Experimental group(n = 175) Control group(n = 188) Z p Very Satisfied Satisfied Dissatisfied Very Dissatisfied Very Satisfied Satisfied Dissatisfied Very Dissatisfied teaching methods 76 (43.43) 88 (50.29) 9 (5.14) 2 (1.14) 45 (23.94) 113 (60.11) 19 (10.11) 11 (5.85) −4.43 < 0.001 learning outcomes 81 (46.29) 83 (47.42) 7 (4) 4 (2.29) 61 (32.45) 86 (45.74) 17 (9.04) 24 (13.71) −3.89 < 0.001 overall evaluation 70 (40) 94 (53.71) 6 (3.43) 5 (2.86) 56 (29.79) 94 (50) 20 (10.64) 18 (9.57) −3.27 0.001 Discussion 3.1 The “BOPPPS + PAD” blended learning model contributes to improving students' course comprehensive grades. Table 2 reveals that the experimental group achieved significantly higher scores than the control group, indicating that the “BOPPPS + PAD” blended learning model enhances student academic performance. This finding aligns with research by Zhang Qing, Aida Bazrgar, and others [ 7 – 9 ].The “BOPPPS + PAD” teaching model emphasizes student-centered, participatory instruction, striving to enable students to fully exercise their initiative and engagement in the classroom.Table 2 shows that the experimental group's course participation scores were significantly higher than the control group's, with post-test scores, final exam scores, and course comprehensive grades all significantly higher than the control group (p < 0.01). Furthermore, linear correlation analysis revealed positive correlations between course participation and post-test(r = 0.286, p = 0.001), final exam scores (r = 0.302, p = 0.001), and course comprehensive grades (r = 0.370, p < 0.001). This indicates that increasing course participation can enhance performance on post-test, final exams, and course comprehensive grades. 3.2 The “BOPPPS + PAD” blended learning model helps enhance students' Self-directed learning ability. Table 3 shows that the experimental group's scores for self-directed learning ability were significantly higher than those of the control group. This finding aligns with the research results of Siying Lu, Anyan Duan [ 10 – 11 ], and others.This indicates that the “BOPPPS + PAD” blended teaching method helps enhance students' Self-directed learning abilities. Traditional blended learning requires students to complete assigned tasks before class, yet they often lack clarity on learning objectives. This will result in students lacking clear objectives and motivation for online learning,while classroom instruction remains teacher-centered, with students primarily passively absorbing knowledge [ 12 ]。Under the guidance of the “BOPPPS + PAD” blended learning model, instructors publish learning objectives through the online platform prior to class and provide learning materials such as instructional videos and case studies. Guided by learning objectives, students independently select relevant content through the online platform for self-directed learning. When encountering difficulties during study, they promptly engage in discussions with peers and instructors to ultimately achieve the learning goals.In the classroom, teachers adhere to the principles of the “PAD” teaching method, dedicating half the class time to student-centered activities. Students engage in discussions with their group members based on learning objectives or assigned tasks, exchange ideas with peers from other groups, and finally report their insights to classmates or the teacher. They may also raise questions during this process. The teacher's role is to guide students in deepening their thinking step by step and promptly address any doubts that arise.Whether online or offline, students' autonomy in learning is fully exercised and cultivated under the guidance of learning objectives or driven by learning tasks, self-directed learning abilities have been significantly enhanced. 3.3 The “BOPPPS + PAD” blended learning model helps cultivate students' critical thinking skills. Critical thinking is the process of reflecting on and questioning one's own or others' viewpoints, and it is the process of conducting independent analytical thinking.In the face of increasingly complex nursing environments and growing care demands, cultivating students' critical thinking skills is crucial for enhancing nursing quality [ 13 ].As shown in Table 4 , the experimental group's scores for critical thinking ability were significantly higher than those of the control group. This finding aligns with the research's results of Zhang Guangyu, Jiang Tao, et al[ 14 – 15 ].In traditional blended learning, after teachers deliver key content in lectures, students must immediately engage in discussions due to limited class time. However, at this stage, students have not yet fully understood or assimilated the knowledge, making it difficult for them to conduct deep thinking and comprehensive analysis. Consequently, this blend learning model is not conducive to cultivating critical thinking skills.Following the blended learning model of “BOPPPS + PAD,” instructors consistently adhere to the principle of student-centered learning [ 16 ]. Before class, teachers upload resources such as learning objectives, tasks, and key concepts to the online learning platform. Students proactively access the platform to study based on these objectives or tasks. When encountering challenges during their learning journey, they are encouraged to engage in deep thinking, explore solutions, and seek answers. They may also initiate discussions on the platform or share their questions and insights during offline class discussions.Teachers then provide targeted guidance based on the questions raised, helping students overcome challenges. This interactive learning approach transforms students from passive recipients into active participants in their learning journey, fostering a high level of interest in learning and enhancing their critical thinking skills [ 17 ]. 3.4 The “BOPPPS + PAD” blended learning model helps enhance students' active collaborative learning abilities. The modern healthcare environment emphasizes multidisciplinary teamwork (MDT). Only through effective collaboration among nurses, physicians, rehabilitation specialists, nutritionists, and other healthcare professionals can effectively resolve complex clinical health issues,ensure patient safety, and provide high-quality holistic care [ 18 ].Therefore, cultivating undergraduate nursing students' ability for active collaborative learning is key to developing composite nursing professionals who can adapte to future challenges.Following the blended learning model of “BOPPPS + PAD,” the teacher divided the class into 5–6 groups before the lesson, with each group consisting of one leader and 4–5 members. During the in-person instruction, the teacher required students to engage in learning, discussion, and exchange within their respective groups.To better achieve learning objectives, the team leader must assign tasks reasonably based on each member's strengths and capabilities. Team members must collaborate closely and communicate promptly and effectively to accomplish shared goals. When challenges arise, the group must harness its team wisdom to analyze problems, engage in in-depth discussions, and exchange insights to resolve issues efficiently and effectively.In group-based case study discussions, students' active collaborative learning abilities are fully developed.This study demonstrates that the “BOPPPS + PAD” blended learning model significantly enhances students' active collaborative learning abilities compared to traditional blended learning models (P < 0.001), as detailed in Table 5 . 