The effectiveness of CBL in teaching specialized courses to undergraduate nursing students

The effectiveness of CBL in teaching specialized courses to undergraduate nursing students | 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 The effectiveness of CBL in teaching specialized courses to undergraduate nursing students Masoumeh Shohani, Mohammadreza Bastami, Leili Abedi Gheshlaghi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1870481/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Jan, 2023 Read the published version in BMC Medical Education → Version 1 posted 10 You are reading this latest preprint version Abstract Background Case-based learning (CBL) is an effective teaching-learning strategy that provides a learning environment similar to actual practice. The present study was conducted to determine the effectiveness of CBL in teaching specialized nursing courses on the learning and satisfaction of nursing students. Methods This quasi-experimental study was conducted in 2019 in School of Nursing and Midwifery in Ilam and all 128 undergraduate nursing students in the 3rd, 4th, and 5th semesters of nursing who had selected “Adult and Geriatric Nursing” and “Critical Care Nursing” courses were enrolled in the study using a census method. Data collection tools included a demographic information questionnaire and a researcher-made questionnaire consisting of 20 questions based on the Likert scale. Data analysis was performed using SPSS Statistics 22. Results More than two thirds of the students (81.3%) found the CBL method better than lectures. 60% of male students and 62% of female students stated that the CBL method increased their self-confidence compared to the traditional lecture-based learning (p < 0.03). Students were very satisfied with the CBL method (9.1 ± 1.1 out of 10). There was no significant relationship between gender-related features and marital status, and the mean score of students' satisfaction with the CBL method (p > 0.05). However, 4th semester students were more satisfied than other students (P = 0.02). Conclusion The results show that as a novel teaching-learning technique, CBL is effective in teaching specialized nursing courses and increases students' satisfaction and self-confidence. CBL effectiveness teaching-learning lecture-based learning nursing students Background Nowadays, one of the challenges of nursing and midwifery schools around the world is to train students who are able to think critically and provide comprehensive and complete care in different clinical situations (1). The fundamental philosophy behind nursing education is to prepare and train professional staff with high levels of problem-solving skills and critical thinking to take care of patients (2). However, the development of nursing education in recent decades has raised concerns about the quality of education in this field (3). Nurses have found a gap between theory and clinical practice. Nursing education through active learning enhances the correlation between education and clinical practice. One of the proposed ways to close the gap between education and clinical practice is to change the traditional educational system to learning based on new methods (4). In fact, effective education requires comprehensive interaction in the teaching process and this interaction is very limited in lecture-based learning. Lecture-based learning methods are suitable for achieving the cognitive goals of lower levels of Bloom's Taxonomy and are not suitable for teaching higher levels which include analysis, evaluation and synthesis and require a comprehensive involvement in learning (5). Case-based learning (CBL) is one of the strategies that enhances active learning in students and prepares them for clinical care. This method was first introduced at Harvard University and has recently been accepted as a teaching strategy and a means of problem-solving and decision-making by various academic fields, including nursing (6). CBL focuses on a well-designed clinical problem through which students identify, research, and link theory and practice to their learning needs. Due to the active participation of students, it increases students' ability to analyze and learn the clinical application of knowledge to treat the patient and can reflect the educational experience gained from cases or problems (7, 8). In a particular CBL method, a real situation is presented in the form of a scenario that requires problem-solving and decision-making. This method requires 45-90 minutes and only one case is raised in each session. The teacher presents the scenario and the students listen carefully and take notes, and students are given the opportunity to think about the case. The teacher then begins with an open-ended question: “What is the topic about?” and asks students to participate in discussions and, if necessary, the teacher provides additional information such as diagnostic tests, symptoms, etc. The role of the teacher in this method is initiating, mediating and facilitating the learning process and guides students towards the objectives of the session (9, 10). The CBL method can be used as one of the teaching methods for educational purposes, facilitating learning to work in clinical practice and problem-solving strategy (11). In addition to the importance of learning, one of the most important qualitative parameters in higher education is to pay attention to learners' satisfaction. The concept of learners' satisfaction is one of the issues that can challenge education providers and the process of education. Furthermore, determining the level of learners' satisfaction has always been an important criterion for measuring the efficiency of educational systems, because student satisfaction is one of the most important factors in the success of educational courses (12). Choosing the right training method plays an important role in satisfaction and highlights the need for education providers to choose the appropriate training method more than ever. In fact, teaching is effective when learners are satisfied with the teaching method (13). Therefore, the use of novel and alternative educational methods seems necessary. Although the CBL method is used in various academic fields, there is less scientific basis and evidence for its design, effects, and evaluation in nursing. Considering the experiences of researchers in nursing education and the importance of