Application Research of the Interdisciplinary “OBE+ADDIE” Model in Surgical Nursing Internship Instruction

Application Research of the Interdisciplinary “OBE+ADDIE” Model in Surgical Nursing Internship Instruction | 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 Application Research of the Interdisciplinary “OBE+ADDIE” Model in Surgical Nursing Internship Instruction Yue Dai, Dan Yu, Yinghui Hu, Zhimin Qiu, Linghua Luo, Na Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8967090/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objective Exploring the Application Effectiveness of the “OBE+ADDIE” Model in Surgical Nursing Internship Teaching from a Multidisciplinary Integration Perspective. Methods A total of 240 third-year undergraduate nursing students undergoing surgical nursing internships at a tertiary-level hospital in Nanchang, Jiangxi Province were selected. The 120 nursing students from the 2021 cohort served as the control group, receiving traditional internship training. The 120 nursing students from the 2022 cohort formed the experimental group, undergoing internship training under a multidisciplinary, integrated “OBE+ADDIE” model. Results After the internship, the experimental group demonstrated significantly higher scores in all dimensions of self-directed learning ability and critical thinking ability, as well as overall scores, compared to their pre-internship levels and the control group. Additionally, the experimental group achieved significantly higher scores in both theoretical and practical assessments than the control group, with all differences being statistically significant (all P < 0.05). Conclusions Within a multidisciplinary integration framework, the“OBE+ADDIE”model effectively enhances nursing students' autonomous learning abilities, clinical critical thinking skills, and surgical nursing practicum assessment scores, thereby improving the teaching effectiveness of surgical nursing practicums. Multidisciplinary Integration Clinical Internship Self-directed learning ability Critical thinking skills Introduction With the rapid advancement of big data, artificial intelligence, precision medicine, and the emergence of the holistic health concept, unprecedented demands have been placed on the capabilities and competencies of healthcare professionals [ 1 ]. The National Nursing Development Plan (2021–2025) emphasizes that nursing professionals must not only possess solid specialized knowledge and clinical skills but also cultivate core competencies such as critical thinking and clinical communication abilities[ 2 ]. Clinical practicum serves as a pivotal bridge for nursing students to translate theoretical knowledge into practical application.In recent years, factors such as continuous expansion of university enrollment, limited hospital resources, and heightened patient self-protection awareness have led to a significant disconnect between theory and practice in clinical internships for nursing students under the traditional “teacher-lectures-student-listens” teaching model [ 3 ]. In 2021, General Secretary Xi Jinping emphasized the need to “leverage interdisciplinary integration as a catalyst to break down disciplinary barriers and accelerate the cultivation of urgently needed talent,” charting a clear course for disciplinary development and talent cultivation [ 4 ]. Facing society's diverse demands for nursing professionals, innovating nursing concepts, integrating into multifaceted social domains, and cultivating more high-level, interdisciplinary nursing professionals will be pivotal to advancing China's nursing education in the future [ 5 ]. Currently, many institutions both domestically and internationally have independently applied either the OBE or ADDIE instructional models to various specialized course offerings, achieving some positive outcomes. However, certain issues persist, such as a lack of analytical focus in instructional design and a scarcity of empirical research [ 6 ].At the same time, reports on the application of the combined OBE+ADDIE teaching model in actual clinical teaching research are also scarce both domestically and internationally [ 7 ].To align with contemporary trends in nursing education, this study constructs an ADDIE instructional model grounded in the Outcome-Based Education (OBE) philosophy within a multidisciplinary integration framework. Employing a reverse-design, forward-implementation approach, it designs and implements teaching strategies for undergraduate nursing students' surgical clinical practicums. This approach holds significant guiding implications and research value for advancing clinical practice teaching reforms and cultivating applied undergraduate nursing talent [ 8 ]. Objects and methods Research subjects This study employed convenience sampling. From March to June 2024, 120 third-year undergraduate nursing students from the 2021 cohort undergoing clinical internships at a Grade III Class A hospital in Nanchang, Jiangxi Province, were selected as the control group and received traditional teaching. From March to June 2025, 120 third-year undergraduate nursing students from the 2022 cohort undergoing clinical internships at the same hospital were selected as the experimental group, implementing a multidisciplinary “OBE+ADDIE” internship teaching model. Inclusion Criteria: ① All students enrolled in the nationally unified four-year undergraduate nursing program; ② All third-year nursing students currently in their clinical practicum phase; ③ All students who agreed to cooperate and voluntarily participate in this study. Exclusion Criteria: ① Students not enrolled in the nationally unified general nursing program; ② Nursing students who had not completed the full required practicum hours; ③ Individuals who refused to participate in this study. There were no statistically significant differences between the two groups in terms of age, gender, or previous semester exam scores. Both groups of nursing students shared identical clinical placement locations, number of placements, clinical departments, and supervising instructors. Prior to clinical placements, both groups had completed foundational public and professional courses, possessing the medical knowledge required to understand the Surgical Nursing course. However, they exhibited relatively underdeveloped clinical reasoning and practical skills.This study adheres to the Declaration of Helsinki,all subjects signed an informed consent form before participating in the study.The study was approved by the Ethics Committee of Jiangxi Cancer Hospital (review approval number: 2024ky016). Study methods Teaching Methods To ensure the quality and management of clinical practicum instruction, based on the Surgical Nursing Practicum Syllabus and the educational requirements for undergraduate nursing students, the practicum is scheduled for the 6th semester with a total of 24 credit hours. Prior to the practicum, both groups of nursing students have completed the theoretical component of the Surgical Nursing course; Both groups of nursing students share identical instructors, curriculum content, teaching materials, and assessment methods. The teaching material is the 7th edition of Surgical Nursing, edited by Li Lezhi and Lu Qian, published by People's Medical Publishing House, which is designated as a “14th Five-Year Plan” textbook by the National Health Commission. All instructors are dual-qualified teachers holding intermediate or higher professional titles with over 15 years of clinical experience. Both groups of nursing students followed the clinical practicum outline and requirements for surgical nursing. The practicum covered eight chapters: care for patients with cranial diseases, care for patients with neck diseases, care for patients with breast diseases, care for patients with thoracic diseases, care for patients with abdominal diseases, care for patients with urinary system diseases, and care for patients with bone and joint system diseases. Each practicum session was scheduled for 3 academic hours, with each hour lasting 40 minutes. Control group The control group of nursing students followed a traditional clinical teaching model. Clinical instructors conducted teaching according to the school's established clinical rotation schedule and teaching syllabus requirements. The teaching method primarily involved instructors lecturing, demonstrating, and posing questions, while nursing students observed, listened, and responded. A clinical assessment was administered after the rotation. Experimental group The experimental group of nursing students underwent a multidisciplinary OBE+ADDIE surgical nursing practicum model, building upon traditional surgical nursing practicum instruction. Preparation Before the Internship Teacher Preparation: Two months prior to the internship, the research team will conduct unified training for clinical instructors on the “SuperStar Learning Pass” platform, the ADDIE model, and OBE teaching methodologies, ensuring instructors master these innovative teaching approaches. Concurrently, the research team will collaborate with clinical instructors, clinical nutritionists, and psychological counselors to develop the clinical surgical nursing internship teaching plan. This plan will incorporate internship content to refine the collection of case information for common surgical conditions. Student Preparation: Prior to the practicum, nursing students in the experimental group were divided into three teams based on their average grades in completed courses, categorized as high, medium, and low performance levels. Each team is supervised by one clinical instructor. During each practicum session, team members take turns serving as team leader, responsible for task allocation and overall coordination within their group. Teaching Analysis Phase(A: Analysis) Occupational Position Survey: This study conducted a questionnaire survey via the Learning Pass platform to investigate the current learning status and practical needs of clinical placement instruction among undergraduate nursing students in the 2021 and 2022 cohorts. Guided by the job requirements of clinical surgical nurses, targeted training indicators and programs were developed to cultivate their core surgical nursing skills, thereby enhancing the comprehensiveness and scientific rigor of the research. Course Nature and Student Profile Analysis: The course “Surgical Nursing” serves as a core professional subject in higher nursing education, requiring undergraduate nursing students to master theoretical knowledge and clinical skills in surgical nursing while developing strong professional ethics and clinical analytical thinking abilities [9]. However, current undergraduate students have not yet engaged in frontline clinical work and possess limited understanding of clinical realities. Consequently, most students struggle to integrate their academic knowledge with specific clinical practices, exhibiting deficiencies in perceptual awareness, systematic analysis, and holistic nursing capabilities. Surgical nursing practicum instruction is scheduled for the sixth semester, followed by clinical internships. Instructional Design(D: Design) 1.Design of Instructional Objectives: The overarching educational objective of surgical nursing practicum instruction centers on nursing professional competence, integrating theoretical knowledge, practical skills, and ideological education. Through integrated theoretical and practical teaching, it cultivates students' clinical nursing abilities and instills a “patient-centered” philosophy [10]. The defined teaching objectives encompass knowledge goals, competency goals, and quality goals.Knowledge Objectives: Be able to describe the fundamental knowledge, clinical manifestations, nursing diagnoses, and interventions for diseases encountered during surgical rotations; understand surgical indications and contraindications; be aware of recent advances in surgical nursing; broaden medical horizons; and apply this knowledge to observe patient conditions and provide health education for surgical rotation patients [11]. Competency Objectives: Independently conduct medical history collection and nursing physical examinations for common surgical conditions; accurately document nursing records; implement personalized care plans using the nursing process for surgical patients during clinical rotations; fundamentally master key perioperative nursing tasks; cultivate clinical reasoning, emergency response capabilities, teamwork, and doctor-patient communication skills among nursing students.Core Objectives: Cultivate a professional ethos centered on“cherishing life and saving the dying”; foster humanistic compassion and patriotic sentiment; establish a commitment to lifelong learning and innovation. 