3.5 The “BOPPPS + PAD” blended learning model helps enhance students' course satisfaction. this study showed that the evaluation of the experimental group students were all higher than those of the control group(P < 0.05),The specific evaluation are shown in Table 6 .This result is consistent with the findings of Deng Fengyuan, Xia Ningning, and others[ 19 – 20 ].Following the “BOPPPS + PAD” blended learning model, the teaching team refined online resources that including uploading instructional videos, teaching cases, and key learning points before students taking this course.The abundance of online resources enables students to utilize fragmented time for learning, better meeting their learing needs;Students can participate in instruction both online and offline.In online discussion forums, students can engage in real-time interaction with teachers and peers. In offline classrooms, half of the class time is dedicated to student-centered discussions and exchanges. When encountering difficulties during the learning process, students can receive timely and effective assistance, enabling them to resolve issues more efficiently and effectively. This model significantly meets students' learning needs, enhances their learning experience and academic performance,and consequently increases their satisfaction with classroom instruction. Summary This study implemented the “BOPPPS + PAD” blended teaching model in Surgical Nursing, which effectively enhancing students' self-directed learning abilities, critical thinking skills, and proactive collaborative learning capabilities. It also improved students' course performance and teaching satisfaction.However, this study was limited by abservation time and single source of sample data. In future, research will expand the scope of instructional implementation, increase sample size, and extend the study duration to further validate the effectiveness of the “BOPPPS + PAD” blended learning model. Declarations Author Contribution Meichun Tan:Conceptualization、methodology、writing、review and editing;Zheng Ruan:Questionnaire preparation, distribution, data collection and collation;Yunxia Ding,Wenjuan Xi:writing,original draft preparation;Caiyu Shen: questionnaires distribution ,data collection All authors reviewed the manuscript. Data Availability “Data is provided within the manuscript，Due to privacy/ethical concerns, the raw data supporting the findings of this study cannot be made openly available. However, de-identified data are available from the corresponding author upon reasonable request, subject to approval by the institutional ethics committee and the execution of a data use agreement. References Jiaying LSZO,Yang, Wang et al. BOPPPS model implementation and students'performance: asystematic literature review[J].Frontiers in Education, 2025,9:05–09. Chunlian PHYX, Li, et al. Application of the Case-Based Collaborative Classroom Teaching Method in Nursing Education for Undergraduate Nursing Students in On-Site Classes[J]. J Nurs Sci. 2024;39(23):74–6. Yu Peng L, Sha Y, Liu, et al. Application of the 7E Teaching Model in Clinical Internship Instruction for Surgical Nursing[J]. Chin Nurs Educ. 2023;20(8):951–2. Lin Y. Anli Jiang. Development of an Assessment Scale for Self-Directed Learning Competence Among Nursing Undergraduates [J]. PLA Nursing Journa,l2004,(06):1–4. Meici Peng G, Wang J, Chen et al. Research on the Reliability and Validity Testing of the Critical Thinking Ability Measurement Scale [J]. Chin J Nurs 2004(09):644–7. Jinghuan Shi H, Zhang F, Guo. Exploring Chinese Learners' Phenomena and Efforts to Construct Autonomous Knowledge in Pedagogy: A Case Study of the Fifteen-Year Exploration of the Chinese College Students' Study and Development Tracking Study (CCSS) Project [J]. J East China Normal Univ (Educational Sci Ed. 2024;42(11):12–4. Zhang Q, Xiao J, Tang Y et al. Application Research of BOPPPS Combined with Micro-Lesson Teaching Model in Breast Surgery Nursing Education [J]. Clin Med Pract 2024,33(05):370–4. Aida Bazrgar M, Rahmanian A, Ghaedi, et al. Face-to-face, online, or blended: which method is more effective in teaching electrocardiogram to medical students[J]. BMC Med Educ. 2023;23:566–9. Cai L, Luo P. Qingqing Hu, Application of Blended Learning Based on the BOPPPS Model in Clinical Teaching of General Surgery [J]. Lingnan J Emerg Med 2024,29(02):137–40. Lu SY, Ren XP, Xu H, et al. Improving self-directed learning ability of medical students using the blended teaching method: a quasi-experimental study[J]. BMC Med Educ. 2023;23:616–8. Anyan Duan F, Jiang L, Li, et al. Design and practice of blended teaching of internal medicine nursing based on O-AMAS effective teaching model[J]. BMC Med Educ. 2024;24:580–3. Kaina Feng Q, Zhong M, Liu et al. Application of Blended Learning in an Elective Course on Disaster Nursing [J]. Chin J Nurs Educ 2022,19(4):309–13. Tao P, Huang H, Pan X et al. Application of Scenario-Based Flipped Classroom Teaching Method in Cultivating Critical Thinking Skills Among Nursing Students [J]. Chinese Higher Medical Education,2024,(2):110–3. Zhang G, Tu S, Zou Q, et al. Application Exploration of the Split-Classroom Approach in Enhancing Clinical Thinking Skills Among Undergraduate Nursing Students in Obstetrics and Gynecology Nursing Education [J]. Health Educ. 2018;36:146–9. Tao Jiang S, Liu X, Li et al. Application Exploration of BOPPPS-Based Blended Learning Model in Cultivating Critical Thinking Among Undergraduate Neurosurgery Students [J]. J Qiqihar Med Coll 2025,46(15):1475–7. Hang F, Wang J, Zhang Y et al. A Qualitative Study on Undergraduate Nursing Students' Learning Experiences with the BOPPPS Teaching Model in Surgical Nursing [J]. Health Vocat Educ 2024,42(04):93–6. Tang XY, Xuejiao H, Guozu. Enhancing educational through blended teaching: an analysis of teaching and learning quality with learning environment and social impacts[J]. Front Educ. 2025;10:05–9. Yanjie H, Li L, Tian Y, et al. First-class discipline construction of nursing leads first-class talent cultivation[J]. J Sichuan Univ (Medical Edition). 2023;54(1):102–7. Fengyuan Deng X, Yue P, Junhua et al. Exploration of an Online-Offline Integrated Teaching Model for Pathophysiology: BOPPPS Combined with PAD [J]. Basic Medical Education,2025,27(8): 755–7. Ningning, Xia. Jing Liu and Hongying Wang.Effectiveness of a BOPPPSteaching in blood purificationnursing within the context ofresident teaching[J]. Front Educ. 2025;6:05–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Nov, 2025 Reviewers agreed at journal 02 Nov, 2025 Reviews received at journal 01 Nov, 2025 Reviews received at journal 31 Oct, 2025 Reviewers agreed at journal 31 Oct, 2025 Reviewers agreed at journal 31 Oct, 2025 Reviewers invited by journal 31 Oct, 2025 Editor assigned by journal 29 Oct, 2025 Editor invited by journal 03 Oct, 2025 Submission checks completed at journal 03 Oct, 2025 First submitted to journal 03 Oct, 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. 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Objective, pre-assessment, Participatory Learning, post-assessment, and Summary)was first established by Douglas Kerr’s team at the University of British Columbia in 1978 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].The BOPPPS teaching model is an education-goal-oriented, student-centered teaching approach which was designed to enhance classroom teaching efficiency and promote active learning.The BOPPPS model can promote students’ interaction and engagement, thus enhancing their performance and learning experience.\u003c/p\u003e\u003cp\u003eThe PAD (Presentation-Assimilation-Discussion) teaching model, formally known as the “Split-Classroom Approach,” is an original teaching methodology proposed by Professor Zhang Xuexin of the Department of Psychology at Fudan University in 2014 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].The core concept of PAD is to divide classroom time into two parts: half allocated for teacher-led instruction, and the other half dedicated to interactive learning through student discussions(This study adheres to its core principle of allocating half the time to students and half to teachers. However, since students have already studied relevant knowledge points online before class, the implementation process begins with organizing student discussions and exchanges, followed by the teacher addressing questions and summarizing key points).This study adheres to its core principle of allocating equal time to both students and teachers. However, since students have already studied relevant knowledge points online prior to class, teachers organize student discussions during instruction. Through prior learning and discussion, students enhance their understanding and cognition of the knowledge. Finally, teachers address questions and provide summaries. The implementation process has been modified to: Discussion-Assimilation-Presentation.