Effect of Problem-based learning combined with Rain Classroom teaching based on outcome-based education on nursing students’ comprehensive abilities in burn unit: a quasi-experimental study

Effect of Problem-based learning combined with Rain Classroom teaching based on outcome-based education on nursing students’ comprehensive abilities in burn unit: a quasi-experimental study | 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 Effect of Problem-based learning combined with Rain Classroom teaching based on outcome-based education on nursing students’ comprehensive abilities in burn unit: a quasi-experimental study Linli SUN, Lihong LIU, Wenjuan FENG, Wuquan LI, Lijuan SUN, Luyan XIANG, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6530519/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background The problem-based learning (PBL) combined with the Rain Classroom teaching model based on the outcome-based education (OBE) is beneficial in enhancing nursing interns' comprehensive ability and teaching satisfaction. This approach can improve teaching outcomes and quality, making it valuable for clinical application. Therefore, nursing educators can consider applying it to clinical nursing teaching. Purpose To investigate the effects of problem-based learning combined with Rain Classroom teaching based on outcome-based education among burn nursing students’ clinical comprehensive abilities. Innovative educational models are required to keep pace with rapid developments in nursing education, and we aimed to provide documentation on the efficacy of novel teaching methods in the challenging field of burns nursing. Methods This quasi-experimental study included 60 nursing students in burn unit of a grade A tertiary hospital in 2023–2024. The samples were allocated randomly into intervention and control groups(30 participants in each group). The control group received the traditional teaching methods combined with PBL teaching. The intervention group received PBL combined with Rain Classroom teaching model based on OBE. After the teaching activities, the two groups of nursing students were assessed based on theory and operation. Questionnaires and classroom evaluation scales were employed to comprehensively assess the effect of the two teaching methods and the satisfaction of the nursing students. Results The intervention group had better effects on terms of increasing theoretical、operational test scores and teaching satisfaction, improving classroom performance and problem-solving skills, cultivating critical thinking skills, developing the ability to integrate knowledge than those of the control group (P < 0.05), the difference was statistically significant. Conclusions PBL combined with Rain Classroom teaching based on OBE improved the classroom participation of nursing students, and further improved their satisfaction with teaching and their comprehensive abilities. It is worthy of being widely applied in clinical teaching to meet the social demands for cultivating medical talents. burns nursing nursing education outcome-based education(OBE) problem-based learning(PBL) Rain Classroom Figures Figure 1 Figure 2 1. Introduction With the rapid advancements in medical science and the Internet era, the comprehensive quality requirements for clinical nursing are constantly increasing [ 1 – 2 ]. Nursingstudents, who serve as the future workforce of nursing personnel, find clinical internships crucial for translating theoretical knowledge into practice [ 1 – 3 ]. However, the traditional clinical teaching model is increasingly challenged to meet the evolving societal needs for talent cultivation and the enhancement of clinical practice for nursing interns. Burns nursing, as a highly specialized branch of surgical nursing, uniquely requires nursing students to have a high level of psychological resilience when dealing with patients with burns. This is an additional challenge to clinical teaching[ 2 – 4 ]. Outcome-based education (OBE) centers on aligning educational activities with the ultimate learning outcomes for students. This approach involves reverse designing of the curriculum structure and evaluation mechanisms to ensure that the education process remains focused on the desired outcomes. It also promotes the efficient achievement of educational goals and fundamentally improves the quality and effectiveness of talent training[ 1 , 5 – 6 ]. Problem-based learning (PBL) drives teaching activities by asking questions and actively solving problems, thereby cultivating and improving the student’s comprehensive abilities and qualities[ 7 – 9 ]. Rain Classroom is a web-based intelligent teaching platform that integrates WeChat and Microsoft PowerPoint[ 10 – 12 ]. It employs both mobile and computer terminals to facilitate the entire teaching process—before, during, and after class—promoting data-based decision-making and comprehensive teaching evaluation[ 13 – 14 ]. Currently, the PBL teaching model based on OBE, along with digital tools such as “Rain Classroom,” has been implemented across various fields of medical education, demonstrating positive results by enhancing students' learning interest and comprehensive skills development[ 3 ]. However, in the “Internet Plus” era, the innovative transformation of education models and teaching methods has become a trend in advancing the education sector. Employing online technologies in Rain Classroom teaching is increasingly effective in motivating students to learn and take initiative[ 10 – 12 ]. This study aimed to investigate the effects of problem-based learning and Rain Classroom teaching based on outcome-based education among burn nursing students’ clinical comprehensive abilities. 2. Methods 2.1 Study design This quasi-experimental study included a total of 60 nursing students practicing in the burn unit of the Second Affiliated Hospital of Kunming Medical University between May 2023 and July 2024. Thirty nursing students were designated as the control group and received the traditional teaching methods combined with PBL teaching, and another thirty nursing students were designated as the intervention group, receiving PBL combined with the Rain Classroom teaching based on OBE. 2.2 Setting and participants The participants were from three specialist colleges and two undergraduate colleges and were randomly divided into two groups. The inclusion criteria were as follows: (1) full-time nursing students with ≥ 4 weeks of internship in the burn unit; and (2) participants who agreed and actively participated in this study. Those who withdrew before completion were excluded from the study. 2.3 Study procedure In the control group, the students received the traditional teaching methods combined with PBL teaching, the nursing teachers of the burn unit completed the design of the PBL teaching case according to the disease-specific characteristics and the established teaching plan. For example, in a typical case of “old-age burns,” the students were encouraged to learn more about the uniqueness of the burns through case studies. They were also guided to understand the uniqueness of burns including pathophysiological characteristics and clinical manifestations in the older adults, while focusing on care during the burn shock period and how to effectively carry out health education for patients and their families[ 3 ]. The intervention group received PBL combined with Rain Classroom teaching based on OBE. 2.3.1 Establishment of the full teaching model Outcome-based education (OBE), also known as competence-based education, is characterized by a student-centered, reverse-engineering approach to teaching and learning. It involves designing course content and teaching methods based on learning outcomes that students are expected to achieve[ 10 ].The OBE emphasizes that students should have clear learning objectives and expected performances[ 15 ]. In this study, we combined PBL with the Rain Classroom teaching based on OBE to align with these expected objectives (Fig. 1 ). The program fully embodied the cultivation objectives of nursing major and the requirements for students' abilities and made use of the “Rain Classroom” platform to smoothly connect with the new education model in the “Internet Plus” era. The program aimed to effectively promote the seamless integration of information technology and traditional classroom teaching, as well as the diversification and flexibility of students’ learning styles, to provide strong support for deepening the process of education informatization. In this study, the teaching effect was comprehensively evaluated before, during, and after the class through multiple evaluations such as theoretical and operational assessments, classroom performance evaluation, and questionnaire surveys. 