3D Printing and Mind Mapping in Clinical Orthopedic Nursing Education: A Comparative Randomized Controlled Trial

3D Printing and Mind Mapping in Clinical Orthopedic Nursing Education: A Comparative Randomized Controlled Trial | 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 3D Printing and Mind Mapping in Clinical Orthopedic Nursing Education: A Comparative Randomized Controlled Trial Juan Wang, Jing Xu, Hui Wang, Jianwen Hou, Zhihong Li, Chong Gao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6095564/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Clinical internships are crucial in nursing education, requiring interns to quickly merge theory with practice in a limited time. Purpose To assess integrating 3D printing and mind mapping in orthopedic nursing education. Methods A randomized controlled trial with 60 nursing interns was conducted. The control group (CG) received traditional teaching, the observation group (OG) was introduced to 3D printed models and mind mapping. Performance was evaluated through assessments and questionnaires. Results The CG score vs the OG score, Theoretical Assessment: 84.90 ± 4.79 vs 89.83 ± 2.94(P < 0.001). Practical Assessment: 80.70 ± 7.42 vs 89.57 ± 2.71(P < 0.001).Improvement in OG vs CG. Learning Interest: 21 vs 11(P = 0.01). Cognitive Abilities: 25 vs 18(P = 0.04). Self-directed Learning: 25 vs 10(P < 0.001). Communication and Collaboration: 24 vs.16(P = 0.03).Information Synthesis: 25 vs 21(P < 0.001). Conclusion Integrating 3D printing and mind mapping significantly enhances theoretical and practical performance, suggesting a promising approach for nursing interns. Orthopedic Nursing Three-Dimensional Printing Mind Mapping Clinical Internship Models Educational Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Clinical nursing internships are a pivotal component of medical education for nursing professionals, where interns must swiftly integrate theoretical knowledge with practical experience within a constrained timeframe. This phase is essential for nursing interns to acquire specialized knowledge and skills, as well as to enhance their critical thinking, teamwork, and communication competencies [ 1 ] . The training of clinical orthopedic specialty nursing skills is marked by a vast curriculum encompassing joints, trauma, the spine, sports medicine, bone diseases, and more, within a relatively brief period of instruction [ 2 ] . Furthermore, orthopedic specialty education encompasses extensive anatomical knowledge of skeletal muscles, yet it faces challenges such as the imprecision of bone models and the scarcity of physical specimen resources [ 3 ] . The conventional pedagogical model, which is instructor-centric and employs a mix of materials, clinical skill demonstrations, and other teaching strategies, falls short of delivering effective and profound learning experiences. It also impedes the development of students' creative thinking and problem-solving skills [ 4 – 5 ] . In response, a variety of innovative approaches have been introduced to clinical teaching to augment traditional methods. Notably, mind mapping, once the central concept is established, employs a vibrant palette of colors and lines to visually and textually organize a structured knowledge framework. This straightforward and cognitively accessible method facilitates better comprehension, analysis, and synthesis of knowledge points. It sustains students' engagement and fosters their self-directed learning and critical thinking capabilities, aligning with the objectives of orthopedic clinical nursing education [ 6 ] . However, it primarily addresses cognitive aspects and may not fully support the nuanced requirements of individualized fracture treatment. Three-dimensional (3D) printing, a cutting-edge rapid prototyping technology, can vividly and precisely present patients' fracture types and locations, enabling personalized care and addressing the limitations posed by the paucity of physical specimens [ 7 , 8 , 9 ] . To date, no studies have explored the integration of these two educational strategies. This study pioneers the application of 3D printing technology in conjunction with mind mapping in the education of orthopedic nursing interns, assessing its impact on elevating the quality of their training, and the findings are reported as follows. Methods General Information This study involved 60 nursing interns who completed rotations in the Orthopedics Department of The Second People’s Hospital of Lianyungang between August 2019 and August 2021. Participants were selected according to pre-defined inclusion and exclusion criteria. The inclusion criteria were as follows: 1) Willingness to participate in the study and to sign an informed consent form; 2) Agreement to subsequent follow-up; 3) Lack of prior exposure to related research training, specifically in thinking skills. The exclusion criteria included: 1) Absences exceeding three consecutive days or a total of more than five days; 2) Failure to sign the informed consent form; 3) Previous training in mind mapping techniques. Participants were randomly assigned to either the observation group or the control group using a random number table, with 30 individuals in each group. The groups comprised 5 males and 55 females, with ages ranging from 16 to 18 and initial theoretical scores between 39 and 71 points. No statistically significant differences were observed between the groups in terms of demographic and baseline characteristics (see Table 1 ). The internship period was set at four weeks. Both groups received instruction from teaching staff with the rank of head nurse or higher, ensuring consistency in teaching quality and hours. The study was granted approval by the hospital's ethics committee, with the ethical approval, Clinical trial number: 2019-025. Table 1 Comparison of General Information between Control Group and Observers Group Gender (M/F) Mean Age (years ± SD) Mean Admission (Score ± SD) Control 3/27 16.93 ± 0.36 54.40 ± 9.587 Observation 2/28 16.97 ± 0.32 54.67 ± 11.32 Statistical Analysis: T-test for age: T = 2.18, P = 0.64 T-test for admission score: T = 0.37, P = 0.71 Chi-square test for gender distribution: χ2 = 0.98, P = 0.92 Establishment of a Professional Teaching Team Our study assembled a team of educators with a minimum of a bachelor's degree, intermediate or higher professional qualifications, and a valid teaching certificate. Each member had accrued at least three years of teaching experience and possessed over five years of specialized expertise in orthopedics. Additionally, they had completed specialized training in mind mapping and 3D printing, successfully passing the relevant assessments. Throughout the research period, this dedicated team provided instruction for both the control and observation groups. Control Group Participants in the control group were educated using conventional pedagogical tools, such as teaching models, images, videos, and radiographic materials. They were introduced to the standard protocols for nursing care in common orthopedic conditions, including emergency and perioperative nursing, based on a robust theoretical framework. Practical skills demonstrations included techniques like axial rotation, wheelchair handling, and patient transfer. Enhanced Teaching in the Observation Group Beyond the traditional teaching approaches of the control group, the observation group was further enriched with the integration of 3D printing technology and mind mapping. The educational content focused on the nursing care of patients with pelvic fractures, drawing from the sixth edition of Surgical Nursing. Utilizing X-Mind 8.0 software, the educational material was structured into a comprehensive mind map, with "Pelvic Fracture Nursing Care" as the central theme. This map expanded to include detailed sub-branches covering etiology, diagnostic procedures, classification, and nursing interventions. A 3D printed model of a pelvic fracture was employed to facilitate an in-depth exploration of injury mechanisms, diagnostic comparisons, and the nuances of nursing care. Interactive discussions were fostered among the students, and the 3D model was circulated to enhance learning through multiple sensory modalities. Students were then encouraged to construct their own mind maps, aligning with the educational objectives and critically analyzing the variances in their maps relative to the instructor's. This approach aimed to bolster the students' self-directed learning and critical thinking competencies (Figs. 1 and 2 ). Assessment Criteria Exit Examination The exit examination is divided into two parts: theoretical assessment(Supplementary material 1)and practical skills assessment༈Supplementary material 2༉. The theoretical assessment is collaboratively developed by the designated instructors of both groups and must be reviewed and approved by the head nurse before use. The practical skills assessment adheres to our hospital's "Clinical Nursing Technical Operation Procedures and Standards for 2019." Both theoretical and practical assessments are scored using a percentage system. Teaching Effectiveness Evaluation Questionnaire The researchers have independently designed a teaching effectiveness satisfaction evaluation questionnaire(Supplementary material 3), which includes five items: learning interest, thinking ability, self-learning ability, communication and collaboration ability, and summarization ability. The questionnaire employs a 3-point Likert scale, with options for improvement, unclear, and no improvement. On the day of the nursing students' exit from the department, the questionnaires are distributed for anonymous completion and are collected immediately afterwards. Statistical Methods Continuous data are presented as mean ± standard deviation (x̄ ± s), and categorical data are analyzed using the chi-square test. For small sample sizes (n ≤ 5), Fisher's exact test is applied. Continuous data are compared using independent samples t-tests, with a significance level set at α = 0.05. Results Theoretical and Practical Assessment Scores The control group achieved a mean theoretical assessment score of 84.90 with a standard deviation of 4.79, while the observation group scored a mean of 89.83 with a standard deviation of 2.94. For practical assessments, the control group's mean score was 80.70 with a standard deviation of 7.42, and the observation group's was 89.57 with a standard deviation of 2.71. Comparative analysis revealed statistically significant differences between the two groups in both theoretical and practical assessment scores (see Fig. 3 ). Improvement in Competencies Learning Interest : In the observation group, 21 participants showed improvement and 9 showed no improvement. In the control group, 11 participants improved and 19 did not. Cognitive Abilities : 25 participants in the observation group and 18 in the control group demonstrated enhanced cognitive abilities, with 5 and 12 participants, respectively, showing no improvement. Self-Learning Abilities : 25 participants in the observation group reported improved self-learning abilities, with 5 showing no change. In the control group, 10 participants reported improvement, and 20 did not. Communication and Collaboration Skills : 24 participants in the observation group showed enhanced communication and collaboration skills, with 1 showing no improvement. In the control group, 16 participants improved and 14 did not. Summarization and Synthesis Abilities : All 25 participants in the observation group reported improved abilities in summarization and synthesis, while 21 participants in the control group showed improvement, and 9 did not. Statistical analysis indicated significant differences between the two groups across all evaluated competencies (see Fig. 4 ). Discussion Cultivation of Clinical Orthopedic Specialty Nursing Skills The development of clinical orthopedic specialty nursing skills is essential for nursing interns to apply foundational theoretical knowledge in practical care scenarios. However, the brief duration of orthopedic internship rotations poses challenges in achieving proficiency within a constrained timeframe [ 9 ] . Traditional teaching models have been criticized for their suboptimal effectiveness. In these models, the teacher is at the center, with students in a passive role, often leading to low engagement