\u003c/p\u003e\u003cp\u003eSurgical Nursing is a required and core course in the nursing program, serving as a vital support for cultivating students' critical thinking skills and clinical nursing practice abilities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].Since 2018, members of the course teaching team have been continuously enhancing the resource development of the online course (online course link: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.xueyinonline.com/detail/254831175\u003c/span\u003e\u003cspan address=\"https://www.xueyinonline.com/detail/254831175\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) in accordance with the standards for first-class course construction.Online resources are organized by chapter, with each chapter containing an introduction, learning objectives, key concepts, chapter assessments (pre-test and post-test), instructional videos (approximately 10 minutes each, recorded by teachers based on key concepts), and mind maps.In recent years, while continuously strengthening the development and management of online resources, the team has also been innovating teaching models. They have adopted “BOPPPS + PAD” blended learning model, as detailed below:\u003c/p\u003e"},{"header":"Objects and methods","content":"\u003ch2\u003e1.1 Research subjects\u003c/h2\u003e\u003cp\u003e363 undergraduate nursing students enrolled in 2021 and 2022 were selected as the study subjects by Convenience sampling .The 188 students enrolled in 2021 served as the control group, comprising 33 males and 155 females with an average age of (20.78 ± 3.95) years. Their average score of completed courses was 80.95 ± 6.88;The 175 students enrolled in 2022 served as the experimental group, comprising 44 males and 131 females with an average age of (20.13 ± 2.74) years. Their average score of completed courses was 80.17 ± 7.03.There were no statistically significant differences between the two groups of students in terms of general characteristics such as gender and age, as well as completed course grades.\u003cb\u003eThis study adheres to the Declaration of Helsinki,all subjects signed an informed consent form before participating in the study.The study was approved by the Ethics Committee of Jiangxi University of Technology (review approval number: A099-20240915-003).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has not been tested on humans, therefore the clinical trial number is: Not applicable.\u003c/p\u003e\u003ch2\u003e1.2 Study Methods\u003c/h2\u003e\u003cp\u003eThe curriculum was divided into two semesters.In the fourth semeter,students completed 56 credit hours of theoritical instruction and 8 credit hours of practical training.In the fifth semeter,students completed 48 credit hours of theoritical instruction and 16 credit hours of practical training.The control group's intervention period runs from February 2023 to December 2023, while the experimental group's intervention period spans from February 2024 to December 2025. The specific intervention methods are as follows:\u003c/p\u003e\u003ch2\u003e1.2.1 Control group\u003c/h2\u003e\u003cp\u003eThe control group conducted instruction primarily through offline methods, supplemented by online approaches, as detailed below:\u003c/p\u003e\u003cp\u003eBefore class, teachers assign preparatory tasks through the online platform. Students complete these preparatory tasks and target assessments on the online learning platform.In the classroom, the teacher first clearly states the learning objectives and requirements. Next, they systematically and methodically explain all content, incorporating some interaction with students as needed during instruction, though the primary focus remains on teacher-led lectures. Finally, the teacher concludes the class with a summary.After class, teachers assign homework through the online platform, and students complete chapter quizzes on the online platform.The implementation path of this teaching model is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.This teaching model primarily utilizes the classroom as the main teaching venue and relies on teacher-led instruction as the primary teaching method. In practice, neither instructors nor students make the most of the online resources for Surgical Nursing. Instructors incorporated only pre- and post-tests into teaching management, while students lacked motivation for online learning due to unclear objectives. Multiple factors resulted in online instruction serving merely as a supplement to in-person teaching. Students remained passive recipients during the process, lacking active critical thinking. Consequently, this teaching model fails to cultivate students' Self-directed learning ability and clinical nursing thinking.\u003c/p\u003e\u003ch2\u003e1.2.2 Experimental group\u003c/h2\u003e\u003cp\u003eFrom February 2023 to February 2024, the teaching team continuously refined key concepts, expanded the test question bank, case library, and assignment collection,etc.They produced several 10-minute instructional videos based on these concepts, created micro-lessons, list key points into mind maps,and summarize teaching priorities and challenges.Before the lesson begins, the teacher divides each class into 5–6 groups, with each group consisting of one group leader and 4–5 members. The teaching team members collaborate with defined roles: one clinical nursing expert is responsible for collecting and organizing teaching cases; one member is responsible for online instruction implementation and management, including assigning learning tasks, addressing student inquiries, analyzing online learning data, summarizing student learning outcomes, and promptly identifying issues in online teaching. Three members oversee in-person instruction, organizing classroom activities such as discussions and presentations around teaching cases using the PAD teaching method.\u003c/p\u003e\u003cp\u003eThe experimental group adopted “BOPPPS + PAD” blended learning model with the implementation path shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. One week prior to the course commencement, instructors released learning tasks such as case studies or instructional videos online, along with supplementary learning materials or resources which guiding students self-directed learning. Concurrently, learning objectives were published online to direct students' learning direction.Students take the pre-test online one day before the course begins. Teachers promptly summarize the pre-test results and provide timely feedback to the instructors responsible for in-person teaching.In-person classes, teachers organize students into small groups to conduct case-centered discussions. Following this, students engage in cross-group exchanges and discussions, group presentations at last. During case discussions, students are encouraged to actively participate in class, fostering their initiative to gain a deep understanding and internalize knowledge. The instructor addresses questions and clarifies issues revealed during discussions and presentations, providing explanations for concepts that students find challenging. At the end of the class, the instructor reviews key points once more.This study adopted the core principles of the PAD teaching method, dividing classroom time into two same segments: half allocated for teacher instruction and half for student engagement. The classroom begins with student discussion, interaction, and presentation followed by teacher-led Q\u0026amp;A and knowledge consolidation.To be precise, the classroom instruction follows the Discussion-Assimilation-Presentation sequence.After class, teachers assign quizzes through the online platform. Upon completing the quizzes, students can discuss learning challenges and insights with teachers and peers in the platform's discussion forum. Students can also reflect on shortcomings in their learning, summarize their experiences, and propose more effective methods.Teachers provide timely feedback, concluding with a chapter summary.