2.3.2 Optimizing PBL teaching based on OBE In this new era, colleges and universities shoulder the important task of cultivating innovative talents, focusing on the promotion of innovative thinking ability, a strong teamwork spirit, and the ability to solve practical problems efficiently. Additionally, the reformed teaching model produces new opportunities and challenges[ 15 ]. The OBE and PBL teaching goal are the same, focusing on cultivating students' ability to adapt to society. Optimizing the PBL teaching case based on OBE can integrate the two in-depth methods. To achieve the cultivation goal, it is more conducive to integrate comprehensive and systematic knowledge learning methods with students’ innovative thinking and active initiative. This study focuses on the goals of clinical nursing talent, further clarifying the clinical teaching content, improving the integration of knowledge, and guiding students to integrate what they have learned to give better play to their subjective initiative and cultivate their innovation and critical thinking ability. 2.3.3 Organizing teacher training and teaching implementation To ensure the quality of teaching in this study, two weeks before the implementation of the study, the instructors of the burn unit were trained in PBL combined with Rain Classroom teaching based on OBE. The full program included the following: Step 1. Writing of PBL teaching cases based on OBE Step 2. Use of the Rain Classroom teaching tool Step 3. Implementation of the PBL in combination with Rain Classroom teaching (1) Pre-course preparation: Establishment of a WeChat teacher-student group. The teacher released the pre-reading materials and each scenario of the PBL teaching case to the Rain Classroom one week in advance and asked the nursing students to pre-read, identify problems, and review the literature in advance. (2) Classroom teaching: The teacher opened the Rain Classroom. The nursing students on the WeChat group scanned the code to enter and sign in. The nursing students discussed the released case in small groups, and expressed their different points of view through pop-ups, and the teacher gave a comprehensive summary. The teacher summarized and made a comprehensive evaluation of their classroom performance. (3) Post-class review: The teacher answered the questions of the nursing students through the Rain Classroom and released the key review contents[ 16 ] and related extended learning materials. In addition, to ensure the smooth implementation of teaching activities, one week before the implementation of teaching, the PBL combined with Rain Classroom teaching based on OBE was introduced to the experimental group of nursing students, including a detailed analysis of the basic steps and key points of the PBL teaching[ 16 – 18 ], the training content is covered in the control group's teaching process, including the preparation (before class), active participation in discussion and practice (during class) in reflection and summary, and extended learning (after class). In all teaching activities, teachers need to take a two-pronged approach: paying attention to the learning dynamics of nursing interns[ 3 ] and paying attention to the quality of teaching interaction to ensure that teaching and learning are closely linked. Teachers need to flexibly manage the classroom and provide timely guidance to adjust the path of the case discussion to promote in-depth learning and continuous optimization of the teaching process, to achieve the maximum teaching effect. 2.4 Teaching results evaluation At the end of the teaching activities, the teachers assessed the theory and operation of the two groups of nursing students. and used the PBL classroom evaluation scale and the teaching effect questionnaire to comprehensively evaluate the classroom performance, teaching effect, and satisfaction of the two groups of nursing students. 2.4.1 Theoretical and practical examinations After the teaching, the teacher organized the exit examination, including the theory and operation examinations; the full score on the examination was 100 points. The theoretical and operational examinations of the control group were completed by the instructor on the spot, whereas the theoretical examination of the experimental group was completed by the teacher through the release of the Rain Classroom and time-limited synchronous answers. The data were collected from the background of the Rain Classroom. 2.4.2 PBL classroom evaluation scale The classroom performance of the two groups of nursing students was evaluated using the PBL classroom evaluation scale designed by Yaqing Zhang, which consists of five entries—participation, communication skills, preparation of materials, critical thinking, and teamwork—scored on a 5-point Likert scale[ 12 , 17 ](1 = very poor, 2 = poor, 3 = average, 4 = better, and 5 = excellent). The total score was 5–25 points; in the evaluation of teaching effectiveness, the higher the score, the better the teaching effect. 2.4.3 Teaching effectiveness questionnaire A self-administered questionnaire[ 3 ] was used to comprehensively evaluate the teaching effectiveness and satisfaction of the two groups of nursing students after teaching. The questionnaire covers multi-dimensional evaluation indexes, including teaching satisfaction, learning interest, classroom participation, literature search ability, teacher-student interaction, broadening knowledge, discovery and problem-solving ability, critical thinking and the ability to integrate knowledge, a total of 12 items. The scoring method was as follows: 1 = disagree, 2 = general, 3 = agree, and 4 = strongly agree [ 19 ]. The total score was 4–48 points. The nursing students made a comprehensive evaluation based on their own learning experience; the higher the score, the higher the satisfaction with teaching[ 20 ] . 2.5 Data analysis In this study, SPSS 26.0 was used for data analysis. Counting data were analyzed using the chi-square test and expressed as ( n , %). For measuring data, independent samples t -tests were employed to compare the differences between the groups, with results expressed as means ± standard deviations (X ± SD), with P < 0.05 indicating that the differences were statistically significant [ 3 , 20 ]. 