and, consequently, low learning efficiency [ 1 , 10 ] . Orthopedic nursing, encompassing areas such as joints, spine, trauma, hand surgery, and bone diseases, demands a strong anatomical foundation, spatial imagination, and adaptive thinking from students. The rote memorization often employed in traditional teaching is monotonous and does not foster effective clinical learning [ 11 ] . Innovative Approaches to Enhance Learning To address these pedagogical shortcomings, our study introduces the use of 3D printed models to replicate patients' fractures and deformities with precision, offering tangible and intuitive educational tools. The novelty of 3D printed models has piqued the interest of nursing interns, as evidenced by the heightened learning enthusiasm observed in the observation group compared to the control group, a difference that is statistically significant [ 12 ] . This increased interest also fosters improved teacher-student interaction. The vivid and interactive nature of individualized 3D printed models enhances cognitive learning and significantly improves communication skills in the observation group [ 12 ] . Furthermore, mind mapping techniques, utilizing a variety of colors, forms, images, and videos, create a structured cognitive framework that reinforces memory points and bolsters the thinking, organizational, self-study, and summarization abilities of nursing interns. The enhanced abilities are reflected in the superior performance of the observation group in departmental assessments compared to the control group. Acknowledging Study Limitations It is important to acknowledge the limitations of this study, including a small sample size, the necessity to expand the sample to mitigate selection bias, and the lack of a double-blind assessment which could introduce potential errors. Conclusion The integration of 3D printed models and mind mapping in the cultivation of clinical orthopedic specialty nursing skills has demonstrated significant educational advantages. This innovative approach effectively boosts the learning interest and enthusiasm of nursing interns, leading to a more proactive and engaged learning experience. Furthermore, it enhances core competencies, including self-study, summarization, and critical thinking abilities, which are essential for the mastery of complex orthopedic concepts. By providing a more interactive and visual learning environment, 3D printed models offer a tangible understanding of anatomical structures and pathological conditions, facilitating a deeper cognitive engagement with the subject matter. Mind mapping, with its structured visual representation, aids in organizing information, reinforcing memory, and fostering a comprehensive understanding of the material. The combined use of these tools not only equips nursing interns with a robust knowledge base in orthopedics but also contributes to the development of personal comprehensive qualities. These include communication and cooperation skills, which are indispensable for effective teamwork in clinical settings, and the ability to synthesize and apply knowledge in innovative ways. This educational strategy, therefore, prepares nursing interns to excel in their professional roles, ensuring they are well-equipped to meet the demands of contemporary healthcare and contribute meaningfully to patient care. Abbreviations Control Group CG Observation Group OG Standard Deviation SD Conceive, Design, Implement, Operate CDIO Clinical Evaluation Exercise CEX Problem-Based Learning PBL Case-Based Learning CBL Declarations Ethics approval and consent to participate The study was granted approval by the hospital's ethics committee, with the ethical approval, Clinical trial number: 2019-025. All students and patients involved in this project have provided informed consent and are willing to participate in this study. This study complies with the Declaration of Helsinki. Consent for publication Informed consent for publication was obtained from all individuals whose data are included in this manuscript. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Lianyungang Science and Technology Bureau Basic Research Program (General Program), number: JCYJ2431; Lianyungang Health Science and Technology Project for Young Doctors, number: QN202416; Natural Science Foundation of Bengbu Medical College, number: 2020byzd338. Authors' contributions Juan Wang, Zhihong Li, Jing Xu and Chong Gao.wrote the main manuscript text and Hui Wang, Jianwen Hou.prepared figures.All authors reviewed the manuscript. Acknowledgements Thanks to Weimin Wang, Nini Zhu, Fang Zhai, Xing Jing, and 60 other students for participating in the study. Also, gratitude to Teacher Shihua Zhao for the technical support provided. We are also grateful for the assistance provided by artificial intelligence，kimi， in refining and polishing the language of this manuscript. References Krishnamurthy K, Selvaraj N, Gupta P, et al. Benefits of gamification in medical education. Clin Anat.2022;35(6):795-807. Keating TC, Jacobs J. Augmented reality in orthopedic practice and education. Orthop Clin North Am.2021;52(1):15-26. González Blum C, Richter R, Fuchs R, et al. An interprofessional teaching approach for medical and physical therapy students to learn functional anatomy and clinical examination of the lower spine and hip. Ann Anat.2020;231:151534. Wan C, Li X, Ding X, Gao L. Application of 3D printing technology combined with problem-based and case-based learning in the training of orthopedic nurses' specialized skills. J Nurs.2019;34(8):756-759. Su X, Ning H, Zhang F, Liu L, Zhang X, Xu H. Application of flipped classroom based on CDIO concept combined with mini-CEX evaluation model in the clinical teaching of orthopedic nursing. BMC Med Educ.2023;23:219. Liu T, Yuizono T. Mind mapping training's effects on reading ability: detection based on eye-tracking sensors. Sensors (Basel).2020;20(16):4422. Skelley NW, Smith MJ, Ma R, et al. Three-dimensional printing technology in orthopaedics. J Am Acad Orthop Surg.2019;27(24):918-925. Jones DG. Three-dimensional printing in anatomy education: assessing potential ethical dimensions. Anat Sci Educ.2019;12(4):435-443. Spencer SR, Watts LK. Three-dimensional printing in medical and allied health practice: a literature review. J Med Imaging Radiat Sci.2020;51(3):489-500. Li S, Wang Y, Han J, et al. The effect of mind mapping combined with case teaching method in clinical nursing safety training for new nurses in surgery. Contem Nurse.2021;28(1):166-169. Liu J, Wang Z, Zhao K, et al. Application of 3D printed models in problem-based learning clinical teaching in orthopedics.Health Vocat Educ.2022;40(7):85-87. Magklara EP, Angelis S, Solia E, et al. Three-dimensional (3D) printing in orthopedics education. J Long Term Eff Med Implants.2020;30(4):255-258. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial1.docx Supplementarymaterial2.docx Supplementarymaterial3.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 10 Jul, 2025 Reviews received at journal 08 May, 2025 Reviews received at journal 02 May, 2025 Reviewers agreed at journal 28 Apr, 2025 Reviewers agreed at journal 24 Apr, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviewers agreed at journal 16 Apr, 2025 Reviewers invited by journal 14 Apr, 2025 Editor assigned by journal 08 Apr, 2025 Editor invited by journal 18 Mar, 2025 Submission checks completed at journal 17 Mar, 2025 First submitted to journal 17 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6095564","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449085724,"identity":"ffb864a2-016e-4254-94d1-92a7529a59ce","order_by":0,"name":"Juan Wang","email":"","orcid":"","institution":"The Second People’s Hospital of Lianyungang","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Wang","suffix":""},{"id":449085726,"identity":"b54ee154-0a44-43af-9c95-86ebb276630a","order_by":1,"name":"Jing Xu","email":"","orcid":"","institution":"The Second People’s Hospital of Lianyungang","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Xu","suffix":""},{"id":449085728,"identity":"1a57d066-f69d-4647-921b-f73c64e45116","order_by":2,"name":"Hui Wang","email":"","orcid":"","institution":"The Second People’s Hospital of Lianyungang","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Wang","suffix":""},{"id":449085731,"identity":"130785b4-4168-4424-8c75-5f9109185bbe","order_by":3,"name":"Jianwen Hou","email":"","orcid":"","institution":"The Second People’s Hospital of Lianyungang","correspondingAuthor":false,"prefix":"","firstName":"Jianwen","middleName":"","lastName":"Hou","suffix":""},{"id":449085732,"identity":"f9728fa6-d16b-43ab-b38e-48c82b08ea8c","order_by":4,"name":"Zhihong Li","email":"","orcid":"","institution":"The Second People’s Hospital of Lianyungang","correspondingAuthor":false,"prefix":"","firstName":"Zhihong","middleName":"","lastName":"Li","suffix":""},{"id":449085733,"identity":"839aed07-ed3b-4ad4-9d49-0ef57e0432f7","order_by":5,"name":"Chong Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACxobDBx8k/rGx42dvIFILc+OxZIOHDWnJkj0HiNTC3nzGTPJhwyHGDTMSiNTC23YsQSJxxwFmA8nHG28w1NhEE9Qi2XP4gEHimTt85tJpxRYMx9JyGwhpMZxxLCEhge0Zs+XsHDMJYGAQ1mJ//43BgQS2w4wbbp4hUgtjwxnDhsQ2oJYbPERrOZbMkHAGFMhAvyQQ4xegucd//qgAReXhjTc+1NgQ1oIMDCQSSFEO0UKqjlEwCkbBKBgZAACfIEpE/HeAQgAAAABJRU5ErkJggg==","orcid":"","institution":"The Second People’s Hospital of Lianyungang","correspondingAuthor":true,"prefix":"","firstName":"Chong","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2025-02-24 09:53:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6095564/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6095564/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81631331,"identity":"13e5e245-ac8d-4152-be81-1e3f33ac645d","added_by":"auto","created_at":"2025-04-29 11:33:36","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":708838,"visible":true,"origin":"","legend":"\u003cp\u003eMind Map for Pelvic Fracture Nursing\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6095564/v1/68bf94b69930106d89347c87.jpeg"},{"id":81632077,"identity":"8e4879b1-0a52-477f-85b1-ff32de5317a7","added_by":"auto","created_at":"2025-04-29 11:41:36","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":817340,"visible":true,"origin":"","legend":"\u003cp\u003eIndividualized 3D Pelvic Fracture Model\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6095564/v1/54669b3ded1458c1b9f7d569.jpeg"},{"id":81631327,"identity":"dbd64f36-2f50-4b6c-a655-fcb1ee3efd44","added_by":"auto","created_at":"2025-04-29 11:33:36","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":76531,"visible":true,"origin":"","legend":"\u003cp\u003eTheoretical and Practical Assessment Scores\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6095564/v1/b620764ddc12df545dfdc069.jpeg"},{"id":81630997,"identity":"e1dd16dd-3dd5-4a4d-bf25-fa01f7ec1428","added_by":"auto","created_at":"2025-04-29 11:25:36","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":152649,"visible":true,"origin":"","legend":"\u003cp\u003eTeaching Effectiveness Evaluation Questionnaire\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6095564/v1/084964ff3ee68a46a3324e60.jpeg"},{"id":81696422,"identity":"c4a798eb-533d-4910-a0ce-75561c61b675","added_by":"auto","created_at":"2025-04-30 12:14:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2454782,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6095564/v1/a89c5d45-b616-4166-9a5b-72a5bdf56a88.pdf"},{"id":81631328,"identity":"a7264e15-ab19-4395-9f48-cf7078f02fd8","added_by":"auto","created_at":"2025-04-29 11:33:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":28503,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6095564/v1/46510e9e3327f0d5797ed405.docx"},{"id":81630992,"identity":"4a9796cb-f10a-43b8-a9e6-63ed9a861ce9","added_by":"auto","created_at":"2025-04-29 11:25:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":41388,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6095564/v1/e9f86b72eeb14e71129dd7d4.docx"},{"id":81631329,"identity":"bb7e7da0-62ff-4e6b-b88c-395132b2562d","added_by":"auto","created_at":"2025-04-29 11:33:36","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":23995,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6095564/v1/eedea4b3e296308f8b3a83c7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"3D Printing and Mind Mapping in Clinical Orthopedic Nursing Education: A Comparative Randomized