\u003c/p\u003e\u003cp\u003eThis teaching model encourages and motivates students to fully utilize online resources for self-directed learning.Offline instruction is fully student-centered, stimulating students' potential through group discussions and intergroup exchanges. This teaching model cultivates students' self-directed learning abilities, clinical nursing thinking, and proactive collaborative learning capabilities with team members.\u003c/p\u003e\u003ch2\u003e1.3 Observation indicators\u003c/h2\u003e\u003ch2\u003e1.3.1 Comprehensive Grade of Surgical Nursing\u003c/h2\u003e\u003cp\u003eUpon completing the course, students will take a final exam, after which their comprehensive course grade will be calculated. The specific components and their respective weightings are as follows: Pre-test 10% 、Course participation (including various online and offline participation forms such as group discussions, intergroup exchanges, group presentations, and online teaching resource learning)20% 、Post-test 10% and Final exam 60%.\u003c/p\u003e\u003ch2\u003e1.3.2 Assessment Scale for Self-Directed Learning Abilities Among Nursing Students\u003c/h2\u003e\u003cp\u003eThe self-directed learning ability assessment scale for nursing students developed by Professors Lin Yi and Jiang Anli of the Second Military Medical University [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] was adopted. The scale demonstrated reliability and validity coefficients of 0.835 and 0.8632 respectively.This scale comprises three dimensions with 28 items: Self-Management Competence (10 items), Learning Collaboration Competence (7 items), and Information Competence (11 items).The scale adopts a 5-point Likert scale: “Strongly Agree,” “Somewhat Agree,” “Neutral,” “Somewhat Disagree,” and “Strongly Disagree.” Positive statements are scored as follows: 5 (strongly agree), 4 (Somewhat Agree), 3 (Neutral), 2 (somewhat disagree), and 1 (Strongly Disagree). Reversed items are scored in the opposite manner. The total score ranges from 28 to 140 points.The higher the score, the better the self-directed learning ability.\u003c/p\u003e\u003ch2\u003e1.3.3 Critical Thinking Skills Assessment Scale\u003c/h2\u003e\u003cp\u003eThe critical thinking ability measurement scale adopted was developed by experts including Peng Meici and Wang Guocheng from the School of Nursing at The Hong Kong Polytechnic University, based on the Chinese adaptation of the California Critical Thinking Dispositions Inventory (CCTDI) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].The Cronbach's alpha coefficient of the scale is 0.9,content validity index is 0.89.This scale comprises seven dimensions with 70 items: Truth-Seeking (10 items), Open-Mindedness (10 items), Analytical Ability (10 items), Systematization Ability (10 items), Confidence in Critical Thinking (10 items), Intellectual Curiosity (10 items), and Cognitive Maturity (10 items).The scale adopts Likert's six-level scoring method, the scores from high to low are 6, 5, 4, 3, 2, and 1, representing respectively\"“Strongly agree,” “Somewhat agree,” “agree,” “Somewhat disagree,” and “Strongly disagree.” .The total score of this scale ranges from 70 to 420. the higher the score, the better the critical thinking ability.\u003c/p\u003e\u003ch2\u003e1.3.4 active collaborative learning capabilities\u003c/h2\u003e\u003cp\u003eReferencing the National Survey of Student Engagement-China (NSSE-China) developed by Tsinghua University's Institute of Education, this scale encompasses five dimensions: Academic Challenge, Active Collaborative Learning, Faculty-Student Interaction, Richness of Educational Experiences, and Campus Environment Support [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This study employs only the dimension of Active and Collaborative Learning. This dimension has a Cronbach's α of 0.87 and consists of 6 items. Using a 4-point Likert scale, the scores from high to low are 4, 3, 2, and 1, representing respectively \"Excellent, Good, Average, Poor.The total score of this scale ranges from 6 to 24.the higher the score, the stronger levels of active collaborative learning among students.\u003c/p\u003e\u003ch2\u003e1.3.5 Course Satisfaction\u003c/h2\u003e\u003cp\u003eTo evaluate the effectiveness of the blended learning model, we developed a questionnaire and conducted a survey through the Wenjuanxing platform. The questionnaire covered three dimensions (three items): satisfaction with teaching, satisfaction with learning outcomes, and overall evaluation.Each item offers four response options: Very Satisfied, Satisfied, Dissatisfied, and Very Dissatisfied. The questionnaire achieved a Cronbach's alpha coefficient of 0.742. Prior to the formal survey, researchers randomly selected 10 students for a pre-survey. Feedback indicated that the pre-survey instructions and questionnaire items were easy to understand.\u003c/p\u003e\u003ch2\u003e1.4 Data analysis\u003c/h2\u003e\u003cp\u003eSPSS version 26.0 is used to analyze the date. General information use descriptive analysis.Quantitative datas that follow normal distribution are described by “mean ± standard deviation”, and the comparison between groups is made by two independent samples T-test.Count data were described using frequency and proportion. Comparisons between groups of ordered categorical data were performed using the Mann-Whitney U test ( Wilcoxon Signed-Rank Test).A p value of \u0026lt; 0.05 is considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Demographics\u003c/h2\u003e\u003cp\u003eParticipant characteristics are presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.There are a total of 363 research subjects.There is no statistical difference between the two groups in Demographic information such as gender and age, as well as average score of completed courses (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\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 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant demographic data(N\u0026thinsp;=\u0026thinsp;363)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAverage score of completed courses\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\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(n\u0026thinsp;=\u0026thinsp;188)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80.95\u0026thinsp;\u0026plusmn;\u0026thinsp;6.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExperimental group(n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80.17\u0026thinsp;\u0026plusmn;\u0026thinsp;7.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT/χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.59\u003csup\u003e1)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.73\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e063\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\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\n\u003ch3\u003e1): χ 2): T\u003c/h3\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Course comprehensive Grades\u003c/h2\u003e\u003cp\u003eThe composition and weighting of the course's comprehensive score are as follows: final exam score 60%, pre-test 10%, post-test 10%, and course participation 20%. Students took the final exam immediately after completing the course. Their comprehensive scores were calculated based on the final exam combined with pre-test, post-test, and course participation scores throughout the teaching process. A statistically significant difference was found between the comprehensive scores of the two groups, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Results indicate that the experimental group achieved significantly higher comprehensive scores in the Surgical Nursing course compared to the control group (t = -3.03, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\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 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Course comprehensive Grades in 2 groups (score, x̅\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;S)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"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\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\u003ePre-test\u003c/p\u003e\u003cp\u003e(10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ecourse participation (20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003epost-test(10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003efinal exam score\u003c/p\u003e\u003cp\u003e(60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCourse comprehensive Grades(100)\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\u003e7.