3. Results 3.1 Assessment of theoretical and practical performance Statistical tests confirmed that there were no significant differences in sex, education, age, and other basic characteristics between the two groups of nursing students (P >0.05；Table1). Regarding theoretical tests and operational skills, the intervention group had significantly higher assessment scores than the control group (P <0.05; Table2) Table 1. Demographics of participants ( n , %) Item Control group ( n =30) Intervention group ( n =30) T value P value Age (years) 22.10±1.09 22.63±1.25 1.762 0.083 Sex 0.75 0.456 Female 27（90.00） 25（83.30） Male 3（10.00） 5（16.70） Educational background 0.776 0.441 Junior college 19（63.30） 16（53.30） Undergraduate college 11（36.70） 14（46.70） Table2. Comparison between theoretical and operational assessment scores (points, M±SD) Group Theoretical knowledge score Clinical practice skills score Control group ( n =30) 89.23±3.51 88.67±2.95 Intervention group ( n =30) 92.03±3.24 90.60±3.14 T value 3.209 2.459 P value 0.002 0.017 3.2 Comparison of classroom performance Comparing the overall classroom performance of the two groups of nursing interns, the experimental group outperformed the control group in classroom participation, communication skills, critical thinking, and teamwork, with statistically significant differences ( P 0.05; Figure 2 ). Table3. Comparison of classroom performance (points, M±SD) Group Classroom participation Communication ability Material preparation Critical thinking Teamwork ability Control group ( n =30) 3.73±0.64 3.70±0.70 4.07±0.25 3.67±0.55 3.80±0.66 Intervention group ( n =30) 4.20±0.48 4.27±0.52 4.20±0.48 4.07±0.69 4.17±0.70 T value 3.186 3.55 1.336 2.485 2.083 P value 0.002 0.001 0.187 0.016 0.042 3.3 Evaluation of teaching effectiveness A comparison of the comprehensive evaluation of the teaching effect between the two groups of nursing students showed that there were significant differences in improving learning interest and classroom participation, increasing teacher-student interaction, deepening memory of knowledge, improving discovery and problem-solving ability, cultivating critical thinking and the ability to integrate knowledge, and improving the ability to search for literature ( P 0.05) in improving the ability to learn independently, broadening the scope of knowledge, and improving teamwork and communication ability. The differences in knowledge and improved teamwork and communication skills were not statistically significant ( P >0.05). Table 4. Comparison of nursing students' evaluation of teaching effectiveness (points, M±SD) Item Control group ( n =30) Intervention group ( n =30) T value P value Teaching satisfaction 3.57±0.50 3.87±0.35 2.688 0.009 Increase interest in learning 3.50±0.51 3.97±0.18 4.731 0.000 Increase classroom participation 3.57±0.73 3.97±0.18 2.919 0.005 Increase teacher-student interaction 3.50±0.82 3.93±0.25 2.765 0.008 Deepen memory of knowledge 3.57±0.50 3.83±0.38 2.316 0.024 Improve problem-solving skills 3.37±0.56 3.73±0.45 2.808 0.007 Improve independent learning skills 3.67±0.76 3.77±0.43 0.628 0.532 Cultivate critical thinking skills 3.37±0.61 3.77±0.43 2.919 0.005 Broaden students' knowledge 3.60±0.62 3.83±0.38 1.756 0.084 Enhance teamwork and communication skills 3.53±0.63 3.73±0.45 1.417 0.162 Develop the ability to integrate knowledge 3.50±0.51 3.80±0.41 2.523 0.014 Improve literature-searching skills 3.53±0.57 3.80±0.41 2.082 0.042 4. Discussion Over the years, global higher education has transitioned from traditional subject-centered and teacher-oriented curricula to more student-centered, problem-oriented, and competency-based curricula that empower students to take ownership of their learning [ 6 ]. The rapid advancement of Internet technology has introduced diverse learning pathways in medical education[ 16 ], significantly reshaping medical students' learning concepts and attitudes. In the current educational environment, teaching strategies must adapt to evolving educational models in the “Internet Plus” era and actively integrate information technology with daily teaching activities, students' self-learning modes, and the overall process of educational innovation[ 15 ]. Clinical internships, essential for nursing students' transition to professional practice, are not only a core responsibility of teaching hospitals but also a crucial element in enhancing the overall effectiveness of nursing education. In the teaching of nursing in burn unit, we adopted a teaching mode that combined PBL with Rain Classroom based on OBE. This approach invigorated the classroom atmosphere. Teachers used students' communication tools to deliver PBL teaching cases and outline requirements, facilitating problem identification through clinical scenarios. By incorporating entertainment and interactive elements, this method enhanced engagement and effectively improved learning among nursing students. In the PBL teaching activity combined with Rain Classroom based on OBE, the teacher released PBL teaching cases via the Rain Classroom platform before the class. Nursing students previewed the related knowledge, identified the problems in the cases, and deepened the understanding by consulting literature. During class, the integration of PBL and Rain Classroom increased student participation through interactive teaching methods, helped students engage with the cases more personally, reduced their fear of burn patients, enhanced empathy, and stimulated their interest in learning. The discussion of teaching cases fostered clinical thinking and teamwork skills among nursing interns. The interactive pop-up screen feature in Rain Classroom enabled real-time communication between teachers and nursing students [ 21 ]. After class, nursing students could consolidate their knowledge using Rain Classroom, while teachers could address questions and provide additional learning materials through the platform. In this study, the intervention group used the PBL combined with Rain Classroom teaching model based on OBE. Compared with the control group, the nursing students in the intervention group had significantly better results in their discharge theory and operation assessments. The study findings showed that PBL combined with Rain Classroom teaching based on OBE was more effective in improving the depth of nursing students' mastery of theoretical knowledge and their level of practical nursing operation skills[ 3 ]. In terms of classroom performance, the intervention group exhibited higher participation and better communication skills, critical thinking, and teamwork than the control group. Regarding the evaluation of teaching effectiveness, the intervention group showed greater improvements in nursing students' interest in learning and classroom participation than the control group. They also demonstrated enhanced knowledge retention, increased teacher-student interaction, and better development of critical thinking and knowledge integration compared with the control group. Additionally, the intervention group improved discovery and problem-solving skills[ 3 ], literature-searching ability, and overall teaching satisfaction. 5. Conclusion The application of PBL combined with Rain Classroom teaching based on OBE in clinical nursing education was beneficial in enhancing nursing students' comprehensive ability and teaching satisfaction. This teaching method also provides a solid foundation for their future clinical nursing work. Our study demonstrates that this teaching method effectively improves teaching outcomes and quality, making it valuable for clinical application. Therefore, it is of great significance to apply it in clinical teaching practice. This study was limited by a small sample size(n = 60) and single-center study, it may limit the statistical power and generalizability of the results.The intervention’s effectiveness might be influenced by institution-specific factors,such as internship time and faculty training programs,this caused it not to fully reflect the teaching advantages of the new model. Despite these limitations, this pilot study provides initial evidence supporting the feasibility of PBL combined with Rain Classroom teaching based on OBE in nursing education. In the future, we will strive for larger multi-center trials to increase the sample size and clinical internship time, and further study the potential teaching advantages of the new model, with the aim to promote its application in clinical teaching so that more clinical interns can benefit from it. Declarations Acknowledgments We would like to thank Editage (www.editage.cn) for English language editing. Author contributions Study conception and design: Linli Sun, Wuquan Li. Data collection: Lijuan Sun, Luyan Xiang, Fan Wu, Ding Li. Data analysis and interpretation: Linli Sun, Wuquan Li. Drafting of the article: Linli Sun, Lihong Liu, Wenjuan Feng. Critical revision of the article: Wenjun Liu. Funding source This study was funded by the 2022 Kunming Medical University School-level Teaching, Research, and Reform Projects (2022-JY-Y-100) and the 2024 Scientific Research Fund Project of the Yunnan Provincial Department of Education (2024J0322). Availability of data and materials All data generated or analysed during this study are not publicly available due privacy protection but are available from the corresponding author on reasonable request. Ethical exemption and consent to participate This quasi-experimental study adhered to the Declaration of Helsinki and had been granted an exemption from requiring ethics approval by the Institutional Review Board of the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (Approval No. YJ-2024-1). The data collection of this study was non-intrusive and participants’identities were fully protected. Informed consent was obtained from all of the participants in this study. 