Controlled Trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eClinical nursing internships are a pivotal component of medical education for nursing professionals, where interns must swiftly integrate theoretical knowledge with practical experience within a constrained timeframe. This phase is essential for nursing interns to acquire specialized knowledge and skills, as well as to enhance their critical thinking, teamwork, and communication competencies \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The training of clinical orthopedic specialty nursing skills is marked by a vast curriculum encompassing joints, trauma, the spine, sports medicine, bone diseases, and more, within a relatively brief period of instruction \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Furthermore, orthopedic specialty education encompasses extensive anatomical knowledge of skeletal muscles, yet it faces challenges such as the imprecision of bone models and the scarcity of physical specimen resources \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The conventional pedagogical model, which is instructor-centric and employs a mix of materials, clinical skill demonstrations, and other teaching strategies, falls short of delivering effective and profound learning experiences. It also impedes the development of students' creative thinking and problem-solving skills \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn response, a variety of innovative approaches have been introduced to clinical teaching to augment traditional methods. Notably, mind mapping, once the central concept is established, employs a vibrant palette of colors and lines to visually and textually organize a structured knowledge framework. This straightforward and cognitively accessible method facilitates better comprehension, analysis, and synthesis of knowledge points. It sustains students' engagement and fosters their self-directed learning and critical thinking capabilities, aligning with the objectives of orthopedic clinical nursing education \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. However, it primarily addresses cognitive aspects and may not fully support the nuanced requirements of individualized fracture treatment. Three-dimensional (3D) printing, a cutting-edge rapid prototyping technology, can vividly and precisely present patients' fracture types and locations, enabling personalized care and addressing the limitations posed by the paucity of physical specimens \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. To date, no studies have explored the integration of these two educational strategies. This study pioneers the application of 3D printing technology in conjunction with mind mapping in the education of orthopedic nursing interns, assessing its impact on elevating the quality of their training, and the findings are reported as follows.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information\u003c/h2\u003e \u003cp\u003eThis study involved 60 nursing interns who completed rotations in the Orthopedics Department of The Second People\u0026rsquo;s Hospital of Lianyungang between August 2019 and August 2021. Participants were selected according to pre-defined inclusion and exclusion criteria. The inclusion criteria were as follows: 1) Willingness to participate in the study and to sign an informed consent form; 2) Agreement to subsequent follow-up; 3) Lack of prior exposure to related research training, specifically in thinking skills. The exclusion criteria included: 1) Absences exceeding three consecutive days or a total of more than five days; 2) Failure to sign the informed consent form; 3) Previous training in mind mapping techniques. Participants were randomly assigned to either the observation group or the control group using a random number table, with 30 individuals in each group. The groups comprised 5 males and 55 females, with ages ranging from 16 to 18 and initial theoretical scores between 39 and 71 points. No statistically significant differences were observed between the groups in terms of demographic and baseline characteristics (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The internship period was set at four weeks. Both groups received instruction from teaching staff with the rank of head nurse or higher, ensuring consistency in teaching quality and hours. The study was granted approval by the hospital's ethics committee, with the ethical approval, Clinical trial number: 2019-025.\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\u003eComparison of General Information between Control Group and Observers\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=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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\u003eGender (M/F)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Age (years\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean Admission (Score\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e54.40\u0026thinsp;\u0026plusmn;\u0026thinsp;9.587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e54.67\u0026thinsp;\u0026plusmn;\u0026thinsp;11.32\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=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eT-test for age: T\u0026thinsp;=\u0026thinsp;2.18, P\u0026thinsp;=\u0026thinsp;0.64\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eT-test for admission score: T\u0026thinsp;=\u0026thinsp;0.37, P\u0026thinsp;=\u0026thinsp;0.71\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eChi-square test for gender distribution: χ2\u0026thinsp;=\u0026thinsp;0.98, P\u0026thinsp;=\u0026thinsp;0.92\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEstablishment of a Professional Teaching Team\u003c/h3\u003e\n\u003cp\u003eOur study assembled a team of educators with a minimum of a bachelor's degree, intermediate or higher professional qualifications, and a valid teaching certificate. Each member had accrued at least three years of teaching experience and possessed over five years of specialized expertise in orthopedics. Additionally, they had completed specialized training in mind mapping and 3D printing, successfully passing the relevant assessments. Throughout the research period, this dedicated team provided instruction for both the control and observation groups.