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46.81\u0026thinsp;\u0026plusmn;\u0026thinsp;8.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e78.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\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\u003e7.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50.12\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e83.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;7.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;6.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;2.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;3.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.20\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\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003\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\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Self-directed learning ability\u003c/h2\u003e\u003cp\u003eAfter completing the course, an online survey was distributed through the Wenjuanxing platform to assess students' self-directed learning abilities. The scores for the two groups of students are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Results indicate that the experimental group achieved significantly higher scores in self-directed learning abilities than the control group (t = -4.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001),.\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 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Self-directed learning ability in 2 groups (score, x̅\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;S)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\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\u003eSelf-management skills\u003c/p\u003e\u003cp\u003e(10\u0026thinsp;~\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCollaborative Learning Skills(7\u0026thinsp;~\u0026thinsp;35)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInformation Literacy Skills(11\u0026thinsp;~\u0026thinsp;55)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal capacity(28\u0026thinsp;~\u0026thinsp;140)\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\u003e32.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.37\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e91.53\u0026thinsp;\u0026plusmn;\u0026thinsp;16.08\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\u003e39.21\u0026thinsp;\u0026plusmn;\u0026thinsp;9.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.08\u0026thinsp;\u0026plusmn;\u0026thinsp;9.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.26\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e103.81\u0026thinsp;\u0026plusmn;\u0026thinsp;15.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;4.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;3.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;4.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;4.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Critical Thinking Skills\u003c/h2\u003e\u003cp\u003eAfter completing the course, an online survey was distributed through the Wenjuanxing platform to assess students' Critical Thinking Skills. The scores for the two groups of students are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Results indicate that the experimental group achieved significantly higher scores than the control group(t=-3.35 p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Critical Thinking Skills in 2 groups (score, x̅\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;S)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\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=\"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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\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\u003eSeeking Truth(10\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOpen-Mindedness(10\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAnalytical skills(10\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSystematic Capability(10\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCT Self-Confidence(10\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCuriosity\u003c/p\u003e\u003cp\u003e(10\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCognitive Maturity(10\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTotal Score\u003c/p\u003e\u003cp\u003e(70\u0026thinsp;~\u0026thinsp;420)\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\u003e36.39\u0026plusmn;\u003c/p\u003e\u003cp\u003e9.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.13\u0026plusmn;\u003c/p\u003e\u003cp\u003e9.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.92\u0026plusmn;\u003c/p\u003e\u003cp\u003e9.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.94\u0026plusmn;\u003c/p\u003e\u003cp\u003e11.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45.84\u0026plusmn;\u003c/p\u003e\u003cp\u003e11.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e37.71\u0026plusmn;\u003c/p\u003e\u003cp\u003e8.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e42.48\u0026plusmn;\u003c/p\u003e\u003cp\u003e11.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e344.84\u0026plusmn;\u003c/p\u003e\u003cp\u003e43.78\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\u003e41.47\u0026plusmn;\u003c/p\u003e\u003cp\u003e11.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.26\u0026plusmn;\u003c/p\u003e\u003cp\u003e9.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.29\u0026plusmn;\u003c/p\u003e\u003cp\u003e8.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39.56\u0026plusmn;\u003c/p\u003e\u003cp\u003e12.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45.84\u0026plusmn;\u003c/p\u003e\u003cp\u003e11.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e44.38\u0026plusmn;\u003c/p\u003e\u003cp\u003e10.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e48.84\u0026plusmn;\u003c/p\u003e\u003cp\u003e13.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e376.84\u0026plusmn;\u003c/p\u003e\u003cp\u003e72.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;3.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;2.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;5.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;2.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;4.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;2.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;4.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;3.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.04\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\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.001\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\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Active Collaborative Learning Ability\u003c/h2\u003e\u003cp\u003eAfter completing the course, an online survey was distributed through the Wenjuanxing platform to assess students' Active Collaborative Learning Ability. The scores for the two groups of students are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Results indicate that the experimental group achieved significantly higher scores than the control group(t=-3.67 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)。