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Kunming","correspondingAuthor":false,"prefix":"","firstName":"Lijuan","middleName":"","lastName":"SUN","suffix":""},{"id":466988512,"identity":"d6cad412-80d5-4b99-a4b7-970efd413551","order_by":5,"name":"Luyan XIANG","email":"","orcid":"","institution":"The Second Affiliated Hospital of Kunming Medical University, Kunming","correspondingAuthor":false,"prefix":"","firstName":"Luyan","middleName":"","lastName":"XIANG","suffix":""},{"id":466988514,"identity":"3da6fefb-f6f3-42a6-8edb-4ee8ab8c535f","order_by":6,"name":"Fan WU","email":"","orcid":"","institution":"The Second Affiliated Hospital of Kunming Medical University, Kunming","correspondingAuthor":false,"prefix":"","firstName":"Fan","middleName":"","lastName":"WU","suffix":""},{"id":466988516,"identity":"1c935276-8148-40e5-87d5-7571d33f5dd9","order_by":7,"name":"Li DING","email":"","orcid":"","institution":"The Second Affiliated Hospital of Kunming Medical University, Kunming","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"DING","suffix":""},{"id":466988518,"identity":"5637da15-b1a1-43d0-a590-33dc10fbe214","order_by":8,"name":"Wenjun LIU","email":"","orcid":"","institution":"The Second Affiliated Hospital of Kunming Medical University, Kunming","correspondingAuthor":false,"prefix":"","firstName":"Wenjun","middleName":"","lastName":"LIU","suffix":""}],"badges":[],"createdAt":"2025-04-25 16:23:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6530519/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6530519/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84365675,"identity":"0efb46c8-aeca-4e2c-ad0d-3c1307446d13","added_by":"auto","created_at":"2025-06-11 06:03:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":148146,"visible":true,"origin":"","legend":"\u003cp\u003eProcess of PBL combined with Rain Classroom teaching based on OBE.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6530519/v1/cfad9fdd5cc8a4cdcbeeddc9.jpg"},{"id":84365690,"identity":"c33b9861-aeb8-4300-9a26-e56d82dee5ef","added_by":"auto","created_at":"2025-06-11 06:03:58","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":70609,"visible":true,"origin":"","legend":"\u003cp\u003eAnalysis of classroom performance results.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6530519/v1/64998cbf01a91864ff671483.jpg"},{"id":84367152,"identity":"e05feba2-837c-4c31-8a7c-6e2d050b839d","added_by":"auto","created_at":"2025-06-11 06:19:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1283851,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6530519/v1/6a2663ac-88f0-4cef-bcb6-f3696d267cd8.pdf"},{"id":84365693,"identity":"d4bc6f4e-e523-4546-bd1d-d1df3139dd9b","added_by":"auto","created_at":"2025-06-11 06:03:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16990,"visible":true,"origin":"","legend":"","description":"","filename":"SunTab1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6530519/v1/73424b9fea382a6b28dda2bb.docx"},{"id":84365674,"identity":"8c41648c-ffe7-48cf-8b56-4beecbb95157","added_by":"auto","created_at":"2025-06-11 06:03:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15174,"visible":true,"origin":"","legend":"","description":"","filename":"SunTab2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6530519/v1/9cfcad5fde0fd18ebe437aba.docx"},{"id":84365694,"identity":"4249c07a-53e6-4247-bc00-5c7cdcd6a579","added_by":"auto","created_at":"2025-06-11 06:03:59","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15696,"visible":true,"origin":"","legend":"","description":"","filename":"SunTab3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6530519/v1/b4d3b3defce04aafc4130afd.docx"},{"id":84365695,"identity":"e63f4f7a-1a8d-4457-8693-66a8efe6c27e","added_by":"auto","created_at":"2025-06-11 06:03:59","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":16665,"visible":true,"origin":"","legend":"","description":"","filename":"SunTab4.docx","url":"https://assets-eu.researchsquare.com/files/rs-6530519/v1/b299c1554a5f86a75e7bda8e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Problem-based learning combined with Rain Classroom teaching based on outcome-based education on nursing students’ comprehensive abilities in burn unit: a quasi-experimental study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eWith the rapid advancements in medical science and the Internet era, the comprehensive quality requirements for clinical nursing are constantly increasing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nursingstudents, who serve as the future workforce of nursing personnel, find clinical internships crucial for translating theoretical knowledge into practice [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, the traditional clinical teaching model is increasingly challenged to meet the evolving societal needs for talent cultivation and the enhancement of clinical practice for nursing interns.\u003c/p\u003e \u003cp\u003eBurns nursing, as a highly specialized branch of surgical nursing, uniquely requires nursing students to have a high level of psychological resilience when dealing with patients with burns. This is an additional challenge to clinical teaching[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOutcome-based education (OBE) centers on aligning educational activities with the ultimate learning outcomes for students. This approach involves reverse designing of the curriculum structure and evaluation mechanisms to ensure that the education process remains focused on the desired outcomes. It also promotes the efficient achievement of educational goals and fundamentally improves the quality and effectiveness of talent training[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Problem-based learning (PBL) drives teaching activities by asking questions and actively solving problems, thereby cultivating and improving the student\u0026rsquo;s comprehensive abilities and qualities[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Rain Classroom is a web-based intelligent teaching platform that integrates WeChat and Microsoft PowerPoint[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It employs both mobile and computer terminals to facilitate the entire teaching process\u0026mdash;before, during, and after class\u0026mdash;promoting data-based decision-making and comprehensive teaching evaluation[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, the PBL teaching model based on OBE, along with digital tools such as \u0026ldquo;Rain Classroom,\u0026rdquo; has been implemented across various fields of medical education, demonstrating positive results by enhancing students' learning interest and comprehensive skills development[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, in the \u0026ldquo;Internet Plus\u0026rdquo; era, the innovative transformation of education models and teaching methods has become a trend in advancing the education sector. Employing online technologies in Rain Classroom teaching is increasingly effective in motivating students to learn and take initiative[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This study aimed to investigate the effects of problem-based learning and Rain Classroom teaching based on outcome-based education among burn nursing students\u0026rsquo; clinical comprehensive abilities.