\u003c/p\u003e\n\u003ch3\u003eControl Group\u003c/h3\u003e\n\u003cp\u003eParticipants in the control group were educated using conventional pedagogical tools, such as teaching models, images, videos, and radiographic materials. They were introduced to the standard protocols for nursing care in common orthopedic conditions, including emergency and perioperative nursing, based on a robust theoretical framework. Practical skills demonstrations included techniques like axial rotation, wheelchair handling, and patient transfer.\u003c/p\u003e\n\u003ch3\u003eEnhanced Teaching in the Observation Group\u003c/h3\u003e\n\u003cp\u003eBeyond the traditional teaching approaches of the control group, the observation group was further enriched with the integration of 3D printing technology and mind mapping. The educational content focused on the nursing care of patients with pelvic fractures, drawing from the sixth edition of Surgical Nursing. Utilizing X-Mind 8.0 software, the educational material was structured into a comprehensive mind map, with \"Pelvic Fracture Nursing Care\" as the central theme. This map expanded to include detailed sub-branches covering etiology, diagnostic procedures, classification, and nursing interventions. A 3D printed model of a pelvic fracture was employed to facilitate an in-depth exploration of injury mechanisms, diagnostic comparisons, and the nuances of nursing care. Interactive discussions were fostered among the students, and the 3D model was circulated to enhance learning through multiple sensory modalities. Students were then encouraged to construct their own mind maps, aligning with the educational objectives and critically analyzing the variances in their maps relative to the instructor's. This approach aimed to bolster the students' self-directed learning and critical thinking competencies (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssessment Criteria\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eExit Examination\u003c/h2\u003e \u003cp\u003eThe exit examination is divided into two parts: theoretical assessment(Supplementary material 1)and practical skills assessment༈Supplementary material 2༉. The theoretical assessment is collaboratively developed by the designated instructors of both groups and must be reviewed and approved by the head nurse before use. The practical skills assessment adheres to our hospital's \"Clinical Nursing Technical Operation Procedures and Standards for 2019.\" Both theoretical and practical assessments are scored using a percentage system.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eTeaching Effectiveness Evaluation Questionnaire\u003c/h3\u003e\n\u003cp\u003eThe researchers have independently designed a teaching effectiveness satisfaction evaluation questionnaire(Supplementary material 3), which includes five items: learning interest, thinking ability, self-learning ability, communication and collaboration ability, and summarization ability. The questionnaire employs a 3-point Likert scale, with options for improvement, unclear, and no improvement. On the day of the nursing students' exit from the department, the questionnaires are distributed for anonymous completion and are collected immediately afterwards.\u003c/p\u003e \u003cp\u003eStatistical Methods\u003c/p\u003e \u003cp\u003eContinuous data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s), and categorical data are analyzed using the chi-square test. For small sample sizes (n\u0026thinsp;\u0026le;\u0026thinsp;5), Fisher's exact test is applied. Continuous data are compared using independent samples t-tests, with a significance level set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTheoretical and Practical Assessment Scores\u003c/p\u003e \u003cp\u003eThe control group achieved a mean theoretical assessment score of 84.90 with a standard deviation of 4.79, while the observation group scored a mean of 89.83 with a standard deviation of 2.94. For practical assessments, the control group's mean score was 80.70 with a standard deviation of 7.42, and the observation group's was 89.57 with a standard deviation of 2.71. Comparative analysis revealed statistically significant differences between the two groups in both theoretical and practical assessment scores (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImprovement in Competencies\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eLearning Interest\u003c/b\u003e: In the observation group, 21 participants showed improvement and 9 showed no improvement. In the control group, 11 participants improved and 19 did not.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCognitive Abilities\u003c/b\u003e: 25 participants in the observation group and 18 in the control group demonstrated enhanced cognitive abilities, with 5 and 12 participants, respectively, showing no improvement.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSelf-Learning Abilities\u003c/b\u003e: 25 participants in the observation group reported improved self-learning abilities, with 5 showing no change. In the control group, 10 participants reported improvement, and 20 did not.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCommunication and Collaboration Skills\u003c/b\u003e: 24 participants in the observation group showed enhanced communication and collaboration skills, with 1 showing no improvement. In the control group, 16 participants improved and 14 did not.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSummarization and Synthesis Abilities\u003c/b\u003e: All 25 participants in the observation group reported improved abilities in summarization and synthesis, while 21 participants in the control group showed improvement, and 9 did not.