\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Active Collaborative Learning Ability in 2 groups(score, x̅\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;S)\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\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperimental group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActive Collaborative Learning Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u0026minus;3.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Course Satisfaction\u003c/h2\u003e\u003cp\u003eAfter completing the course, an online survey was distributed through the Wenjuanxing platform to assess students' evaluations of teaching methods, learning outcomes, and overall evaluations.The specific evaluations are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.The results showed that the evaluation scores of the experimental group students were all higher than those of the control group(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Course Satisfaction in 2 groups(Frequency, composition ratio)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\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=\"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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eExperimental group(n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eControl group(n\u0026thinsp;=\u0026thinsp;188)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery Satisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDissatisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVery Dissatisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVery Satisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSatisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDissatisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eVery Dissatisfied\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eteaching methods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76\u003c/p\u003e\u003cp\u003e(43.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88\u003c/p\u003e\u003cp\u003e(50.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(5.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45\u003c/p\u003e\u003cp\u003e(23.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e113\u003c/p\u003e\u003cp\u003e(60.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19\u003c/p\u003e\u003cp\u003e(10.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(5.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;4.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003elearning outcomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003cp\u003e(46.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003cp\u003e(47.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(2.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61\u003c/p\u003e\u003cp\u003e(32.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e86\u003c/p\u003e\u003cp\u003e(45.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e17\u003c/p\u003e\u003cp\u003e(9.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e(13.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;3.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eoverall evaluation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003cp\u003e(40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94\u003c/p\u003e\u003cp\u003e(53.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(3.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(2.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e56\u003c/p\u003e\u003cp\u003e(29.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e94\u003c/p\u003e\u003cp\u003e(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003cp\u003e(10.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(9.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;3.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.001\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":"\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e3.1 The \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model contributes to improving students' course comprehensive grades.\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reveals that the experimental group achieved significantly higher scores than the control group, indicating that the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model enhances student academic performance. This finding aligns with research by Zhang Qing, Aida Bazrgar, and others [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; teaching model emphasizes student-centered, participatory instruction, striving to enable students to fully exercise their initiative and engagement in the classroom.Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the experimental group's course participation scores were significantly higher than the control group's, with post-test scores, final exam scores, and course comprehensive grades all significantly higher than the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Furthermore, linear correlation analysis revealed positive correlations between course participation and post-test(r\u0026thinsp;=\u0026thinsp;0.286, p\u0026thinsp;=\u0026thinsp;0.001), final exam scores (r\u0026thinsp;=\u0026thinsp;0.302, p\u0026thinsp;=\u0026thinsp;0.001), and course comprehensive grades (r\u0026thinsp;=\u0026thinsp;0.370, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This indicates that increasing course participation can enhance performance on post-test, final exams, and course comprehensive grades.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e3.2 The \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model helps enhance students' Self-directed learning ability.\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the experimental group's scores for self-directed learning ability were significantly higher than those of the control group. This finding aligns with the research results of Siying Lu, Anyan Duan [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and others.This indicates that the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended teaching method helps enhance students' Self-directed learning abilities.\u003c/p\u003e\u003cp\u003eTraditional blended learning requires students to complete assigned tasks before class, yet they often lack clarity on learning objectives. This will result in students lacking clear objectives and motivation for online learning,while classroom instruction remains teacher-centered, with students primarily passively absorbing knowledge [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]。Under the guidance of the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model, instructors publish learning objectives through the online platform prior to class and provide learning materials such as instructional videos and case studies. Guided by learning objectives, students independently select relevant content through the online platform for self-directed learning. When encountering difficulties during study, they promptly engage in discussions with peers and instructors to ultimately achieve the learning goals.In the classroom, teachers adhere to the principles of the \u0026ldquo;PAD\u0026rdquo; teaching method, dedicating half the class time to student-centered activities. Students engage in discussions with their group members based on learning objectives or assigned tasks, exchange ideas with peers from other groups, and finally report their insights to classmates or the teacher. They may also raise questions during this process. The teacher's role is to guide students in deepening their thinking step by step and promptly address any doubts that arise.Whether online or offline, students' autonomy in learning is fully exercised and cultivated under the guidance of learning objectives or driven by learning tasks, self-directed learning abilities have been significantly enhanced.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e3.3 The \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model helps cultivate students' critical thinking skills.