2.Instructional Content Design: The multidisciplinary nursing teaching and research team, grounded in the educational objectives of surgical nursing internships and centered on job competency, has constructed a knowledge framework for clinical surgical nursing internships. Through an imperceptibly nurturing approach, it seamlessly integrates ideological and political education with professional knowledge. The team has systematically organized and established eight nursing modules (care for patients with cranial and cerebral diseases, care for patients with neck diseases, breast disease patients, thoracic disease patients, abdominal disease patients, urological disease patients, and musculoskeletal disease patients). Focusing on real-world surgical clinical issues and research advancements, the team selects representative and complex surgical cases. These cases ensure coverage of knowledge points across multiple disciplines, including multidisciplinary diseases, nutrition, psychology, rehabilitation medicine, artificial intelligence, biology, medical materials science, and humanistic care [12]. Teaching primarily employs scenario-based methods, integrating and connecting related knowledge points across disciplines to enrich and refine nursing students' knowledge structures, achieving deep interdisciplinary integration in teaching [13]. 3.Course-Based Ideological and Political Education Design: This study addresses the ideological and political education needs of undergraduate nursing students by seamlessly integrating such education with professional knowledge during clinical placements. Guided by socialist core values, professional ethics, and cultural heritage, it incorporates case studies on “current news, medical advancements, and industry trends” to enrich educational materials. This approach subtly infuses ideological and political education throughout the entire placement experience, ensuring its pervasive influence [14]. Instructional Development(D: Develop) This study, grounded in a multidisciplinary and industry-academia integration teaching philosophy, simulates authentic clinical scenarios of surgical diseases. By collaborating with multidisciplinary experts in teaching environments, resources, and teams, it develops instructional materials including a clinical case repository of typical surgical scenarios, internship syllabi, and practical training manuals. This forms an integrated “teaching, learning, and doing” learning model, establishing a multifaceted surgical nursing internship platform that combines research, education, and practice [15]. Concurrently, the teaching team collaborates with clinical experts and specialists in biomaterials science, computer information science, and basic medical sciences to deliver joint instruction. This approach achieves a school-hospital dual-subject education model characterized by multidisciplinary integration.This study designed a multidisciplinary integrated teaching case using the nursing care of a breast cancer patient as an example, with the following specific tasks: ①Surgeons and Plastic Surgeons: Assess the patient's surgical indications, introduce breast cancer treatment methods and surgical approaches, and explain how to monitor postoperative recovery. ②Oncologists: Provide specialized recommendations for radiotherapy, chemotherapy, targeted therapy, and endocrine therapy based on the patient's current condition, and develop an individualized comprehensive treatment plan.③Pathologist: Explain how to perform pathological analysis on surgical or biopsy specimens to determine tumor type, grade, and stage; ④Nursing Staff: Provide pre- and post-operative care guidance for breast cancer patients, including pain management, wound care, and health education; ⑤Biomaterial Specialist: Introduce applications of nanomaterials and 3D printing technology in breast cancer patients; ⑥ Psychologist: Provides psychological support and counseling services to help patients manage treatment-related stress and develop psychological intervention plans; ⑦Nutritionist: Offers scientific nutritional guidance and dietary plans for breast cancer patients; ⑧Physical Therapist: Develops and implements rehabilitation programs, including functional exercises for the affected limb post-surgery and lymphedema management. Teaching Implementation(I: Implement) The experimental group's teaching implementation adopted a teacher-led, student-centered approach. Based on prior instructional analysis and design, a diversified online clinical training network platform was established to facilitate multi-perspective, multi-tiered teaching design. Utilizing simulation wards, simulators, and VR technology to replicate authentic surgical nursing scenarios. Through task-driven teaching, scenario-based instruction, role-playing, case studies, and collaborative group learning, multidisciplinary skills are seamlessly integrated. This immerses students in realistic clinical work environments, ensuring comprehensive understanding and mastery of key concepts during surgical nursing internships [16].This study employs a blended teaching approach combining online and offline methods, structured as a three-phase hybrid model: pre-class, in-class, and post-class. Before class, instructors assign learning tasks, guide students toward self-directed study using online open courses, and dynamically adjust teaching content and strategies by tracking learning data and collecting feedback questions. Students complete knowledge acquisition through online learning, discussions, and quizzes. During class, instructors deliver blended instruction through case-based guidance, real-time assessment, and summary sessions to address pre-class questions with targeted teaching. Students proactively pose questions, engage in group discussions, and submit learning reports to deepen understanding through collaborative interaction. After class, instructors assign follow-up tasks, forming a closed-loop teaching cycle through effectiveness evaluation, resource refinement, and instructional improvement. Students consolidate knowledge and enhance skills through online quizzes, report revisions, and self-assessment. Teaching Evaluation(E, Evaluation) In surgical nursing practicum instruction, a comprehensive evaluation approach combining formative and summative assessments is employed. Formative evaluation primarily focuses on process control, such as pre-class preparation tasks and knowledge assessments before lectures; during class, it examines nursing students' learning outcomes and the achievement of teaching objectives through clinical case discussions and classroom questioning. Instructors provide evaluations and feedback based on students' mastery of key concepts and classroom performance [17].The summative evaluation primarily investigates the effectiveness of nursing students' competency development and their mastery of knowledge and skills through theoretical assessments, skill evaluations, and questionnaires. It facilitates reflection on all aspects of the clinical teaching design process, continuously refining the surgical nursing clinical teaching design plan. Evaluation Indicators 1. Evaluation scale of autonomous learning ability This study employed the Self-Directed Learning Ability Scale for Nursing Students developed by Zhang Xiyan et al. [18]. The scale comprises four dimensions: Self-Management Ability (11 items), Collaborative Learning Ability (5 items), Learning Motivation (8 items), and Information Literacy (6 items), totaling 30 items. The scale employs a 5-point Likert scale for scoring: 1 = Strongly disagree; 2 = Somewhat disagree; 3 = Neutral; 4 = Somewhat agree; 5 = Strongly agree. The total score ranges from 30 to 150 points. The Cronbach's alpha coefficient is 0.822, indicating good internal consistency. All questionnaires were effectively recovered. 2.Chinese Critical Thinking Disposition Inventory This study employed the Critical Thinking Ability Measurement Scale developed by Peng Meici et al. from The Hong Kong Polytechnic University to evaluate nursing students' critical thinking abilities [19]. The scale comprises seven dimensions: truth-seeking, open-mindedness, analytical ability, systematization ability, confidence in critical thinking, intellectual curiosity, and cognitive maturity. Each dimension contains 10 items, totaling 70 items. Each item is scored using a 6-point Likert scale: 1 = Strongly Agree, 2 = Agree, 3 = Somewhat Agree, 4 = Neutral, 5 = Somewhat Disagree, 6 = Strongly Disagree. The total score ranges from 70 to 420 points, with a Cronbach's alpha coefficient of 0.900, indicating high reliability and validity.A total scale score < 210 indicates a tendency toward negative critical thinking, 211–279 indicates moderate critical thinking tendencies, 280–349 indicates a tendency toward positive critical thinking, and ≥ 350 indicates strong critical thinking tendencies [20]. The questionnaire was administered uniformly via the Wenjuanxing platform before and after the internship, achieving a 100% valid response rate. 3.Internship Assessment Results Theory Score: The theory exam is a 60-minute closed-book test scored on a 100-point scale. Question types include multiple-choice questions (30 points), true/false questions (10 points), short-answer questions (30 points), and case analysis questions (30 points). Practical Assessment: Clinical competency is evaluated using actual patient cases. Students are randomly assigned one case from their clinical rotation and required to conduct a nursing assessment of the patient's current condition. They must identify primary nursing issues, develop targeted nursing interventions and individualized health education plans, and evaluate the effectiveness of these interventions. Assessment criteria include: Clinical reasoning (60 points total): nursing assessment skills (20 points), analytical judgment (20 points), clinical nursing skills (20 points); Nursing skills (30 points); Related knowledge (10 points). Total possible score: 100 points. Following the internship, both groups of nursing students were assessed on their theoretical knowledge and practical skills using identical methods. The assessment format and content were the same for both groups. 4.Data analysis Data collected were analyzed using SPSS 26.0 software. Normality tests were performed on both datasets. For continuous variables such as self-directed learning ability, critical nursing thinking, and course examination scores, those meeting normal distribution requirements were expressed as mean ± standard deviation; non-normally distributed variables were presented as median and interquartile range. For categorical variables like examination scores, data were reported as frequency and percentage. For continuous variables, t-tests were applied when data followed a normal distribution (independent samples t-test for between-group comparisons, paired samples t-test for within-group comparisons). Non-normally distributed continuous variables underwent Mann-Whitney U nonparametric tests. Categorical variables were analyzed using chi-square (χ²) tests, Fisher's exact probability test, or stratified chi-square tests. A P value < 0.05 indicates a statistically significant difference. Results 1.Demographics Participant characteristics are presented in Table 1 . There are a total of 240research subjects. This study involved full-time third-year undergraduate nursing students. Chi-square tests and t-tests were used to compare general characteristics between the two groups. The experimental group comprised 120 participants, including 98 females (81.67%) and 22 males (18.33%); The average age of students was (20.03 ± 0.82) years old; the average score in surgical nursing was (82.01 ± 2.77) points. The control group comprised 120 students, including 101 females (84.17%) and 19 males (15.83%); The mean age of students was (20.02 ± 0.83) years old; the mean score in surgical nursing was (81.18 ± 2.73) points. Comparisons between the two nursing student groups in terms of gender, age, and mean surgical nursing scores showed no statistically significant differences (P > 0.05), indicating comparable data between the two groups. 