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eStatistical analysis indicated significant differences between the two groups across all evaluated competencies (see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCultivation of Clinical Orthopedic Specialty Nursing Skills\u003c/h2\u003e \u003cp\u003eThe development of clinical orthopedic specialty nursing skills is essential for nursing interns to apply foundational theoretical knowledge in practical care scenarios. However, the brief duration of orthopedic internship rotations poses challenges in achieving proficiency within a constrained timeframe \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Traditional teaching models have been criticized for their suboptimal effectiveness. In these models, the teacher is at the center, with students in a passive role, often leading to low engagement and, consequently, low learning efficiency \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Orthopedic nursing, encompassing areas such as joints, spine, trauma, hand surgery, and bone diseases, demands a strong anatomical foundation, spatial imagination, and adaptive thinking from students. The rote memorization often employed in traditional teaching is monotonous and does not foster effective clinical learning \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInnovative Approaches to Enhance Learning\u003c/h2\u003e \u003cp\u003eTo address these pedagogical shortcomings, our study introduces the use of 3D printed models to replicate patients' fractures and deformities with precision, offering tangible and intuitive educational tools. The novelty of 3D printed models has piqued the interest of nursing interns, as evidenced by the heightened learning enthusiasm observed in the observation group compared to the control group, a difference that is statistically significant \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. This increased interest also fosters improved teacher-student interaction. The vivid and interactive nature of individualized 3D printed models enhances cognitive learning and significantly improves communication skills in the observation group \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, mind mapping techniques, utilizing a variety of colors, forms, images, and videos, create a structured cognitive framework that reinforces memory points and bolsters the thinking, organizational, self-study, and summarization abilities of nursing interns. The enhanced abilities are reflected in the superior performance of the observation group in departmental assessments compared to the control group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAcknowledging Study Limitations\u003c/h2\u003e \u003cp\u003eIt is important to acknowledge the limitations of this study, including a small sample size, the necessity to expand the sample to mitigate selection bias, and the lack of a double-blind assessment which could introduce potential errors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe integration of 3D printed models and mind mapping in the cultivation of clinical orthopedic specialty nursing skills has demonstrated significant educational advantages. This innovative approach effectively boosts the learning interest and enthusiasm of nursing interns, leading to a more proactive and engaged learning experience. Furthermore, it enhances core competencies, including self-study, summarization, and critical thinking abilities, which are essential for the mastery of complex orthopedic concepts.\u003c/p\u003e \u003cp\u003eBy providing a more interactive and visual learning environment, 3D printed models offer a tangible understanding of anatomical structures and pathological conditions, facilitating a deeper cognitive engagement with the subject matter. Mind mapping, with its structured visual representation, aids in organizing information, reinforcing memory, and fostering a comprehensive understanding of the material.\u003c/p\u003e \u003cp\u003eThe combined use of these tools not only equips nursing interns with a robust knowledge base in orthopedics but also contributes to the development of personal comprehensive qualities. These include communication and cooperation skills, which are indispensable for effective teamwork in clinical settings, and the ability to synthesize and apply knowledge in innovative ways.\u003c/p\u003e \u003cp\u003eThis educational strategy, therefore, prepares nursing interns to excel in their professional roles, ensuring they are well-equipped to meet the demands of contemporary healthcare and contribute meaningfully to patient care.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eControl Group\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCG\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eObservation Group\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eOG\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eStandard Deviation\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSD\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eConceive, Design, Implement, Operate\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCDIO\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eClinical Evaluation Exercise\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCEX\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eProblem-Based Learning\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePBL\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCase-Based Learning\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCBL\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was granted approval by the hospital's ethics committee, with the ethical approval, Clinical trial number: 2019-025. All students and patients involved in this project have provided informed consent and are willing to participate in this study. This study complies with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent for publication was obtained from all individuals whose data are included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLianyungang Science and Technology Bureau Basic Research Program (General Program), number: JCYJ2431; Lianyungang Health Science and Technology Project for Young Doctors, number:\u0026nbsp;QN202416; Natural Science Foundation of Bengbu Medical College, number: 2020byzd338.