\u003c/h2\u003e\u003cp\u003eCritical thinking is the process of reflecting on and questioning one's own or others' viewpoints, and it is the process of conducting independent analytical thinking.In the face of increasingly complex nursing environments and growing care demands, cultivating students' critical thinking skills is crucial for enhancing nursing quality [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the experimental group's scores for critical thinking ability were significantly higher than those of the control group. This finding aligns with the research's results of Zhang Guangyu, Jiang Tao, et al[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].In traditional blended learning, after teachers deliver key content in lectures, students must immediately engage in discussions due to limited class time. However, at this stage, students have not yet fully understood or assimilated the knowledge, making it difficult for them to conduct deep thinking and comprehensive analysis. Consequently, this blend learning model is not conducive to cultivating critical thinking skills.Following the blended learning model of \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD,\u0026rdquo; instructors consistently adhere to the principle of student-centered learning [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Before class, teachers upload resources such as learning objectives, tasks, and key concepts to the online learning platform. Students proactively access the platform to study based on these objectives or tasks. When encountering challenges during their learning journey, they are encouraged to engage in deep thinking, explore solutions, and seek answers. They may also initiate discussions on the platform or share their questions and insights during offline class discussions.Teachers then provide targeted guidance based on the questions raised, helping students overcome challenges. This interactive learning approach transforms students from passive recipients into active participants in their learning journey, fostering a high level of interest in learning and enhancing their critical thinking skills [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003e3.4 The \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model helps enhance students' active collaborative learning abilities.\u003c/h2\u003e\u003cp\u003eThe modern healthcare environment emphasizes multidisciplinary teamwork (MDT). Only through effective collaboration among nurses, physicians, rehabilitation specialists, nutritionists, and other healthcare professionals can effectively resolve complex clinical health issues,ensure patient safety, and provide high-quality holistic care [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].Therefore, cultivating undergraduate nursing students' ability for active collaborative learning is key to developing composite nursing professionals who can adapte to future challenges.Following the blended learning model of \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD,\u0026rdquo; the teacher divided the class into 5\u0026ndash;6 groups before the lesson, with each group consisting of one leader and 4\u0026ndash;5 members. During the in-person instruction, the teacher required students to engage in learning, discussion, and exchange within their respective groups.To better achieve learning objectives, the team leader must assign tasks reasonably based on each member's strengths and capabilities. Team members must collaborate closely and communicate promptly and effectively to accomplish shared goals. When challenges arise, the group must harness its team wisdom to analyze problems, engage in in-depth discussions, and exchange insights to resolve issues efficiently and effectively.In group-based case study discussions, students' active collaborative learning abilities are fully developed.This study demonstrates that the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model significantly enhances students' active collaborative learning abilities compared to traditional blended learning models (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003e3.5 The \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model helps enhance students' course satisfaction.\u003c/h2\u003e\u003cp\u003ethis study showed that the evaluation of the experimental group students were all higher than those of the control group(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05),The specific evaluation are shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.This result is consistent with the findings of Deng Fengyuan, Xia Ningning, and others[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].Following the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model, the teaching team refined online resources that including uploading instructional videos, teaching cases, and key learning points before students taking this course.The abundance of online resources enables students to utilize fragmented time for learning, better meeting their learing needs;Students can participate in instruction both online and offline.In online discussion forums, students can engage in real-time interaction with teachers and peers. In offline classrooms, half of the class time is dedicated to student-centered discussions and exchanges. When encountering difficulties during the learning process, students can receive timely and effective assistance, enabling them to resolve issues more efficiently and effectively. This model significantly meets students' learning needs, enhances their learning experience and academic performance,and consequently increases their satisfaction with classroom instruction.\u003c/p\u003e\u003c/div\u003e"},{"header":"Summary","content":"\u003cp\u003eThis study implemented the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended teaching model in Surgical Nursing, which effectively enhancing students' self-directed learning abilities, critical thinking skills, and proactive collaborative learning capabilities. It also improved students' course performance and teaching satisfaction.However, this study was limited by abservation time and single source of sample data. In future, research will expand the scope of instructional implementation, increase sample size, and extend the study duration to further validate the effectiveness of the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMeichun Tan:Conceptualization、methodology、writing、review and editing;Zheng Ruan:Questionnaire preparation, distribution, data collection and collation;Yunxia Ding,Wenjuan Xi:writing,original draft preparation;Caiyu Shen: questionnaires distribution ,data collection All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003e\u0026ldquo;Data is provided within the manuscript，Due to privacy/ethical concerns, the raw data supporting the findings of this study cannot be made openly available. However, de-identified data are available from the corresponding author upon reasonable request, subject to approval by the institutional ethics committee and the execution of a data use agreement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJiaying LSZO,Yang, Wang et al. BOPPPS model implementation and students'performance: asystematic literature review[J].Frontiers in Education, 2025,9:05\u0026ndash;09.