reducing the distance between theory and clinical practice, the present study was conducted to determine the effectiveness of the CBL method on the learning and satisfaction of nursing students in comparison with lecture-based learning. Methods Study design and aim This quasi-experimental study was conducted in 2019 in School of Nursing and Midwifery in Ilam to determine the effectiveness of CBL in teaching specialized nursing courses on the learning and satisfaction of nursing students. Setting and sample All 128 undergraduate nursing students in the 3rd, 4th, and 5th semesters of nursing who had selected the elderly/adult nursing unit and critical care nursing and were willing to participate in the study were enrolled in the study using a census method. Instruments Data collection tools in this study included a demographic information questionnaire (age, gender, marital status and semester) and a researcher-made 20-item questionnaire to compare the features of the CBL method and lecture-based learning using 5-point Likert scale questions including strongly agree, agree, neither agree nor disagree, disagree and strongly disagree. Finally, a question was included to determine the level of satisfaction with the CBL method on a scale of 0 to 10. The face and content validity of the questionnaire was confirmed using valid scientific sources and consulting ten experts. The reliability of the tool based on the test-retest method and Cronbach's alpha was 0.9. Participants and data interventions In this study, to compare students' learning and satisfaction with CBL and lecture-based learning, students were assigned into different groups based on semester. 3rd, 4th and 5th semester students chose “Adult and Geriatric Nursing” 2 and 3 and “Critical Care Nursing” courses, respectively. Accordingly, based on the experience of researchers as lecturers, two topics were selected for teaching based on CBL and lecture-based learning for each group of students, respectively. Thus, the topics MI and heart failure for 3rd semester students, stroke and multiple sclerosis for 4th semester students, and acute and chronic kidney failure were adopted for 5th semester students. The topics of each group were presented based on CBL and lecture-based learning in one session, respectively, and each topic took about 45 minutes. Kaddoura method was used for CBL which includes five steps of case presentation, presentation of different questions by the teacher, creating a free and comfortable atmosphere for learners, participation of all learners in discussions and summarization of contents by the teacher (6). Thus, first the objectives of teaching and then a specific case was presented and the symptoms of the disease and its clinical manifestations were described to the students and the diagnostic tests including graphs and related blood and urine tests were explained and the students were asked to diagnose the disease. All students were asked to take an active part in the discussions. Then, the disease was diagnosed step by step based on the guidance and participation of students, and at each stage, the symptoms and treatment methods of the disease were discussed at the beginning of the session, and these symptoms and care were matched to that specific case. Various questions were constantly asked about the presented case, and the students gradually became familiar with this case of disease. This situation lasted for 45 minutes and at the end, the final conclusion was made by the lecturer. In the second part of the session, the teacher taught the second topic to the students for 45 minutes based on lecture-based learning. At the end of the session, students were asked to complete the study questionnaire. Ethical considerations The ethics committee of Ilam University of Medical Sciences (IR.MEDILAM.REC.1398.034) approved the study. This study was carried out in accordance with the declaration of Helsinki. Participants entered the study voluntarily, consciously and with satisfaction after were provided with both verbal and written information about the study. In addition, informed consent was obtained from all subjects. Their information remained confidential. Data analysis After completing the questionnaires, the extracted data were entered into SPSS Statistics 22. Significance level was considered P<0.05. Descriptive statistics were reported as mean (standard deviation) for quantitative variables and as frequency (percentage) for qualitative variables. Chi-square test was used to examine the relationship between the features of the CBL method in each of the questions based on gender, marital status and semester. Independent t-test was used to examine the relationship between the mean score of students' satisfaction and gender and marital status based on the CBL method. However, ANOVA test was used to examine the relationship between satisfaction score and semester. The normality of quantitative variables was evaluated using Kolmogorov-Smirnov test. Results 128 nursing students participated in this present study. The mean (standard deviation) age of students was 23.3 (4.1) years. About 67% (86 students) were male and the rest were female. More than two thirds of the students (113 students, 88%) were single. In the present study, 5th semester students (52 students, 40.1%), 3rd semester students (43 students, 33.9%) and 4th semester students (32 students, 25.2%) had the highest participation, respectively. From the viewpoint of students, the most important features of the CBL method were respectively being closer to reality (86%), higher student comprehension (82%), high coverage of study objectives (81%), applicability of this method (81%) and less classroom monotony (81%) compared to the lecture-based learning (Table 1 ). There was no significant difference between the features of the CBL based on gender in each of the questions except questions 5 and 13 (p > 0.05). There was a significant relationship between gender and the feature of being closer to reality (p < 0.03); 68 (80%) male students and 41 (97.6%) female students stated that the CBL method has been closer to reality compared to the lecture-based learning. About 60% (52 students) of male students and 62% (26 students) of female students stated that the CBL method increased the students' self-confidence compared to the lecture-based learning (p 0.05). Furthermore, there was no significant difference between