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJuan Wang, Zhihong Li, Jing Xu and Chong Gao.wrote the main manuscript text and Hui Wang, Jianwen Hou.prepared figures.All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to Weimin Wang, Nini Zhu, Fang Zhai, Xing Jing, and 60 other students for participating in the study. Also, gratitude to Teacher Shihua Zhao for the technical support provided. We are also grateful for the assistance provided by artificial intelligence，kimi， in refining and polishing the language of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKrishnamurthy K, Selvaraj N, Gupta P, et al. Benefits of gamification in medical education. Clin Anat.2022;35(6):795-807.\u003c/li\u003e\n\u003cli\u003eKeating TC, Jacobs J. Augmented reality in orthopedic practice and education. Orthop Clin North Am.2021;52(1):15-26.\u003c/li\u003e\n\u003cli\u003eGonz\u0026aacute;lez Blum C, Richter R, Fuchs R, et al. An interprofessional teaching approach for medical and physical therapy students to learn functional anatomy and clinical examination of the lower spine and hip. Ann Anat.2020;231:151534.\u003c/li\u003e\n\u003cli\u003eWan C, Li X, Ding X, Gao L. Application of 3D printing technology combined with problem-based and case-based learning in the training of orthopedic nurses\u0026apos; specialized skills. J Nurs.2019;34(8):756-759.\u003c/li\u003e\n\u003cli\u003eSu X, Ning H, Zhang F, Liu L, Zhang X, Xu H. Application of flipped classroom based on CDIO concept combined with mini-CEX evaluation model in the clinical teaching of orthopedic nursing. BMC Med Educ.2023;23:219.\u003c/li\u003e\n\u003cli\u003eLiu T, Yuizono T. Mind mapping training\u0026apos;s effects on reading ability: detection based on eye-tracking sensors. Sensors (Basel).2020;20(16):4422.\u003c/li\u003e\n\u003cli\u003eSkelley NW, Smith MJ, Ma R, et al. Three-dimensional printing technology in orthopaedics. J Am Acad Orthop Surg.2019;27(24):918-925.\u003c/li\u003e\n\u003cli\u003eJones DG. Three-dimensional printing in anatomy education: assessing potential ethical dimensions. Anat Sci Educ.2019;12(4):435-443.\u003c/li\u003e\n\u003cli\u003eSpencer SR, Watts LK. Three-dimensional printing in medical and allied health practice: a literature review. J Med Imaging Radiat Sci.2020;51(3):489-500.\u003c/li\u003e\n\u003cli\u003eLi S, Wang Y, Han J, et al. The effect of mind mapping combined with case teaching method in clinical nursing safety training for new nurses in surgery. Contem Nurse.2021;28(1):166-169.\u003c/li\u003e\n\u003cli\u003eLiu J, Wang Z, Zhao K, et al. Application of 3D printed models in problem-based learning clinical teaching in orthopedics.Health Vocat Educ.2022;40(7):85-87.\u003c/li\u003e\n\u003cli\u003eMagklara EP, Angelis S, Solia E, et al. Three-dimensional (3D) printing in orthopedics education. J Long Term Eff Med Implants.2020;30(4):255-258.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-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":"Orthopedic Nursing, Three-Dimensional Printing, Mind Mapping, Clinical Internship, Models, Educational","lastPublishedDoi":"10.21203/rs.3.rs-6095564/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6095564/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eClinical internships are crucial in nursing education, requiring interns to quickly merge theory with practice in a limited time.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo assess integrating 3D printing and mind mapping in orthopedic nursing education.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA randomized controlled trial with 60 nursing interns was conducted. The control group (CG) received traditional teaching, the observation group (OG) was introduced to 3D printed models and mind mapping. Performance was evaluated through assessments and questionnaires.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe CG score vs the OG score, Theoretical Assessment: 84.90\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79 vs 89.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94(P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Practical Assessment: 80.70\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42 vs 89.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71(P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).Improvement in OG vs CG. Learning Interest: 21 vs 11(P\u0026thinsp;=\u0026thinsp;0.01). Cognitive Abilities: 25 vs 18(P\u0026thinsp;=\u0026thinsp;0.04). Self-directed Learning: 25 vs 10(P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Communication and Collaboration: 24 vs.16(P\u0026thinsp;=\u0026thinsp;0.03).Information Synthesis: 25 vs 21(P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIntegrating 3D printing and mind mapping significantly enhances theoretical and practical performance, suggesting a promising approach for nursing interns.\u003c/p\u003e","manuscriptTitle":"3D Printing and Mind Mapping in Clinical Orthopedic Nursing Education: A Comparative Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 11:25:31","doi":"10.21203/rs.3.rs-6095564/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-10T13:47:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-08T18:50:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-02T07:35:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8280628973732307687901158251381740666","date":"2025-04-28T12:03:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17985405828401043397727769563320484204","date":"2025-04-24T18:21:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295897205407184543173873657870217153217","date":"2025-04-23T23:41:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307085127003634918851049793863485790451","date":"2025-04-16T06:35:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-14T06:28:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-08T17:23:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-18T12:48:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-17T06:19:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-03-17T06:18:53+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":"939d5293-fb70-4474-8408-c988b10341af","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T16:39:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-29 11:25:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6095564","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6095564","identity":"rs-6095564","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}