2.Comparison of Self-Directed Learning Abilities Before and After Clinical Placements Among Two Groups of Nursing Students The self-directed learning ability scale was administered to both groups of nursing students before and after clinical practice for intergroup and intragroup comparisons. Results indicated that prior to clinical practice, there were no statistically significant differences (P > 0.05) in the total self-directed learning ability scores or the scores across the four dimensions—learning motivation, self-management ability, collaborative learning ability, and information literacy—between the two groups, demonstrating comparability. Table 1 Participant demographic data(N = 240) Group Gender Age Average Score of the Surgical Nursing Course Female Male Experimental group 98 22 20.03 ± 0.82 82.01 ± 2.77 Control group 101 19 20.02 ± 0.83 81.18 ± 2.73 t/ χ 2 0.265 0.110 1.628 P 0.607 0.912 0.106 After the practicum, the experimental group of nursing students demonstrated significantly higher total scores in self-directed learning ability and scores across all four dimensions—learning motivation, self-management ability, collaborative learning ability, and information literacy—compared to the control group (P < 0.05). This indicates that the multidisciplinary “OBE+ADDIE” practicum teaching model outperforms traditional practicum approaches in enhancing nursing students' self-directed learning abilities. Post-clinical placement, the experimental group's total self-directed learning ability score and scores across all four dimensions were higher than pre-intervention levels, with statistically significant differences (P 0.05), the specific scores are shown in Table 2 and Table 3 . Table 2 Comparison of Self-Directed Learning Ability Scores Between Nursing Student Groups Before and After Internship (Points, \(\stackrel{-}{x}\) ±s) Project Learning Motivation Self-management skills Collaborative Learning Skills Information Literacy Total Score for Self-Directed Learning Ability Before the internship Experimental group 27.00 ± 1.40 33.95 ± 1.66 15.53 ± 1.35 21.15 ± 1.69 97.92 ± 3.66 Control group 26.63 ± 1.15 33.92 ± 1.82 15.23 ± 1.48 21.20 ± 1.47 96.98 ± 3.06 t 1.567 0.105 1.163 -0.173 1.516 P 0.491 0.917 0.247 0.863 0.1323 After the internship Experimental group 34.23 ± 2.09 45.92 ± 4.01 20.53 ± 1.84 26.10 ± 1.04 126.78 ± 4.88 Control group 26.70 ± 1.28 33.95 ± 1.66 15.25 ± 1.17 21.18 ± 1.08 97.08 ± 2.98 t 23.845 21.376 18.780 25.425 40.257 P <0.001 <0.001 <0.001 <0.001 <0.001 Table 3 Comparison of Self-Directed Learning Ability Scores Among Nursing Students Before and After Internship (Points, \(\stackrel{-}{x}\) ±s) Project Learning Motivation Self-management skills Collaborative Learning Skills Information Literacy Total Score for Self-Directed Learning Ability Experimental group Before the internship 27.00 ± 1.40 33.95 ± 1.66 15.53 ± 1.35 21.15 ± 1.69 97.92 ± 3.66 After the internship 34.23 ± 2.09 45.92 ± 4.01 20.53 ± 1.84 26.10 ± 1.04 126.78 ± 4.88 t -35.979 -21.628 -28.626 -19.384 -48.253 P <0.001 <0.001 <0.001 <0.001 <0.001 Control group Before the internship 26.63 ± 1.15 33.92 ± 1.82 15.23 ± 1.48 21.20 ± 1.47 96.98 ± 3.06 After the internship 26.70 ± 1.28 33.95 ± 1.66 15.25 ± 1.17 21.18 ± 1.08 97.08 ± 2.98 t -0.382 -0.211 -0.100 0.115 -0.281 P 0.704 0.833 0.921 0.909 0.779 3.Comparative Study of Critical Thinking Abilities Among Nursing Students Before and After Clinical Internships Prior to the internship, two groups of nursing students were compared in terms of their critical thinking abilities before the intervention. There were no statistically significant differences (P > 0.05) between the two groups in their total critical thinking scores or in scores across dimensions such as truth-seeking, open-mindedness, analytical ability, systematization ability, self-confidence, intellectual curiosity, and cognitive maturity. The two groups were comparable. After the clinical rotation, the experimental group of nursing students demonstrated significantly higher scores than before the rotation across all dimensions of critical thinking ability, including total scores, seeking truth, open-mindedness, analytical skills, systematization ability, self-confidence, intellectual curiosity, and cognitive maturity (P < 0.05). After the practicum, the control group nursing students showed slightly higher scores in both the total critical thinking ability score and all dimensions compared to before the practicum, but the differences were not statistically significant (P > 0.05). Comparing the two groups' critical thinking abilities post-clinical placement, the experimental group's total score was significantly higher than the control group's, indicating that the “OBE+ADDIE” clinical teaching model is more effective than traditional clinical teaching models in enhancing nursing students' critical thinking abilities. The differences in both total critical thinking scores and scores across all dimensions between the two groups were statistically significant (P < 0.001), the specific scores are shown in Table 4 and Table 5 . Table 4 Comparison of Critical Thinking Scores Between Nursing Student Groups Before and After Internship (Points, \(\stackrel{-}{x}\) ±s) Project Seeking the truth Open-mindedness Analytical skills Systematic capability Self-confidence curiosity Cognitive Maturity Total Score Before the internship Experimental group 37.87 ± 1.38 39.43 ± 1.57 40.27 ± 1.34 40.12 ± 1.34 40.20 ± 1.01 41.10 ± 0.93 39.88 ± 1.17 278.87 ± 3.83 Control group 37.78 ± 1.21 39.22 ± 0.88 40.13 ± 1.13 39.73 ± 0.99 40.42 ± 1.31 41.32 ± 1.24 39.65 ± 1.16 278.25 ± 3.13 t 0.362 0.933 0.590 1.781 -1.019 -1.080 1.098 0.966 P 0.718 0.353 0.556 0.077 0.310 0.282 0.274 0.336 After the internship Experimental group 39.93 ± 1.82 41.43 ± 1.23 42.33 ± 1.19 42.13 ± 1.36 43.22 ± 1.45 44.33 ± 1.28 41.90 ± 1.31 294.98 ± 4.18 Control group 37.80 ± 0.95 39.25 ± 1.32 40.17 ± 1.15 39.77 ± 1.18 40.43 ± 1.49 41.35 ± 1.19 39.70 ± 1.38 278.47 ± 3.63 t 8.038 9.375 10.139 10.171 10.372 11.914 8.948 23.099 P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 Table 5 Comparison of Critical Thinking Scores Between Nursing Student Groups Before and After Internship (Points, \(\stackrel{-}{x}\) ±s) Project Seeking the truth Open-mindedness Analytical skills Systematic capability Self-confidence curiosity Cognitive Maturity Total Score Experimental group Before the internship 37.87 ± 1.38 39.43 ± 1.57 40.27 ± 1.34 40.12 ± 1.34 40.20 ± 1.01 41.10 ± 0.93 39.88 ± 1.17 278.87 ± 3.83 After the internship 39.93 ± 1.82 41.43 ± 1.23 42.33 ± 1.19 42.13 ± 1.36 43.22 ± 1.45 44.03 ± 1.28 41.90 ± 1.31 294.98 ± 4.18 t -12.108 -12.685 -11.054 -12.865 -14.511 -14.871 -11.601 -24.724 P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 Control group Before the internship 37.78 ± 1.21 39.22 ± 0.88 40.13 ± 1.13 39.73 ± 0.99 40.42 ± 1.31 41.32 ± 1.24 39.65 ± 1.16 278.25 ± 3.13 After the internship 37.80 ± 0.95 39.25 ± 1.32 40.17 ± 1.15 39.77 ± 1.18 40.43 ± 1.49 41.35 ± 1.19 39.70 ± 1.38 278.47 ± 3.63 t -0.105 -0.216 -0.209 -0.216 -0.105 -0.219 -0.316 -0.598 P 0.917 0.829 0.835 0.829 0.917 0.827 0.753 0.552 4.Comparison of Assessment Scores Between Two Groups of Nursing Students After Clinical Internships After the internship, the experimental group demonstrated higher theoretical and practical scores than the control group. The difference between the two groups was statistically significant (P < 0.05), the specific scores are shown in Table 6 . Table 6 Comparison of Theoretical and Practical Scores Among Two Groups of Nursing Students After Clinical Internships (Points, \(\stackrel{-}{x}\) ±s) Group Number of people Theoretical Score Practical Score Experimental group Control group t P 120 120 85.83 ± 2.03 80.92 ± 2.08 13.123 <0.001 84.78 ± 1.85 79.98 ± 1.38 16.087 <0.001 Discussion The multidisciplinary OBE+ADDIE internship teaching model enhances students' self-directed learning abilities. Self-directed learning ability, as a core competency essential for nursing students, is determined by the unique characteristics of the nursing profession. It provides a foundation for continuous learning, updating knowledge and skills, and adapting to the evolving demands of health services [21]. The study findings indicate that after implementing the “OBE+ADDIE” clinical teaching model within a multidisciplinary integration framework, nursing students in the experimental group demonstrated significantly higher total scores for autonomous learning ability and scores across all dimensions—self-management, collaborative learning, learning motivation, and information literacy—compared to pre-intervention levels. These scores were also markedly superior to those of the control group using traditional teaching methods (P 0.05). This indicates that the teaching model can effectively enhance undergraduate nursing students' self-directed learning abilities. Traditional clinical teaching currently centers on teacher-led lectures and demonstrations, leaving nursing students in a passive knowledge-receiving role. This approach lacks opportunities for independent planning, inquiry, and collaboration, resulting in insufficient development of self-management and information-seeking skills. Consequently, students struggle to meet the demands for autonomous learning required in modern nursing practice [22]. In contrast, the multidisciplinary “OBE+ADDIE” model employs outcome-based reverse design. During the instructional analysis phase, it identifies core objectives for cultivating self-directed learning based on surgical nursing job requirements and nursing students' learning profiles, ensuring students clearly understand learning directions and expected outcomes [23]. In the implementation phase, instructors employ a blended online-offline model. Through the SuperStar Learning Pass platform, multidisciplinary preparatory resources are distributed, guiding students to integrate case studies with interdisciplinary materials from nutrition, psychology, rehabilitation medicine, and biomedicine to hone their information screening and synthesis skills. Scenario-based simulations further strengthen self-management and collaboration abilities through task allocation and case discussions [24]. Formative assessment in the evaluation phase spans pre-class, in-class, and post-class activities. Through pre-study assessments, classroom performance feedback, and online quizzes, students continuously monitor learning outcomes, fostering intrinsic motivation to adjust strategies and achieve comprehensive enhancement of self-directed learning abilities [25]. The multidisciplinary “OBE+ADDIE” instructional design process breaks away from traditional one-way teaching models, fully emphasizing nursing students' central role in learning. Through independent inquiry, interdisciplinary collaboration, and continuous reflection, students progressively develop self-directed learning competencies aligned with modern nursing education's demand for autonomous learning literacy. The multidisciplinary OBE+ADDIE internship teaching model enhances students' critical thinking skills. Critical thinking in nursing is a self-regulated process of judgment and reflection guided by nursing objectives and grounded in professional knowledge and skills, employing scientific methods in clinical practice [26]. Clinical practicum serves as a crucial component in cultivating nursing students' critical thinking abilities [27]. The study findings indicate that post-internship, the experimental group's nursing students demonstrated significantly higher total scores in critical thinking ability and scores across all dimensions—truth-seeking, open-mindedness, analytical ability, systematization ability, self-confidence, intellectual curiosity, and cognitive maturity—compared to pre-intervention levels. These scores were also substantially higher than those of the control group, which followed a traditional teaching model (P 0.05). This indicates that the “OBE+ADDIE” practicum teaching model, developed within a multidisciplinary integration framework, significantly enhances undergraduate nursing students' critical thinking abilities. In clinical nursing practice, critical thinking serves as the core competency enabling nursing students to translate theoretical knowledge into clinical application and independently resolve nursing challenges [28]. The traditional “teacher-led lecture–passive student reception” internship model emphasizes knowledge transmission while neglecting systematic training in clinical reasoning, thereby failing to cultivate students' capacity for independent analysis and problem-solving. The multidisciplinary “OBE+ADDIE” model adopts an outcomes-based approach, integrating critical thinking development throughout the entire teaching process. During instructional design, it centers on real surgical clinical issues, integrating knowledge points from nursing, nutrition, psychology, rehabilitation medicine, and other disciplines to design complex and comprehensive cases. This requires nursing students to analyze patient conditions from multiple dimensions [29]. During implementation, methods like scenario-based teaching, role-playing, and group case discussions guide students to independently conduct nursing assessments, formulate nursing problems, and develop personalized care plans. This process of exploring multidisciplinary collaborative care hones their analytical, reasoning, and systematic thinking skills. Concurrently, joint lectures by multidisciplinary experts expose students to diverse disciplinary perspectives, breaking the limitations of single-discipline cognition and fostering open-mindedness and an investigative spirit dedicated to uncovering truth [30].The teaching evaluation process integrates formative and summative assessments. Through classroom questioning, case analysis assessments, and other methods, instructors provide timely feedback on students' cognitive gaps, guiding them to reflect and refine their thinking approaches. This gradually enhances students' confidence in critical thinking and cognitive maturity [31]. The multidisciplinary “OBE+ADDIE” model deeply integrates critical thinking development with clinical practice across disciplines. This approach enables nursing students to develop scientific thinking methods while solving real-world problems, aligning with modern nursing practice's core demand for clinical reasoning skills. The multidisciplinary OBE+ADDIE internship teaching model enhances students' course performance. Clinical practicum serves as a vital pathway for nursing students to solidify theoretical foundations and master practical skills, while also constituting an essential component for cultivating comprehensive nursing competencies such as integrating theory with practice, communication and coordination, and health education [32]. The findings reveal that after the practicum, nursing students in the experimental group achieved significantly higher scores in both theoretical and practical assessments compared to the control group, with statistically significant differences between the two groups (P < 0.05). This confirms that the “OBE+ADDIE” practicum teaching model, developed within a multidisciplinary integration framework, effectively enhances undergraduate nursing students' performance in surgical nursing courses. It provides an efficient