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChunlian PHYX, Li, et al. Application of the Case-Based Collaborative Classroom Teaching Method in Nursing Education for Undergraduate Nursing Students in On-Site Classes[J]. J Nurs Sci. 2024;39(23):74\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu Peng L, Sha Y, Liu, et al. Application of the 7E Teaching Model in Clinical Internship Instruction for Surgical Nursing[J]. Chin Nurs Educ. 2023;20(8):951\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin Y. Anli Jiang. Development of an Assessment Scale for Self-Directed Learning Competence Among Nursing Undergraduates [J]. PLA Nursing Journa,l2004,(06):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMeici Peng G, Wang J, Chen et al. Research on the Reliability and Validity Testing of the Critical Thinking Ability Measurement Scale [J]. Chin J Nurs 2004(09):644\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJinghuan Shi H, Zhang F, Guo. Exploring Chinese Learners' Phenomena and Efforts to Construct Autonomous Knowledge in Pedagogy: A Case Study of the Fifteen-Year Exploration of the Chinese College Students' Study and Development Tracking Study (CCSS) Project [J]. J East China Normal Univ (Educational Sci Ed. 2024;42(11):12\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Q, Xiao J, Tang Y et al. Application Research of BOPPPS Combined with Micro-Lesson Teaching Model in Breast Surgery Nursing Education [J]. Clin Med Pract 2024,33(05):370\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAida Bazrgar M, Rahmanian A, Ghaedi, et al. Face-to-face, online, or blended: which method is more effective in teaching electrocardiogram to medical students[J]. BMC Med Educ. 2023;23:566\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCai L, Luo P. Qingqing Hu, Application of Blended Learning Based on the BOPPPS Model in Clinical Teaching of General Surgery [J]. Lingnan J Emerg Med 2024,29(02):137\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLu SY, Ren XP, Xu H, et al. Improving self-directed learning ability of medical students using the blended teaching method: a quasi-experimental study[J]. BMC Med Educ. 2023;23:616\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnyan Duan F, Jiang L, Li, et al. Design and practice of blended teaching of internal medicine nursing based on O-AMAS effective teaching model[J]. BMC Med Educ. 2024;24:580\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaina Feng Q, Zhong M, Liu et al. Application of Blended Learning in an Elective Course on Disaster Nursing [J]. Chin J Nurs Educ 2022,19(4):309\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTao P, Huang H, Pan X et al. Application of Scenario-Based Flipped Classroom Teaching Method in Cultivating Critical Thinking Skills Among Nursing Students [J]. Chinese Higher Medical Education,2024,(2):110\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang G, Tu S, Zou Q, et al. Application Exploration of the Split-Classroom Approach in Enhancing Clinical Thinking Skills Among Undergraduate Nursing Students in Obstetrics and Gynecology Nursing Education [J]. Health Educ. 2018;36:146\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTao Jiang S, Liu X, Li et al. Application Exploration of BOPPPS-Based Blended Learning Model in Cultivating Critical Thinking Among Undergraduate Neurosurgery Students [J]. J Qiqihar Med Coll 2025,46(15):1475\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHang F, Wang J, Zhang Y et al. A Qualitative Study on Undergraduate Nursing Students' Learning Experiences with the BOPPPS Teaching Model in Surgical Nursing [J]. Health Vocat Educ 2024,42(04):93\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTang XY, Xuejiao H, Guozu. Enhancing educational through blended teaching: an analysis of teaching and learning quality with learning environment and social impacts[J]. Front Educ. 2025;10:05\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYanjie H, Li L, Tian Y, et al. First-class discipline construction of nursing leads first-class talent cultivation[J]. J Sichuan Univ (Medical Edition). 2023;54(1):102\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFengyuan Deng X, Yue P, Junhua et al. Exploration of an Online-Offline Integrated Teaching Model for Pathophysiology: BOPPPS Combined with PAD [J]. Basic Medical Education,2025,27(8): 755\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNingning, Xia. Jing Liu and Hongying Wang.Effectiveness of a BOPPPSteaching in blood purificationnursing within the context ofresident teaching[J]. Front Educ. 2025;6:05\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"BOPPPS, PAD, Blended learning model, Surgical Nursing, Teaching effectiveness","lastPublishedDoi":"10.21203/rs.3.rs-7677614/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7677614/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThe study aimed to Design and Implementation of the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended Learning model in Surgical Nursing teaching, and evaluate Its Outcomes\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 363 undergraduate nursing students enrolled in 2021 and 2022 were selected as research subjects by using convenience sampling. The 188 students enrolled in 2021 formed the control group, while the 175 students enrolled in 2022 constituted the experimental group.For the control group students, instructors delivered surgical nursing instruction using traditional blended learning model which centered on classroom instruction supplemented by online resources. For the experimental group students, instructors implemented surgical nursing instruction through the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended teaching methodology. After completing the course, learning outcomes and course satisfaction were compared between the two groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe course comprehensive grades for students in the control group and experimental group were 78.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41 and 83.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.42, respectively (t = -3.03, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01); The self-directed learning ability scores were 91.53\u0026thinsp;\u0026plusmn;\u0026thinsp;16.08 and 103.81\u0026thinsp;\u0026plusmn;\u0026thinsp;15.48, respectively (t = -4.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); The critical thinking ability scores were 344.84\u0026thinsp;\u0026plusmn;\u0026thinsp;43.78 and 376.84\u0026thinsp;\u0026plusmn;\u0026thinsp;72.33, respectively (t = -3.35, p\u0026thinsp;=\u0026thinsp;0.001); Active collaborative learning ability scores were 16.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.57 and 18.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05, respectively (t = -3.67, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). All results showed statistically significant differences. Course satisfaction among experimental group students was higher than that of the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating a statistically significant difference.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe implementation of the \u0026ldquo;BOPPPS\u0026thinsp;+\u0026thinsp;PAD\u0026rdquo; blended learning model in Surgical Nursing teaching enhances students' academic performance and course satisfaction, while fostering their self-directed learning abilities, critical thinking skills, and active collaborative learning capabilities.\u003c/p\u003e","manuscriptTitle":"Design and practice of the “BOPPPS+PAD” Blended Learning Model in Teaching of Surgical Nursing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:53:40","doi":"10.21203/rs.3.rs-7677614/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-20T09:14:12+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"224144284817931593036642094389490532933","date":"2025-11-02T07:39:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-01T21:09:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-31T11:27:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189230654717160444558977157194229317944","date":"2025-10-31T09:17:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125762985884559113308836196428021726648","date":"2025-10-31T07:38:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-31T07:35:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T18:02:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-03T10:31:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-03T09:13:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-10-03T09:10:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4cce1ed-a82c-4bfb-a601-7062dd82bebb","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-06T09:40:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 16:53:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7677614","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7677614","identity":"rs-7677614","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}