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThis quasi-experimental study included a total of 60 nursing students practicing in the burn unit of the Second Affiliated Hospital of Kunming Medical University between May 2023 and July 2024. Thirty nursing students were designated as the control group and received the traditional teaching methods combined with PBL teaching, and another thirty nursing students were designated as the intervention group, receiving PBL combined with the Rain Classroom teaching based on OBE.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Setting and participants\u003c/h2\u003e \u003cp\u003eThe participants were from three specialist colleges and two undergraduate colleges and were randomly divided into two groups. The inclusion criteria were as follows: (1) full-time nursing students with \u0026ge;\u0026thinsp;4 weeks of internship in the burn unit; and (2) participants who agreed and actively participated in this study. Those who withdrew before completion were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Study procedure\u003c/h2\u003e \u003cp\u003e In the control group, the students received the traditional teaching methods combined with PBL teaching, the nursing teachers of the burn unit completed the design of the PBL teaching case according to the disease-specific characteristics and the established teaching plan. For example, in a typical case of \u0026ldquo;old-age burns,\u0026rdquo; the students were encouraged to learn more about the uniqueness of the burns through case studies. They were also guided to understand the uniqueness of burns including pathophysiological characteristics and clinical manifestations in the older adults, while focusing on care during the burn shock period and how to effectively carry out health education for patients and their families[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The intervention group received PBL combined with Rain Classroom teaching based on OBE.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Establishment of the full teaching model\u003c/h2\u003e \u003cp\u003eOutcome-based education (OBE), also known as competence-based education, is characterized by a student-centered, reverse-engineering approach to teaching and learning. It involves designing course content and teaching methods based on learning outcomes that students are expected to achieve[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].The OBE emphasizes that students should have clear learning objectives and expected performances[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this study, we combined PBL with the Rain Classroom teaching based on OBE to align with these expected objectives (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe program fully embodied the cultivation objectives of nursing major and the requirements for students' abilities and made use of the \u0026ldquo;Rain Classroom\u0026rdquo; platform to smoothly connect with the new education model in the \u0026ldquo;Internet Plus\u0026rdquo; era. The program aimed to effectively promote the seamless integration of information technology and traditional classroom teaching, as well as the diversification and flexibility of students\u0026rsquo; learning styles, to provide strong support for deepening the process of education informatization. In this study, the teaching effect was comprehensively evaluated before, during, and after the class through multiple evaluations such as theoretical and operational assessments, classroom performance evaluation, and questionnaire surveys.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Optimizing PBL teaching based on OBE\u003c/h2\u003e \u003cp\u003eIn this new era, colleges and universities shoulder the important task of cultivating innovative talents, focusing on the promotion of innovative thinking ability, a strong teamwork spirit, and the ability to solve practical problems efficiently. Additionally, the reformed teaching model produces new opportunities and challenges[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe OBE and PBL teaching goal are the same, focusing on cultivating students' ability to adapt to society. Optimizing the PBL teaching case based on OBE can integrate the two in-depth methods. To achieve the cultivation goal, it is more conducive to integrate comprehensive and systematic knowledge learning methods with students\u0026rsquo; innovative thinking and active initiative. This study focuses on the goals of clinical nursing talent, further clarifying the clinical teaching content, improving the integration of knowledge, and guiding students to integrate what they have learned to give better play to their subjective initiative and cultivate their innovation and critical thinking ability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Organizing teacher training and teaching implementation\u003c/h2\u003e \u003cp\u003eTo ensure the quality of teaching in this study, two weeks before the implementation of the study, the instructors of the burn unit were trained in PBL combined with Rain Classroom teaching based on OBE. The full program included the following:\u003c/p\u003e \u003cp\u003eStep 1. Writing of PBL teaching cases based on OBE\u003c/p\u003e \u003cp\u003eStep 2. Use of the Rain Classroom teaching tool\u003c/p\u003e \u003cp\u003eStep 3. Implementation of the PBL in combination with Rain Classroom teaching\u003c/p\u003e \u003cp\u003e(1) Pre-course preparation: Establishment of a WeChat teacher-student group. The teacher released the pre-reading materials and each scenario of the PBL teaching case to the Rain Classroom one week in advance and asked the nursing students to pre-read, identify problems, and review the literature in advance.\u003c/p\u003e \u003cp\u003e(2) Classroom teaching: The teacher opened the Rain Classroom. The nursing students on the WeChat group scanned the code to enter and sign in. The nursing students discussed the released case in small groups, and expressed their different points of view through pop-ups, and the teacher gave a comprehensive summary. The teacher summarized and made a comprehensive evaluation of their classroom performance.\u003c/p\u003e \u003cp\u003e(3) Post-class review: The teacher answered the questions of the nursing students through the Rain Classroom and released the key review contents[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and related extended learning materials.\u003c/p\u003e \u003cp\u003eIn addition, to ensure the smooth implementation of teaching activities, one week before the implementation of teaching, the PBL combined with Rain Classroom teaching based on OBE was introduced to the experimental group of nursing students, including a detailed analysis of the basic steps and key points of the PBL teaching[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the training content is covered in the control group's teaching process, including the preparation (before class), active participation in discussion and practice (during class) in reflection and summary, and extended learning (after class).\u003c/p\u003e \u003cp\u003eIn all teaching activities, teachers need to take a two-pronged approach: paying attention to the learning dynamics of nursing interns[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and paying attention to the quality of teaching interaction to ensure that teaching and learning are closely linked. Teachers need to flexibly manage the classroom and provide timely guidance to adjust the path of the case discussion to promote in-depth learning and continuous optimization of the teaching process, to achieve the maximum teaching effect.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Teaching results evaluation\u003c/h2\u003e \u003cp\u003eAt the end of the teaching activities, the teachers assessed the theory and operation of the two groups of nursing students. and used the PBL classroom evaluation scale and the teaching effect questionnaire to comprehensively evaluate the classroom performance, teaching effect, and satisfaction of the two groups of nursing students.