pathway for deepening the integration of theory and practice in nursing education. Traditional clinical teaching centers on a “teacher-led lecture-student passive reception” model, depriving nursing students of opportunities to actively apply knowledge to solve complex clinical problems. This limits improvements in course performance, particularly in practical assessments [33]. In contrast, the multidisciplinary “OBE+ADDIE” model employs backward design to clearly define learning outcomes for academic improvement. Its forward-implemented five-phase process forms a closed-loop teaching system, providing systematic support for enhancing student performance. During the instructional analysis phase, educators precisely identify students' knowledge gaps and skill deficiencies. In the instructional design phase, centered on job competency, they select representative cases integrating multidisciplinary knowledge points—such as a breast cancer nursing case combining surgical treatment, psychological intervention, and nutritional support—enabling students to systematically master core knowledge while solving real-world problems. During instructional development, the teaching team establishes an integrated “teaching, learning, and practice” platform. Multidisciplinary experts co-teach to broaden knowledge horizons, while tools like simulated wards and VR technology compensate for limited practical training opportunities [34]. Implementation adopts a blended online-offline model with a three-phase process: pre-class self-study, in-class interactive inquiry, and post-class consolidation/reflection, reinforcing knowledge retention. Assessment combines formative and summative evaluations, providing timely feedback for targeted reinforcement. This approach strengthens students' theoretical foundations and standardizes practical skills, ultimately achieving significant course performance improvements and offering a replicable model for surgical nursing education reform. Conclusions Against the backdrop of “Healthy China 2030” and the national health strategy, cultivating innovative, multidisciplinary nursing professionals with cross-disciplinary competencies has become an inevitable trend in nursing education development [ 35 ]. This study adopts a multidisciplinary integration perspective, utilizing the “OBE+ADDIE” model to construct a blended learning system integrating “online self-directed learning—clinical clerkship—offline simulation instruction.” This approach establishes a surgical nursing clinical clerkship teaching plan and evaluation system centered on nursing innovation capabilities. Practice demonstrates that this model effectively refines practical teaching mechanisms, optimizes instructional content and platforms, enhances nursing students' interdisciplinary thinking, self-directed learning abilities, and clinical critical thinking, and improves teaching outcomes. It better prepares nursing students for surgical nursing roles and holds feasibility and scalability value for undergraduate nursing practicum education. Declarations Ethical approval and consent to participate This study adheres to the ethical principles outlined in the Declaration of Consent for publication Not applicable. No identifying personal data are included in this Manuscript. Competing interests The authors declare that they have no competing interests. Funding NO1. 2024 Jiangxi Provincial Undergraduate Higher Education Teaching Reform Research Projects(Project Name:Application Research of the “OBE+ADDIE” Model in Surgical Nursing Internship Teaching from a Multidisciplinary Integration Perspective)((Project NO. JXJG-24-40-2). NO2.2024 Nanchang Medical College Teaching Reform Research Project(Project Name:Application Research of the “OBE+ADDIE” Model in Surgical Nursing Internship Teaching from a Multidisciplinary Integration Perspective)((Project NO. NYJG-20240023). Author Contribution Design proposals, write papers: Yue Dai, Xiuping Huang ;Data Analysis: Na Zheng;Investigation, Questionnaire preparation and distribution: Yinghui Hu;Organize data, data statistics: Linghua Luo, Zhimin QiuWriting—original draft preparation: Yue Dai Writing—review and editing.All authors have read and agreed to the published version of the manuscript. Acknowledgements The authors would like to thank all the participants for their support and contribution to the study. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Tang SY. Development idea of nursing discipline based on Interdisciplinary integration [J].Mil Nurs, 2022, 39(8): 1–2. Yang YY, Chen H, Guo LT. Design and application of online teaching in clinical teaching of Neonatal Nursing [J]. Chin J Nurs Educ 2021,18(9): 809–13. Zhang LL, Xue F, Zheng YM, et al. Practice of acute abdomen case video drama in general surgery clerkship for undergraduate nursing students [J]. J Nurs Admin. 2024;31(2):32–6. Zhou DM, Shen YP. Xi Jinping's important discourses on technological innovation guide the direction of emerging engineering education development [J]. Res High Educ Eng, 2021, (4): 1–7. Rao WY, Yang LY. 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Construction and application of CBL teaching program for surgical nursing clinical clerkship based on learning style theory [D]. Dalian Med Univ; 2024. Wang HJ, Zhang XX, Jin J, et al. Development and practice of online clerkship course for Surgical Nursing [J]. Health Voc Educ. 2023;41(13):65–7. Li QY, Liang T, Ma SM, et al. Teaching reform under the cultivation of excellent nursing talents[J]. China J Nurs Educ. 2022;19(8):765–8. Sun HY, Li Q, Su ZY et al. Research on OBE-based teaching mode and evaluation methods in universities [J]. Chin J High Med Educ, 2022, (2): 69–70. Sun N, Zhao WX, Zhao XL, et al. Analysis of talent training paths for nursing discipline in China under the background of interdisciplinary integration [J]. J Nurs Train. 2024;39(4):369–71. Liu W, Yao XL. Discussion on constructing integrated undergraduate nursing courses combined with clinical MDT model [J]. Educ Teach Forum, 2020, (53): 290–1. McIntyre JRS, Burton C, Holmes D. From discipline to control in nursing practice: a poststructuralist reflection[J]. Nurs Philos. 2020;21(4):e12317. PILKINGTON B. GIULIANTE M.Nursing ethics as a distinct entity within bioethics: implications for clinical ethics practice[J].Nurs Ethics, 2023, 30(5):671–9. Zhang XY, Li XH. Development of an evaluation tool for autonomous learning ability of nursing students [J]. Nurs Res. 2009;23(3):639–40. Peng MC, Wang GC, Chen JL et al. Reliability and validity test of the Critical Thinking Disposition Inventory [J]. Chin J Nurs, 2004, (9): 7–10. Dehong Y, Yaqing Z, ,Yun X et al. Improvement in critical thinking dispositions of undergraduate nursing students through problem-based learning: a crossover- experimental study.[J]. J Nurs Educ 2013,52(10):574–81. Wang P, Li YR, Ge H, Liu JY, Li SW. Experience in developing innovative practical ability for Master of Nursing Specialist degree program in China: A qualitative descriptive study of postgraduates. 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Analysis of current status and influencing factors of interprofessional collaboration ability among clinical nurses [J]. Shanghai Nurs J. 2023;23(5):30–4. Liu HY, Wang IT, Hsu DY, et al. Conflict and interactions on interdisciplinary nursing student teams: The moderating effects of spontaneous communication[J]. Nurse Educ Today. 2020;94:104562. Ying Z, Yingxin L, ,Zheng L. Interdisciplinary collaboration between nursing and engineering in health care: A scoping review[J]. Int J Nurs Stud,2021,117103900–103900. Zhang QH, Fan SG, Shimpuku YOKO, et al. Investigation on current status and demand of interdisciplinary training for nursing professional master’s students [J]. Health Voc Educ. 2026;44(6):84–7. Dai Y, Dou YX, Wang ML. Research on core competency-based nursing talent training mode in universities under the background of industry-education integration [J]. Technol Wind, 2025, (27): 16–8. Li K, Nie WB, Peng X, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8967090","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":612488340,"identity":"f8989c56-eb7d-44da-b65f-fa4802c63e98","order_by":0,"name":"Yue Dai","email":"","orcid":"","institution":"Nanchang Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Dai","suffix":""},{"id":612488341,"identity":"00b3cb5b-7b3d-4034-b13c-ab4645a22ee9","order_by":1,"name":"Dan Yu","email":"","orcid":"","institution":"Nanchang Medical College","correspondingAuthor":false,"prefix":"","firstName":"Dan","middleName":"","lastName":"Yu","suffix":""},{"id":612488342,"identity":"a85c8da2-c9fe-4120-a482-1330e71bf1d9","order_by":2,"name":"Yinghui Hu","email":"","orcid":"","institution":"Nanchang Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yinghui","middleName":"","lastName":"Hu","suffix":""},{"id":612488343,"identity":"12aed36b-4505-427b-8930-f5171da80a57","order_by":3,"name":"Zhimin Qiu","email":"","orcid":"","institution":"Jiangxi Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhimin","middleName":"","lastName":"Qiu","suffix":""},{"id":612488344,"identity":"051e97f1-73b7-4498-b0f1-45f84d95ab53","order_by":4,"name":"Linghua Luo","email":"","orcid":"","institution":"The Third Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Linghua","middleName":"","lastName":"Luo","suffix":""},{"id":612488345,"identity":"f2286481-d482-4c3c-948f-f54c9170aa25","order_by":5,"name":"Na Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBACxmbmgw8+/mOr72dvIFILcztbsuEMNj7GmT0HiNTC3s9jJs3BJse44UYCkVp4mxkMpBl4zJgZbj7eeIOhxiaaoBbJZoYE4wKJNDbG2WnFFgzH0nIbCGkxbGY4kDzD4BgPs3SOmQRjw2HCWuwPA5XxJPyXYJM8Q6QWYCAzNvMcYDPgkeAhWgsbM+PMBrYECR6gXxKI8Qtj//nvPz4CtdgfP7zxxocaG8JakIGBRAIpyiFaSNUxCkbBKBgFIwMAAOi8O/JRQ2BTAAAAAElFTkSuQmCC","orcid":"","institution":"Nanchang Medical College","correspondingAuthor":true,"prefix":"","firstName":"Na","middleName":"","lastName":"Zheng","suffix":""}],"badges":[],"createdAt":"2026-02-25 11:23:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8967090/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8967090/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105903888,"identity":"c5dba76c-7f45-495c-bd1f-4ba19a16a7df","added_by":"auto","created_at":"2026-04-01 09:56:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1038995,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8967090/v1/c74a66bf-5903-4600-a8e5-bc056bec7177.pdf"},{"id":105505459,"identity":"7298eafb-c039-435b-8abd-0dfa32ed1a54","added_by":"auto","created_at":"2026-03-26 18:48:56","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":239616,"visible":true,"origin":"","legend":"","description":"","filename":"file.doc","url":"https://assets-eu.researchsquare.com/files/rs-8967090/v1/7bb0353676a79fb090aee06c.doc"},{"id":105505460,"identity":"68f8c936-84b5-4ac5-b224-503023b48fcd","added_by":"auto","created_at":"2026-03-26 18:48:56","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":442381,"visible":true,"origin":"","legend":"","description":"","filename":"file.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8967090/v1/54a193275bfb77cf11972125.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application Research of the Interdisciplinary “OBE+ADDIE” Model in Surgical Nursing Internship Instruction","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the rapid advancement of big data, artificial intelligence, precision medicine, and the emergence of the holistic health concept, unprecedented demands have been placed on the capabilities and competencies of healthcare professionals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The National Nursing Development Plan (2021\u0026ndash;2025) emphasizes that nursing professionals must not only possess solid specialized knowledge and clinical skills but also cultivate core competencies such as critical thinking and clinical communication abilities[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Clinical practicum serves as a pivotal bridge for nursing students to translate theoretical knowledge into practical application.In recent years, factors such as continuous expansion of university enrollment, limited hospital resources, and heightened patient self-protection awareness have led to a significant disconnect between theory and practice in clinical internships for nursing students under the traditional \u0026ldquo;teacher-lectures-student-listens\u0026rdquo; teaching model [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2021, General Secretary Xi Jinping emphasized the need to \u0026ldquo;leverage interdisciplinary integration as a catalyst to break down disciplinary barriers and accelerate the cultivation of urgently needed talent,\u0026rdquo; charting a clear course for disciplinary development and talent cultivation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Facing society's diverse demands for nursing professionals, innovating nursing concepts, integrating into multifaceted social domains, and cultivating more high-level, interdisciplinary nursing professionals will be pivotal to advancing China's nursing education in the future [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, many institutions both domestically and internationally have independently applied either the OBE or ADDIE instructional models to various specialized course offerings, achieving some positive outcomes. However, certain issues persist, such as a lack of analytical focus in instructional design and a scarcity of empirical research [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].At the same time, reports on the application of the combined OBE+ADDIE teaching model in actual clinical teaching research are also scarce both domestically and internationally [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].To align with contemporary trends in nursing education, this study constructs an ADDIE instructional model grounded in the Outcome-Based Education (OBE) philosophy within a multidisciplinary integration framework. Employing a reverse-design, forward-implementation approach, it designs and implements teaching strategies for undergraduate nursing students' surgical clinical practicums. This approach holds significant guiding implications and research value for advancing clinical practice teaching reforms and cultivating applied undergraduate nursing talent [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e"},{"header":"Objects and methods","content":"\u003cdiv\u003e\n\u003ch2\u003eResearch subjects\u003c/h2\u003e\n\u003cp\u003eThis study employed convenience sampling. From March to June 2024, 120 third-year undergraduate nursing students from the 2021 cohort undergoing clinical internships at a Grade III Class A hospital in Nanchang, Jiangxi Province, were selected as the control group and received traditional teaching. From March to June 2025, 120 third-year undergraduate nursing students from the 2022 cohort undergoing clinical internships at the same hospital were selected as the experimental group, implementing a multidisciplinary \u0026ldquo;OBE+ADDIE\u0026rdquo; internship teaching model.\u003c/p\u003e\n\u003cp\u003eInclusion Criteria: ① All students enrolled in the nationally unified four-year undergraduate nursing program; ② All third-year nursing students currently in their clinical practicum phase; ③ All students who agreed to cooperate and voluntarily participate in this study. Exclusion Criteria: ① Students not enrolled in the nationally unified general nursing program; ② Nursing students who had not completed the full required practicum hours; ③ Individuals who refused to participate in this study. There were no statistically significant differences between the two groups in terms of age, gender, or previous semester exam scores. Both groups of nursing students shared identical clinical placement locations, number of placements, clinical departments, and supervising instructors. Prior to clinical placements, both groups had completed foundational public and professional courses, possessing the medical knowledge required to understand the Surgical Nursing course. However, they exhibited relatively underdeveloped clinical reasoning and practical skills.This study adheres to the Declaration of Helsinki,all subjects signed an informed consent form before participating in the study.The study was approved by the Ethics Committee of Jiangxi Cancer Hospital (review approval number: 2024ky016).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy methods\u003c/h3\u003e\n\u003cdiv\u003e\n\u003ch2\u003eTeaching Methods\u003c/h2\u003e\n\u003cp\u003eTo ensure the quality and management of clinical practicum instruction, based on the Surgical Nursing Practicum Syllabus and the educational requirements for undergraduate nursing students, the practicum is scheduled for the 6th semester with a total of 24 credit hours. Prior to the practicum, both groups of nursing students have completed the theoretical component of the Surgical Nursing course; Both groups of nursing students share identical instructors, curriculum content, teaching materials, and assessment methods. The teaching material is the 7th edition of Surgical Nursing, edited by Li Lezhi and Lu Qian, published by People's Medical Publishing House, which is designated as a \u0026ldquo;14th Five-Year Plan\u0026rdquo; textbook by the National Health Commission. All instructors are dual-qualified teachers holding intermediate or higher professional titles with over 15 years of clinical experience. Both groups of nursing students followed the clinical practicum outline and requirements for surgical nursing. The practicum covered eight chapters: care for patients with cranial diseases, care for patients with neck diseases, care for patients with breast diseases, care for patients with thoracic diseases, care for patients with abdominal diseases, care for patients with urinary system diseases, and care for patients with bone and joint system diseases. Each practicum session was scheduled for 3 academic hours, with each hour lasting 40 minutes.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eControl group\u003c/h3\u003e\n\u003cp\u003eThe control group of nursing students followed a traditional clinical teaching model. Clinical instructors conducted teaching according to the school's established clinical rotation schedule and teaching syllabus requirements. The teaching method primarily involved instructors lecturing, demonstrating, and posing questions, while nursing students observed, listened, and responded. A clinical assessment was administered after the rotation.\u003c/p\u003e\n\u003ch3\u003eExperimental group\u003c/h3\u003e\n\u003cp\u003eThe experimental group of nursing students underwent a multidisciplinary OBE+ADDIE surgical nursing practicum model, building upon traditional surgical nursing practicum instruction.\u003c/p\u003e\n\u003cp\u003ePreparation Before the Internship\u003c/p\u003e\n\u003cp\u003eTeacher Preparation: Two months prior to the internship, the research team will conduct unified training for clinical instructors on the \u0026ldquo;SuperStar Learning Pass\u0026rdquo; platform, the ADDIE model, and OBE teaching methodologies, ensuring instructors master these innovative teaching approaches. Concurrently, the research team will collaborate with clinical instructors, clinical nutritionists, and psychological counselors to develop the clinical surgical nursing internship teaching plan. This plan will incorporate internship content to refine the collection of case information for common surgical conditions.\u003c/p\u003e\n\u003cp\u003eStudent Preparation: Prior to the practicum, nursing students in the experimental group were divided into three teams based on their average grades in completed courses, categorized as high, medium, and low performance levels. Each team is supervised by one clinical instructor. During each practicum session, team members take turns serving as team leader, responsible for task allocation and overall coordination within their group.\u003c/p\u003e\n\u003cp\u003eTeaching Analysis Phase(A: Analysis)\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eOccupational Position Survey: This study conducted a questionnaire survey via the Learning Pass platform to investigate the current learning status and practical needs of clinical placement instruction among undergraduate nursing students in the 2021 and 2022 cohorts. Guided by the job requirements of clinical surgical nurses, targeted training indicators and programs were developed to cultivate their core surgical nursing skills, thereby enhancing the comprehensiveness and scientific rigor of the research.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eCourse Nature and Student Profile Analysis: The course \u0026ldquo;Surgical Nursing\u0026rdquo; serves as a core professional subject in higher nursing education, requiring undergraduate nursing students to master theoretical knowledge and clinical skills in surgical nursing while developing strong professional ethics and clinical analytical thinking abilities [9]. However, current undergraduate students have not yet engaged in frontline clinical work and possess limited understanding of clinical realities. Consequently, most students struggle to integrate their academic knowledge with specific clinical practices, exhibiting deficiencies in perceptual awareness, systematic analysis, and holistic nursing capabilities. Surgical nursing practicum instruction is scheduled for the sixth semester, followed by clinical internships.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eInstructional Design(D: Design)\u003c/p\u003e\n\u003cp\u003e1.Design of Instructional Objectives: The overarching educational objective of surgical nursing practicum instruction centers on nursing professional competence, integrating theoretical knowledge, practical skills, and ideological education. Through integrated theoretical and practical teaching, it cultivates students' clinical nursing abilities and instills a \u0026ldquo;patient-centered\u0026rdquo; philosophy [10]. The defined teaching objectives encompass knowledge goals, competency goals, and quality goals.Knowledge Objectives: Be able to describe the fundamental knowledge, clinical manifestations, nursing diagnoses, and interventions for diseases encountered during surgical rotations; understand surgical indications and contraindications; be aware of recent advances in surgical nursing; broaden medical horizons; and apply this knowledge to observe patient conditions and provide health education for surgical rotation patients [11]. Competency Objectives: Independently conduct medical history collection and nursing physical examinations for common surgical conditions; accurately document nursing records; implement personalized care plans using the nursing process for surgical patients during clinical rotations; fundamentally master key perioperative nursing tasks; cultivate clinical reasoning, emergency response capabilities, teamwork, and doctor-patient communication skills among nursing students.Core Objectives: Cultivate a professional ethos centered on\u0026ldquo;cherishing life and saving the dying\u0026rdquo;; foster humanistic compassion and patriotic sentiment; establish a commitment to lifelong learning and innovation.\u003c/p\u003e\n\u003cp\u003e2.Instructional Content Design: The multidisciplinary nursing teaching and research team, grounded in the educational objectives of surgical nursing internships and centered on job competency, has constructed a knowledge framework for clinical surgical nursing internships. Through an imperceptibly nurturing approach, it seamlessly integrates ideological and political education with professional knowledge. The team has systematically organized and established eight nursing modules (care for patients with cranial and cerebral diseases, care for patients with neck diseases, breast disease patients, thoracic disease patients, abdominal disease patients, urological disease patients, and musculoskeletal disease patients). Focusing on real-world surgical clinical issues and research advancements, the team selects representative and complex surgical cases. These cases ensure coverage of knowledge points across multiple disciplines, including multidisciplinary diseases, nutrition, psychology, rehabilitation medicine, artificial intelligence, biology, medical materials science, and humanistic care [12]. Teaching primarily employs scenario-based methods, integrating and connecting related knowledge points across disciplines to enrich and refine nursing students' knowledge structures, achieving deep interdisciplinary integration in teaching [13].\u003c/p\u003e\n\u003cp\u003e3.Course-Based Ideological and Political Education Design: This study addresses the ideological and political education needs of undergraduate nursing students by seamlessly integrating such education with professional knowledge during clinical placements. Guided by socialist core values, professional ethics, and cultural heritage, it incorporates case studies on \u0026ldquo;current news, medical advancements, and industry trends\u0026rdquo; to enrich educational materials. This approach subtly infuses ideological and political education throughout the entire placement experience, ensuring its pervasive influence [14].\u003c/p\u003e\n\u003cp\u003eInstructional Development(D: Develop)\u003c/p\u003e\n\u003cp\u003eThis study, grounded in a multidisciplinary and industry-academia integration teaching philosophy, simulates authentic clinical scenarios of surgical diseases. By collaborating with multidisciplinary experts in teaching environments, resources, and teams, it develops instructional materials including a clinical case repository of typical surgical scenarios, internship syllabi, and practical training manuals. This forms an integrated \u0026ldquo;teaching, learning, and doing\u0026rdquo; learning model, establishing a multifaceted surgical nursing internship platform that combines research, education, and practice [15]. Concurrently, the teaching team collaborates with clinical experts and specialists in biomaterials science, computer information science, and basic medical sciences to deliver joint instruction. This approach achieves a school-hospital dual-subject education model characterized by multidisciplinary integration.This study designed a multidisciplinary integrated teaching case using the nursing care of a breast cancer patient as an example, with the following specific tasks: ①Surgeons and Plastic Surgeons: Assess the patient's surgical indications, introduce breast cancer treatment methods and surgical approaches, and explain how to monitor postoperative recovery. ②Oncologists: Provide specialized recommendations for radiotherapy, chemotherapy, targeted therapy, and endocrine therapy based on the patient's current condition, and develop an individualized comprehensive treatment plan.