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Theoretical and practical examinations\u003c/h2\u003e \u003cp\u003eAfter the teaching, the teacher organized the exit examination, including the theory and operation examinations; the full score on the examination was 100 points. The theoretical and operational examinations of the control group were completed by the instructor on the spot, whereas the theoretical examination of the experimental group was completed by the teacher through the release of the Rain Classroom and time-limited synchronous answers. The data were collected from the background of the Rain Classroom.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 PBL classroom evaluation scale\u003c/h2\u003e \u003cp\u003eThe classroom performance of the two groups of nursing students was evaluated using the PBL classroom evaluation scale designed by Yaqing Zhang, which consists of five entries\u0026mdash;participation, communication skills, preparation of materials, critical thinking, and teamwork\u0026mdash;scored on a 5-point Likert scale[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e](1\u0026thinsp;=\u0026thinsp;very poor, 2\u0026thinsp;=\u0026thinsp;poor, 3\u0026thinsp;=\u0026thinsp;average, 4\u0026thinsp;=\u0026thinsp;better, and 5\u0026thinsp;=\u0026thinsp;excellent). The total score was 5\u0026ndash;25 points; in the evaluation of teaching effectiveness, the higher the score, the better the teaching effect.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3 Teaching effectiveness questionnaire\u003c/h2\u003e \u003cp\u003eA self-administered questionnaire[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] was used to comprehensively evaluate the teaching effectiveness and satisfaction of the two groups of nursing students after teaching. The questionnaire covers multi-dimensional evaluation indexes, including teaching satisfaction, learning interest, classroom participation, literature search ability, teacher-student interaction, broadening knowledge, discovery and problem-solving ability, critical thinking and the ability to integrate knowledge, a total of 12 items. The scoring method was as follows: 1\u0026thinsp;=\u0026thinsp;disagree, 2\u0026thinsp;=\u0026thinsp;general, 3\u0026thinsp;=\u0026thinsp;agree, and 4\u0026thinsp;=\u0026thinsp;strongly agree [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The total score was 4\u0026ndash;48 points. The nursing students made a comprehensive evaluation based on their own learning experience; the higher the score, the higher the satisfaction with teaching[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] .\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data analysis\u003c/h2\u003e \u003cp\u003eIn this study, SPSS 26.0 was used for data analysis. Counting data were analyzed using the chi-square test and expressed as (\u003cem\u003en\u003c/em\u003e, %). For measuring data, independent samples \u003cem\u003et\u003c/em\u003e-tests were employed to compare the differences between the groups, with results expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (X\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating that the differences were statistically significant [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Assessment of theoretical and practical performance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical tests confirmed that there were no significant differences in sex, education, age, and other basic characteristics between the two groups of nursing students (P \u0026gt;0.05；Table1). Regarding theoretical tests and operational skills, the intervention group had significantly higher assessment scores than the control group (P \u0026lt;0.05; Table2) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographics of participants\u003c/strong\u003e (\u003cem\u003en\u003c/em\u003e, %)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group (\u003cem\u003en\u003c/em\u003e=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003egroup (\u003cem\u003en\u003c/em\u003e=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eT\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 197px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e22.10\u0026plusmn;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e22.63\u0026plusmn;1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 197px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e27（90.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e25（83.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e3（10.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e5（16.70）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 197px;\"\u003e\n \u003cp\u003eEducational background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026nbsp;Junior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e19（63.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e16（53.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Undergraduate college\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e11（36.70）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e14（46.70）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable2. Comparison between theoretical and operational assessment scores (points, M\u0026plusmn;SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"597\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheoretical knowledge score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical practice skills score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eControl group (\u003cem\u003en\u003c/em\u003e=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e89.23\u0026plusmn;3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88.67\u0026plusmn;2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntervention group (\u003cem\u003en\u003c/em\u003e=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92.03\u0026plusmn;3.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90.60\u0026plusmn;3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Comparison of classroom performance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparing the overall classroom performance of the two groups of nursing interns, the experimental group outperformed the control group in classroom participation, communication skills, critical thinking, and teamwork, with statistically significant differences (\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05; \u003cstrong\u003eTable 3\u003c/strong\u003e). However, the differences in material preparation were not statistically significant (\u003cem\u003eP\u003c/em\u003e \u0026gt;0.05; \u003cstrong\u003eFigure 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable3. Comparison of classroom performance (points, M\u0026plusmn;SD)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"580\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClassroom participation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunication ability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaterial preparation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCritical thinking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTeamwork ability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eControl group (\u003cem\u003en\u003c/em\u003e=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3.73\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e3.70\u0026plusmn;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e4.07\u0026plusmn;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e3.67\u0026plusmn;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e3.80\u0026plusmn;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eIntervention group (\u003cem\u003en\u003c/em\u003e=30)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e4.20\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e4.27\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e4.20\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e4.07\u0026plusmn;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e4.17\u0026plusmn;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e3.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e1.