③Pathologist: Explain how to perform pathological analysis on surgical or biopsy specimens to determine tumor type, grade, and stage; ④Nursing Staff: Provide pre- and post-operative care guidance for breast cancer patients, including pain management, wound care, and health education; ⑤Biomaterial Specialist: Introduce applications of nanomaterials and 3D printing technology in breast cancer patients; ⑥ Psychologist: Provides psychological support and counseling services to help patients manage treatment-related stress and develop psychological intervention plans; ⑦Nutritionist: Offers scientific nutritional guidance and dietary plans for breast cancer patients; ⑧Physical Therapist: Develops and implements rehabilitation programs, including functional exercises for the affected limb post-surgery and lymphedema management.\u003c/p\u003e\n\u003cp\u003eTeaching Implementation(I: Implement)\u003c/p\u003e\n\u003cp\u003eThe experimental group's teaching implementation adopted a teacher-led, student-centered approach. Based on prior instructional analysis and design, a diversified online clinical training network platform was established to facilitate multi-perspective, multi-tiered teaching design. Utilizing simulation wards, simulators, and VR technology to replicate authentic surgical nursing scenarios. Through task-driven teaching, scenario-based instruction, role-playing, case studies, and collaborative group learning, multidisciplinary skills are seamlessly integrated. This immerses students in realistic clinical work environments, ensuring comprehensive understanding and mastery of key concepts during surgical nursing internships [16].This study employs a blended teaching approach combining online and offline methods, structured as a three-phase hybrid model: pre-class, in-class, and post-class. Before class, instructors assign learning tasks, guide students toward self-directed study using online open courses, and dynamically adjust teaching content and strategies by tracking learning data and collecting feedback questions. Students complete knowledge acquisition through online learning, discussions, and quizzes. During class, instructors deliver blended instruction through case-based guidance, real-time assessment, and summary sessions to address pre-class questions with targeted teaching. Students proactively pose questions, engage in group discussions, and submit learning reports to deepen understanding through collaborative interaction. After class, instructors assign follow-up tasks, forming a closed-loop teaching cycle through effectiveness evaluation, resource refinement, and instructional improvement. Students consolidate knowledge and enhance skills through online quizzes, report revisions, and self-assessment.\u003c/p\u003e\n\u003cp\u003eTeaching Evaluation(E, Evaluation)\u003c/p\u003e\n\u003cp\u003eIn surgical nursing practicum instruction, a comprehensive evaluation approach combining formative and summative assessments is employed. Formative evaluation primarily focuses on process control, such as pre-class preparation tasks and knowledge assessments before lectures; during class, it examines nursing students' learning outcomes and the achievement of teaching objectives through clinical case discussions and classroom questioning. Instructors provide evaluations and feedback based on students' mastery of key concepts and classroom performance [17].The summative evaluation primarily investigates the effectiveness of nursing students' competency development and their mastery of knowledge and skills through theoretical assessments, skill evaluations, and questionnaires. It facilitates reflection on all aspects of the clinical teaching design process, continuously refining the surgical nursing clinical teaching design plan.\u003c/p\u003e\n\u003cdiv\u003e\n\u003ch2\u003eEvaluation Indicators\u003c/h2\u003e\n\u003cstrong\u003e1.\u003c/strong\u003eEvaluation scale of autonomous learning ability\u003cbr /\u003e\n\u003cp\u003eThis study employed the Self-Directed Learning Ability Scale for Nursing Students developed by Zhang Xiyan et al. [18]. The scale comprises four dimensions: Self-Management Ability (11 items), Collaborative Learning Ability (5 items), Learning Motivation (8 items), and Information Literacy (6 items), totaling 30 items. The scale employs a 5-point Likert scale for scoring: 1\u0026thinsp;=\u0026thinsp;Strongly disagree; 2\u0026thinsp;=\u0026thinsp;Somewhat disagree; 3\u0026thinsp;=\u0026thinsp;Neutral; 4\u0026thinsp;=\u0026thinsp;Somewhat agree; 5\u0026thinsp;=\u0026thinsp;Strongly agree. The total score ranges from 30 to 150 points. The Cronbach's alpha coefficient is 0.822, indicating good internal consistency. All questionnaires were effectively recovered.\u003c/p\u003e\n\u003cp\u003e2.Chinese Critical Thinking Disposition Inventory\u003c/p\u003e\n\u003cp\u003eThis study employed the Critical Thinking Ability Measurement Scale developed by Peng Meici et al. from The Hong Kong Polytechnic University to evaluate nursing students' critical thinking abilities [19]. The scale comprises seven dimensions: truth-seeking, open-mindedness, analytical ability, systematization ability, confidence in critical thinking, intellectual curiosity, and cognitive maturity. Each dimension contains 10 items, totaling 70 items. Each item is scored using a 6-point Likert scale: 1\u0026thinsp;=\u0026thinsp;Strongly Agree, 2\u0026thinsp;=\u0026thinsp;Agree, 3\u0026thinsp;=\u0026thinsp;Somewhat Agree, 4\u0026thinsp;=\u0026thinsp;Neutral, 5\u0026thinsp;=\u0026thinsp;Somewhat Disagree, 6\u0026thinsp;=\u0026thinsp;Strongly Disagree. The total score ranges from 70 to 420 points, with a Cronbach's alpha coefficient of 0.900, indicating high reliability and validity.A total scale score\u0026thinsp;\u0026lt;\u0026thinsp;210 indicates a tendency toward negative critical thinking, 211\u0026ndash;279 indicates moderate critical thinking tendencies, 280\u0026ndash;349 indicates a tendency toward positive critical thinking, and \u0026ge;\u0026thinsp;350 indicates strong critical thinking tendencies [20]. The questionnaire was administered uniformly via the Wenjuanxing platform before and after the internship, achieving a 100% valid response rate.\u003c/p\u003e\n\u003cp\u003e3.Internship Assessment Results\u003c/p\u003e\n\u003cp\u003eTheory Score: The theory exam is a 60-minute closed-book test scored on a 100-point scale. Question types include multiple-choice questions (30 points), true/false questions (10 points), short-answer questions (30 points), and case analysis questions (30 points).\u003c/p\u003e\n\u003cp\u003ePractical Assessment: Clinical competency is evaluated using actual patient cases. Students are randomly assigned one case from their clinical rotation and required to conduct a nursing assessment of the patient's current condition. They must identify primary nursing issues, develop targeted nursing interventions and individualized health education plans, and evaluate the effectiveness of these interventions. Assessment criteria include: Clinical reasoning (60 points total): nursing assessment skills (20 points), analytical judgment (20 points), clinical nursing skills (20 points); Nursing skills (30 points); Related knowledge (10 points). Total possible score: 100 points.\u003c/p\u003e\n\u003cp\u003eFollowing the internship, both groups of nursing students were assessed on their theoretical knowledge and practical skills using identical methods. The assessment format and content were the same for both groups.\u003c/p\u003e\n\u003cp\u003e4.Data analysis\u003c/p\u003e\n\u003cp\u003eData collected were analyzed using SPSS 26.0 software. Normality tests were performed on both datasets. For continuous variables such as self-directed learning ability, critical nursing thinking, and course examination scores, those meeting normal distribution requirements were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; non-normally distributed variables were presented as median and interquartile range. For categorical variables like examination scores, data were reported as frequency and percentage. For continuous variables, t-tests were applied when data followed a normal distribution (independent samples t-test for between-group comparisons, paired samples t-test for within-group comparisons). Non-normally distributed continuous variables underwent Mann-Whitney U nonparametric tests. Categorical variables were analyzed using chi-square (\u0026chi;\u0026sup2;) tests, Fisher's exact probability test, or stratified chi-square tests. A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates a statistically significant difference.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e1.Demographics\u003c/p\u003e\n\u003cp\u003eParticipant characteristics are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. There are a total of 240research subjects.\u003c/p\u003e\n\u003cp\u003eThis study involved full-time third-year undergraduate nursing students. Chi-square tests and t-tests were used to compare general characteristics between the two groups. The experimental group comprised 120 participants, including 98 females (81.67%) and 22 males (18.33%); The average age of students was (20.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82) years old; the average score in surgical nursing was (82.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77) points. The control group comprised 120 students, including 101 females (84.17%) and 19 males (15.83%); The mean age of students was (20.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83) years old; the mean score in surgical nursing was (81.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73) points. Comparisons between the two nursing student groups in terms of gender, age, and mean surgical nursing scores showed no statistically significant differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating comparable data between the two groups.\u003c/p\u003e\n\u003cp\u003e2.Comparison of Self-Directed Learning Abilities Before and After Clinical Placements Among Two Groups of Nursing Students\u003c/p\u003e\n\u003cp\u003eThe self-directed learning ability scale was administered to both groups of nursing students before and after clinical practice for intergroup and intragroup comparisons. Results indicated that prior to clinical practice, there were no statistically significant differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) in the total self-directed learning ability scores or the scores across the four dimensions\u0026mdash;learning motivation, self-management ability, collaborative learning ability, and information literacy\u0026mdash;between the two groups, demonstrating comparability.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eParticipant demographic data(N\u0026thinsp;=\u0026thinsp;240)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAverage Score of the Surgical Nursing Course\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eFemale Male\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperimental group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et/\u003cem\u003e\u0026chi; 2\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.265\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.628\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.607\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.912\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.106\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAfter the practicum, the experimental group of nursing students demonstrated significantly higher total scores in self-directed learning ability and scores across all four dimensions\u0026mdash;learning motivation, self-management ability, collaborative learning ability, and information literacy\u0026mdash;compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This indicates that the multidisciplinary \u0026ldquo;OBE+ADDIE\u0026rdquo; practicum teaching model outperforms traditional practicum approaches in enhancing nursing students' self-directed learning abilities. Post-clinical placement, the experimental group's total self-directed learning ability score and scores across all four dimensions were higher than pre-intervention levels, with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Comparisons within the control group showed no significant differences in total self-directed learning ability or the four dimension scores (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), the specific scores are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of Self-Directed Learning Ability Scores Between Nursing Student Groups Before and After Internship (Points, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eProject\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLearning Motivation\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSelf-management skills\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCollaborative Learning Skills\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eInformation Literacy\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal Score for Self-Directed Learning Ability\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBefore the internship\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperimental group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.567\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.173\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.516\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.491\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.917\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.863\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.1323\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAfter the internship\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperimental group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.845\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.376\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.780\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.425\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.257\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of Self-Directed Learning Ability Scores Among Nursing Students Before and After Internship (Points, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eProject\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLearning Motivation\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSelf-management skills\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCollaborative Learning Skills\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eInformation Literacy\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal Score for Self-Directed Learning Ability\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eExperimental group\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBefore the internship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAfter the internship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-35.979\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-21.628\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-28.626\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-19.384\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-48.253\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBefore the internship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAfter the internship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.382\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.211\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.115\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.281\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.704\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.833\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.921\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.909\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.779\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e3.Comparative Study of Critical Thinking Abilities Among Nursing Students Before and After Clinical Internships\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrior to the internship, two groups of nursing students were compared in terms of their critical thinking abilities before the intervention. There were no statistically significant differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between the two groups in their total critical thinking scores or in scores across dimensions such as truth-seeking, open-mindedness, analytical ability, systematization ability, self-confidence, intellectual curiosity, and cognitive maturity. The two groups were comparable.\u003c/p\u003e\n\u003cp\u003eAfter the clinical rotation, the experimental group of nursing students demonstrated significantly higher scores than before the rotation across all dimensions of critical thinking ability, including total scores, seeking truth, open-mindedness, analytical skills, systematization ability, self-confidence, intellectual curiosity, and cognitive maturity (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After the practicum, the control group nursing students showed slightly higher scores in both the total critical thinking ability score and all dimensions compared to before the practicum, but the differences were not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Comparing the two groups' critical thinking abilities post-clinical placement, the experimental group's total score was significantly higher than the control group's, indicating that the \u0026ldquo;OBE+ADDIE\u0026rdquo; clinical teaching model is more effective than traditional clinical teaching models in enhancing nursing students' critical thinking abilities. The differences in both total critical thinking scores and scores across all dimensions between the two groups were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the specific scores are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e and Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of Critical Thinking Scores Between Nursing Student Groups Before and After Internship (Points, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eProject\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSeeking the truth\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOpen-mindedness\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAnalytical skills\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSystematic\u003c/p\u003e\n\u003cp\u003ecapability\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSelf-confidence\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ecuriosity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCognitive Maturity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal Score\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBefore the internship\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperimental group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e278.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.83\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e278.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.362\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.933\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.590\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.781\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.080\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.098\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.966\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.718\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.353\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.556\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.077\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.310\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.282\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.274\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.336\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAfter the internship\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperimental group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e294.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e278.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.375\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.171\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.372\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.914\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.948\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.099\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of Critical Thinking Scores Between Nursing Student Groups Before and After Internship (Points, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eProject\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSeeking the truth\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOpen-mindedness\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAnalytical skills\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSystematic\u003c/p\u003e\n\u003cp\u003ecapability\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSelf-confidence\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ecuriosity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCognitive Maturity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal Score\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eExperimental group\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBefore the internship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e278.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.83\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAfter the internship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e294.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-12.108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-12.685\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-11.054\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-12.865\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-14.511\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-14.871\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-11.601\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-24.724\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBefore the internship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e278.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAfter the internship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e278.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.209\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.219\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.316\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.598\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.917\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.829\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.835\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.829\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.917\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.827\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.753\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.552\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e4.Comparison of Assessment Scores Between Two Groups of Nursing Students After Clinical Internships\u003c/p\u003e\n\u003cp\u003eAfter the internship, the experimental group demonstrated higher theoretical and practical scores than the control group. The difference between the two groups was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the specific scores are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of Theoretical and Practical Scores Among Two Groups of Nursing Students After Clinical Internships (Points, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of people\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTheoretical Score\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePractical Score\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperimental group\u003c/p\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e\n\u003cp\u003e80.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e\n\u003cp\u003e13.123\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e\n\u003cp\u003e79.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n\u003cp\u003e16.087\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"The multidisciplinary OBE+ADDIE internship teaching model enhances students' self-directed learning abilities.\n\nSelf-directed learning ability, as a core competency essential for nursing students, is determined by the unique characteristics of the nursing profession. It provides a foundation for continuous learning, updating knowledge and skills, and adapting to the evolving demands of health services [21]. The study findings indicate that after implementing the “OBE+ADDIE” clinical teaching model within a multidisciplinary integration framework, nursing students in the experimental group demonstrated significantly higher total scores for autonomous learning ability and scores across all dimensions—self-management, collaborative learning, learning motivation, and information literacy—compared to pre-intervention levels. These scores were also markedly superior to those of the control group using traditional teaching methods (P \u003c 0.05). In contrast, the control group showed no statistically significant differences in any dimension or total score of self-directed learning ability before and after the intervention (P \u003e 0.05). This indicates that the teaching model can effectively enhance undergraduate nursing students' self-directed learning abilities.\n\nTraditional clinical teaching currently centers on teacher-led lectures and demonstrations, leaving nursing students in a passive knowledge-receiving role. This approach lacks opportunities for independent planning, inquiry, and collaboration, resulting in insufficient development of self-management and information-seeking skills. Consequently, students struggle to meet the demands for autonomous learning required in modern nursing practice [22]. In contrast, the multidisciplinary “OBE+ADDIE” model employs outcome-based reverse design. During the instructional analysis phase, it identifies core objectives for cultivating self-directed learning based on surgical nursing job requirements and nursing students' learning profiles, ensuring students clearly understand learning directions and expected outcomes [23]. In the implementation phase, instructors employ a blended online-offline model. Through the SuperStar Learning Pass platform, multidisciplinary preparatory resources are distributed, guiding students to integrate case studies with interdisciplinary materials from nutrition, psychology, rehabilitation medicine, and biomedicine to hone their information screening and synthesis skills. Scenario-based simulations further strengthen self-management and collaboration abilities through task allocation and case discussions [24]. Formative assessment in the evaluation phase spans pre-class, in-class, and post-class activities. Through pre-study assessments, classroom performance feedback, and online quizzes, students continuously monitor learning outcomes, fostering intrinsic motivation to adjust strategies and achieve comprehensive enhancement of self-directed learning abilities [25]. The multidisciplinary “OBE+ADDIE” instructional design process breaks away from traditional one-way teaching models, fully emphasizing nursing students' central role in learning. Through independent inquiry, interdisciplinary collaboration, and continuous reflection, students progressively develop self-directed learning competencies aligned with modern nursing education's demand for autonomous learning literacy.