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e2.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e2.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Evaluation of teaching effectiveness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comparison of the comprehensive evaluation of the teaching effect between the two groups of nursing students showed that there were significant differences in improving learning interest and classroom participation, increasing teacher-student interaction, deepening memory of knowledge, improving discovery and problem-solving ability, cultivating critical thinking and the ability to integrate knowledge, and improving the ability to search for literature (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.05; \u003cstrong\u003eTable4\u003c/strong\u003e). The experimental group\u0026apos;s satisfaction with the teaching was significantly higher than that of the control group, with no statistically significant differences (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026gt;0.05) in improving the ability to learn independently, broadening the scope of knowledge, and improving teamwork and communication ability. The differences in knowledge and improved teamwork and communication skills were not statistically significant (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026gt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Comparison of nursing students\u0026apos; evaluation of teaching effectiveness\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(points, M\u0026plusmn;SD)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"599\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group (\u003cem\u003en\u003c/em\u003e=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention group (\u003cem\u003en\u003c/em\u003e=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eT\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eTeaching satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.57\u0026plusmn;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.87\u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eIncrease interest in learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.50\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.97\u0026plusmn;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e4.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eIncrease classroom participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.57\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.97\u0026plusmn;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.919\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eIncrease teacher-student interaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.50\u0026plusmn;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.93\u0026plusmn;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eDeepen memory of knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.57\u0026plusmn;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.83\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eImprove problem-solving skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.37\u0026plusmn;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.73\u0026plusmn;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eImprove independent learning skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.67\u0026plusmn;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.77\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eCultivate critical thinking skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.37\u0026plusmn;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.77\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.919\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eBroaden students\u0026apos; knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.60\u0026plusmn;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.83\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eEnhance teamwork and communication skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.53\u0026plusmn;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.73\u0026plusmn;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eDevelop the ability to integrate knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.50\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.80\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 249px;\"\u003e\n \u003cp\u003eImprove literature-searching skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.53\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e3.80\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eOver the years, global higher education has transitioned from traditional subject-centered and teacher-oriented curricula to more student-centered, problem-oriented, and competency-based curricula that empower students to take ownership of their learning [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The rapid advancement of Internet technology has introduced diverse learning pathways in medical education[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], significantly reshaping medical students' learning concepts and attitudes. In the current educational environment, teaching strategies must adapt to evolving educational models in the \u0026ldquo;Internet Plus\u0026rdquo; era and actively integrate information technology with daily teaching activities, students' self-learning modes, and the overall process of educational innovation[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Clinical internships, essential for nursing students' transition to professional practice, are not only a core responsibility of teaching hospitals but also a crucial element in enhancing the overall effectiveness of nursing education.\u003c/p\u003e \u003cp\u003eIn the teaching of nursing in burn unit, we adopted a teaching mode that combined PBL with Rain Classroom based on OBE. This approach invigorated the classroom atmosphere. Teachers used students' communication tools to deliver PBL teaching cases and outline requirements, facilitating problem identification through clinical scenarios. By incorporating entertainment and interactive elements, this method enhanced engagement and effectively improved learning among nursing students.\u003c/p\u003e \u003cp\u003eIn the PBL teaching activity combined with Rain Classroom based on OBE, the teacher released PBL teaching cases via the Rain Classroom platform before the class. Nursing students previewed the related knowledge, identified the problems in the cases, and deepened the understanding by consulting literature. During class, the integration of PBL and Rain Classroom increased student participation through interactive teaching methods, helped students engage with the cases more personally, reduced their fear of burn patients, enhanced empathy, and stimulated their interest in learning. The discussion of teaching cases fostered clinical thinking and teamwork skills among nursing interns. The interactive pop-up screen feature in Rain Classroom enabled real-time communication between teachers and nursing students [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. After class, nursing students could consolidate their knowledge using Rain Classroom, while teachers could address questions and provide additional learning materials through the platform.\u003c/p\u003e \u003cp\u003eIn this study, the intervention group used the PBL combined with Rain Classroom teaching model based on OBE. Compared with the control group, the nursing students in the intervention group had significantly better results in their discharge theory and operation assessments. The study findings showed that PBL combined with Rain Classroom teaching based on OBE was more effective in improving the depth of nursing students' mastery of theoretical knowledge and their level of practical nursing operation skills[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In terms of classroom performance, the intervention group exhibited higher participation and better communication skills, critical thinking, and teamwork than the control group. Regarding the evaluation of teaching effectiveness, the intervention group showed greater improvements in nursing students' interest in learning and classroom participation than the control group. They also demonstrated enhanced knowledge retention, increased teacher-student interaction, and better development of critical thinking and knowledge integration compared with the control group. Additionally, the intervention group improved discovery and problem-solving skills[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], literature-searching ability, and overall teaching satisfaction.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe application of PBL combined with Rain Classroom teaching based on OBE in clinical nursing education was beneficial in enhancing nursing students' comprehensive ability and teaching satisfaction. This teaching method also provides a solid foundation for their future clinical nursing work. Our study demonstrates that this teaching method effectively improves teaching outcomes and quality, making it valuable for clinical application. Therefore, it is of great significance to apply it in clinical teaching practice.\u003c/p\u003e \u003cp\u003eThis study was limited by a small sample size(n\u0026thinsp;=\u0026thinsp;60) and single-center study, it may limit the statistical power and generalizability of the results.The intervention\u0026rsquo;s effectiveness might be influenced by institution-specific factors,such as internship time and faculty training programs,this caused it not to fully reflect the teaching advantages of the new model. Despite these limitations, this pilot study provides initial evidence supporting the feasibility of PBL combined with Rain Classroom teaching based on OBE in nursing education. In the future, we will strive for larger multi-center trials to increase the sample size and clinical internship time, and further study the potential teaching advantages of the new model, with the aim to promote its application in clinical teaching so that more clinical interns can benefit from it.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.cn) for English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy conception and design: Linli Sun, Wuquan Li.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData collection: Lijuan Sun, Luyan Xiang, Fan Wu, Ding Li.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData analysis and interpretation: Linli Sun, Wuquan Li.\u003c/p\u003e\n\u003cp\u003eDrafting of the article: Linli Sun, Lihong Liu, Wenjuan Feng.\u003c/p\u003e\n\u003cp\u003eCritical revision of the article: Wenjun Liu.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the 2022 Kunming Medical University School-level Teaching, Research, and Reform Projects (2022-JY-Y-100) and the 2024 Scientific Research Fund Project of the Yunnan Provincial Department of Education (2024J0322).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are not publicly available due privacy protection but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical exemption and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis quasi-experimental study adhered to the Declaration of Helsinki and had been granted an exemption from requiring ethics approval by the Institutional Review Board of the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (Approval No. YJ-2024-1). The data collection of this study was non-intrusive and participants\u0026rsquo;identities were fully protected. Informed consent was obtained from all of the participants in this study. During the research period, the identities of the participants were kept confidential and they were informed that the research data might be used for educational research purposes,and all data were anonymized prior to analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen D, Zhao W, Ren L, Tao K, Li M, Su B et al. 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Front Med (Lausanne). 2024;11:1334919. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fmed.2024.1334919\u003c/span\u003e\u003cspan address=\"10.3389/fmed.2024.1334919\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\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":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"burns nursing, nursing education, outcome-based education(OBE), problem-based learning(PBL), Rain Classroom","lastPublishedDoi":"10.21203/rs.3.rs-6530519/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6530519/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe problem-based learning (PBL) combined with the Rain Classroom teaching model based on the outcome-based education (OBE) is beneficial in enhancing nursing interns' comprehensive ability and teaching satisfaction. This approach can improve teaching outcomes and quality, making it valuable for clinical application. Therefore, nursing educators can consider applying it to clinical nursing teaching.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo investigate the effects of problem-based learning combined with Rain Classroom teaching based on outcome-based education among burn nursing students\u0026rsquo; clinical comprehensive abilities. Innovative educational models are required to keep pace with rapid developments in nursing education, and we aimed to provide documentation on the efficacy of novel teaching methods in the challenging field of burns nursing.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis quasi-experimental study included 60 nursing students in burn unit of a grade A tertiary hospital in 2023\u0026ndash;2024. The samples were allocated randomly into intervention and control groups(30 participants in each group). The control group received the traditional teaching methods combined with PBL teaching. The intervention group received PBL combined with Rain Classroom teaching model based on OBE. After the teaching activities, the two groups of nursing students were assessed based on theory and operation. Questionnaires and classroom evaluation scales were employed to comprehensively assess the effect of the two teaching methods and the satisfaction of the nursing students.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe intervention group had better effects on terms of increasing theoretical、operational test scores and teaching satisfaction, improving classroom performance and problem-solving skills, cultivating critical thinking skills, developing the ability to integrate knowledge than those of the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the difference was statistically significant.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePBL combined with Rain Classroom teaching based on OBE improved the classroom participation of nursing students, and further improved their satisfaction with teaching and their comprehensive abilities. It is worthy of being widely applied in clinical teaching to meet the social demands for cultivating medical talents.\u003c/p\u003e","manuscriptTitle":"Effect of Problem-based learning combined with Rain Classroom teaching based on outcome-based education on nursing students’ comprehensive abilities in burn unit: a quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-11 06:03:52","doi":"10.21203/rs.3.rs-6530519/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-06-05T11:33:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-28T06:48:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-09T06:39:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-08T15:03:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-05-08T15:01:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"67f9cc88-0076-44a4-bd5a-f15618ce28e8","owner":[],"postedDate":"June 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-11T06:03:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-11 06:03:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6530519","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6530519","identity":"rs-6530519","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}