\n\nThe multidisciplinary OBE+ADDIE internship teaching model enhances students' critical thinking skills.\n\nCritical thinking in nursing is a self-regulated process of judgment and reflection guided by nursing objectives and grounded in professional knowledge and skills, employing scientific methods in clinical practice [26]. Clinical practicum serves as a crucial component in cultivating nursing students' critical thinking abilities [27]. The study findings indicate that post-internship, the experimental group's nursing students demonstrated significantly higher total scores in critical thinking ability and scores across all dimensions—truth-seeking, open-mindedness, analytical ability, systematization ability, self-confidence, intellectual curiosity, and cognitive maturity—compared to pre-intervention levels. These scores were also substantially higher than those of the control group, which followed a traditional teaching model (P \u003c 0.001). In contrast, the control group showed no statistically significant differences in critical thinking scores across dimensions or overall scores before and after the practicum (P \u003e 0.05). This indicates that the “OBE+ADDIE” practicum teaching model, developed within a multidisciplinary integration framework, significantly enhances undergraduate nursing students' critical thinking abilities.\n\nIn clinical nursing practice, critical thinking serves as the core competency enabling nursing students to translate theoretical knowledge into clinical application and independently resolve nursing challenges [28]. The traditional “teacher-led lecture–passive student reception” internship model emphasizes knowledge transmission while neglecting systematic training in clinical reasoning, thereby failing to cultivate students' capacity for independent analysis and problem-solving. The multidisciplinary “OBE+ADDIE” model adopts an outcomes-based approach, integrating critical thinking development throughout the entire teaching process. During instructional design, it centers on real surgical clinical issues, integrating knowledge points from nursing, nutrition, psychology, rehabilitation medicine, and other disciplines to design complex and comprehensive cases. This requires nursing students to analyze patient conditions from multiple dimensions [29]. During implementation, methods like scenario-based teaching, role-playing, and group case discussions guide students to independently conduct nursing assessments, formulate nursing problems, and develop personalized care plans. This process of exploring multidisciplinary collaborative care hones their analytical, reasoning, and systematic thinking skills. Concurrently, joint lectures by multidisciplinary experts expose students to diverse disciplinary perspectives, breaking the limitations of single-discipline cognition and fostering open-mindedness and an investigative spirit dedicated to uncovering truth [30].The teaching evaluation process integrates formative and summative assessments. Through classroom questioning, case analysis assessments, and other methods, instructors provide timely feedback on students' cognitive gaps, guiding them to reflect and refine their thinking approaches. This gradually enhances students' confidence in critical thinking and cognitive maturity [31]. The multidisciplinary “OBE+ADDIE” model deeply integrates critical thinking development with clinical practice across disciplines. This approach enables nursing students to develop scientific thinking methods while solving real-world problems, aligning with modern nursing practice's core demand for clinical reasoning skills.\n\nThe multidisciplinary OBE+ADDIE internship teaching model enhances students' course performance.\n\nClinical practicum serves as a vital pathway for nursing students to solidify theoretical foundations and master practical skills, while also constituting an essential component for cultivating comprehensive nursing competencies such as integrating theory with practice, communication and coordination, and health education [32]. The findings reveal that after the practicum, nursing students in the experimental group achieved significantly higher scores in both theoretical and practical assessments compared to the control group, with statistically significant differences between the two groups (P \u003c 0.05). This confirms that the “OBE+ADDIE” practicum teaching model, developed within a multidisciplinary integration framework, effectively enhances undergraduate nursing students' performance in surgical nursing courses. It provides an efficient pathway for deepening the integration of theory and practice in nursing education.\n\nTraditional clinical teaching centers on a “teacher-led lecture-student passive reception” model, depriving nursing students of opportunities to actively apply knowledge to solve complex clinical problems. This limits improvements in course performance, particularly in practical assessments [33]. In contrast, the multidisciplinary “OBE+ADDIE” model employs backward design to clearly define learning outcomes for academic improvement. Its forward-implemented five-phase process forms a closed-loop teaching system, providing systematic support for enhancing student performance. During the instructional analysis phase, educators precisely identify students' knowledge gaps and skill deficiencies. In the instructional design phase, centered on job competency, they select representative cases integrating multidisciplinary knowledge points—such as a breast cancer nursing case combining surgical treatment, psychological intervention, and nutritional support—enabling students to systematically master core knowledge while solving real-world problems. During instructional development, the teaching team establishes an integrated “teaching, learning, and practice” platform. Multidisciplinary experts co-teach to broaden knowledge horizons, while tools like simulated wards and VR technology compensate for limited practical training opportunities [34]. Implementation adopts a blended online-offline model with a three-phase process: pre-class self-study, in-class interactive inquiry, and post-class consolidation/reflection, reinforcing knowledge retention. Assessment combines formative and summative evaluations, providing timely feedback for targeted reinforcement. This approach strengthens students' theoretical foundations and standardizes practical skills, ultimately achieving significant course performance improvements and offering a replicable model for surgical nursing education reform."},{"header":"Conclusions","content":"\u003cp\u003eAgainst the backdrop of \u0026ldquo;Healthy China 2030\u0026rdquo; and the national health strategy, cultivating innovative, multidisciplinary nursing professionals with cross-disciplinary competencies has become an inevitable trend in nursing education development [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]. This study adopts a multidisciplinary integration perspective, utilizing the \u0026ldquo;OBE+ADDIE\u0026rdquo; model to construct a blended learning system integrating \u0026ldquo;online self-directed learning\u0026mdash;clinical clerkship\u0026mdash;offline simulation instruction.\u0026rdquo; This approach establishes a surgical nursing clinical clerkship teaching plan and evaluation system centered on nursing innovation capabilities. Practice demonstrates that this model effectively refines practical teaching mechanisms, optimizes instructional content and platforms, enhances nursing students' interdisciplinary thinking, self-directed learning abilities, and clinical critical thinking, and improves teaching outcomes. It better prepares nursing students for surgical nursing roles and holds feasibility and scalability value for undergraduate nursing practicum education.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study adheres to the ethical principles outlined in the Declaration of\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable. No identifying personal data are included in this Manuscript.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNO1. 2024 Jiangxi Provincial Undergraduate Higher Education Teaching Reform Research Projects(Project Name:Application Research of the \u0026ldquo;OBE+ADDIE\u0026rdquo; Model in Surgical Nursing Internship Teaching from a Multidisciplinary Integration Perspective)((Project NO. JXJG-24-40-2). NO2.2024 Nanchang Medical College Teaching Reform Research Project(Project Name:Application Research of the \u0026ldquo;OBE+ADDIE\u0026rdquo; Model in Surgical Nursing Internship Teaching from a Multidisciplinary Integration Perspective)((Project NO. NYJG-20240023).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDesign proposals, write papers: Yue Dai, Xiuping Huang ;Data Analysis: Na Zheng;Investigation, Questionnaire preparation and distribution: Yinghui Hu;Organize data, data statistics: Linghua Luo, Zhimin QiuWriting\u0026mdash;original draft preparation: Yue Dai Writing\u0026mdash;review and editing.All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to thank all the participants for their support and contribution to the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTang SY. 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Guiding Opinions on Accelerating the Innovative Development of Medical Education [A]. Guobanfa [2020] No.34.\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-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":"Multidisciplinary Integration, Clinical Internship, Self-directed learning ability, Critical thinking skills","lastPublishedDoi":"10.21203/rs.3.rs-8967090/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8967090/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eObjective\u003c/b\u003e Exploring the Application Effectiveness of the \u0026ldquo;OBE+ADDIE\u0026rdquo; Model in Surgical Nursing Internship Teaching from a Multidisciplinary Integration Perspective.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e A total of 240 third-year undergraduate nursing students undergoing surgical nursing internships at a tertiary-level hospital in Nanchang, Jiangxi Province were selected. The 120 nursing students from the 2021 cohort served as the control group, receiving traditional internship training. The 120 nursing students from the 2022 cohort formed the experimental group, undergoing internship training under a multidisciplinary, integrated \u0026ldquo;OBE+ADDIE\u0026rdquo; model.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e After the internship, the experimental group demonstrated significantly higher scores in all dimensions of self-directed learning ability and critical thinking ability, as well as overall scores, compared to their pre-internship levels and the control group. Additionally, the experimental group achieved significantly higher scores in both theoretical and practical assessments than the control group, with all differences being statistically significant (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e Within a multidisciplinary integration framework, the\u0026ldquo;OBE+ADDIE\u0026rdquo;model effectively enhances nursing students' autonomous learning abilities, clinical critical thinking skills, and surgical nursing practicum assessment scores, thereby improving the teaching effectiveness of surgical nursing practicums.\u003c/p\u003e","manuscriptTitle":"Application Research of the Interdisciplinary “OBE+ADDIE” Model in Surgical Nursing Internship Instruction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 18:48:51","doi":"10.21203/rs.3.rs-8967090/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-07T08:40:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-04T03:34:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34997067941818660978279463795384838341","date":"2026-04-04T03:09:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297718053595779904476033122491942067364","date":"2026-04-02T09:11:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-25T07:34:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-23T09:52:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-02T12:18:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-01T09:21:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-01T09:13:25+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":"3aff4790-6ab6-4cb2-a64d-e0bf50c8e237","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-26T18:48:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 18:48:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8967090","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8967090","identity":"rs-8967090","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}