variables of gender and marital status with the features of CBL method in each of the questions (p > 0.05). Overall, more than two thirds of the students (81.3%) found the CBL method better than the lecture-based learning. The mean (standard deviation) score of student satisfaction with the CBL method was 9.1 (1.1%), which indicates high level of student satisfaction with this method. There was no significant relationship between gender and marital status and mean score of student satisfaction with the CBL method (p > 0.05). Moreover, 4th semester students were more satisfied with the CBL method compared to other students (P = 0.02). Table 1 Description of the frequency (percentage) of the features of the CBL method compared to lecture-based learning from the viewpoint of nursing students of Ilam University of Medical Sciences Questions CBL versus lecture-based learning agree and strongly agree neither agree nor disagree disagree and strongly disagree 1. Covers objectives well 104(81.3) 17(13.3) 7(5.5) 2. It is more interesting. 96(75) 23(18) 9(7) 3. Increases students' comprehension. 104(81.9) 20(15.7) 3(2.4) 4. More cooperation and participation from students. 100(78.1) 25(19.5) 3(2.3) 5. It is closer to reality. 109(85.8) 15(11.8) 3(2.4) 6. Increases students' motivation to learn. 69(53.9) 34(26.6) 25(19.5) 7. Facilitates students' learning. 84(65.6) 37(28.9) 7(5.5) 8. Information is well organized. 61(47.7) 43(33.6) 24(18.8) 9. It is more practical. 104(81.3) 19(14.8) 5(3.9) 10. The learned material has higher persistence. 71(55.9) 34(26.8) 22(17.3) 11. Increases students' visualization power. 77(61.1) 37(21.4) 22(17.5) 12. Most nursing courses can be offered through CBL method. 86(67.7) 30(23.6) 11(8.7) 13- Increases students' self-confidence. 78(60.9) 22(29.7) 21(16.4) 14. Reduces class monotony. 104(81.3) 19(14.8) 5(3.9) 15. Makes students think deeply. 78(60.9) 27(21.1) 23(18) 16. There is possibility for more questions and answers. 81(63.3) 34(26.6) 13(10.2) 17. If this method is used in clinical practice, it will be more efficient. 88(68.8) 31(24.2) 9(7) 18. Students' information is well assessed and evaluated. 76(59.4) 41(32) 11(8.6) 19. Summarizing the contents is easy. 88(68.8) 21(16.4) 19(14.8) 20. In general, CBL method is better than lecture-based learning. 104(81.3) 19(14.8) 5(3.9) Table 2 Correlation between student satisfaction score and demographic variables based on CBL method variable Satisfaction M(SD)* P value** gender male 9(1.1) 0.5 female 9.2(0.9) Marital Status single 9(1.1) 0.7 married 9(0.6) Educational Semester 3rd 9.1(1.2) 0.02 4th 9.4(0.7) 5th 8.8(1.1) *Median (Standard Deviation) ** Using independent t-test and one-way analysis of variance (ANOVA) Discussion Student-centered learning strategies have been developed to improve the learning process that focus on active and independent learning ( 14 ). CBL, as a student-centered learning method, provides students with a learning environment similar to actual practice ( 15 ). Numerous studies have been performed to evaluate the effectiveness of CBL compared to the lecture-based learning, which have shown different results. Some performed better with CBL ( 16 – 18 ), some with lecture-based learning ( 19 , 20 ), and some studies showed no difference between the two methods ( 21 ). The difference in results may be due to the way CBL is performed and the sample size of the studies. In this study, more than two thirds of the students (81.3%) found the CBL method generally better than the lecture-based learning, which is similar to the findings of other studies. Ma et al. cited CBL as an effective learning strategy which motivates students to learn, solve problems, and master knowledge in a better way than lecture-based learning ( 22 ). Sangam et al. also cited CBL as a teaching-learning method that is more effective in promoting and maintaining knowledge. The results of their study showed that the mean scores of the CBL group were significantly higher than the lecture-based learning group ( 23 ). In our study, from the viewpoint students, the most important features of the CBL method were respectively being closer to reality (86%), higher student comprehension (82%), high coverage of study objectives (81%), applicability of this method (81%) and less classroom monotony (81%) compared to the lecture-based learning. Most previous studies reported that CBL is a powerful tool and educational strategy that improves students' problem-solving abilities, independent learning skills, and ability to prepare for exams, and is a self-directed learning approach ( 22 , 24 , 25 ). As learning environment plays a crucial role in determining students' satisfaction and readiness to learn, CBL creates a positive learning environment, encourages students to actively discuss and participate in the learning process ( 26 ) and creates an effective learning environment for students and gives them the opportunity to learn through active sharing ( 27 ). Obviously, active participation in the discussion and readiness to respond are signs of positive effect of this method in increasing students' self-confidence, which is one of the results of this study and other studies ( 25 , 28 ). In addition, the results of this study show that students' satisfaction with this learning method is high, which has led to improved motivation, satisfaction and participation in students. According to other results, this method increases motivation to learn and helps the students to master the necessary knowledge ( 22 ). In fact, according to the results of the study, this method reduces the monotony of the classroom. Increasing students' attendance and interest in classes is one of the positive effects of this method ( 29 ). The important point is to use this method as an educational strategy in clinical disciplines that enables students to gain clinical competence through case analysis ( 26 , 30 ). In fact, CBL focuses on a well-designed clinical problem through which students identify, research, and link theory and practice to their learning needs ( 29 ). In a study by Ma et al. ( 22 ), 90.6% of students stated that CBL helped them with clinical problem-solving skills, learning skills, and help them prepare for the examination, and improved their understanding of the subject. CBL helped them develop their clinical thinking in their diagnosis. Conclusion The results of the study showed that as a teaching-learning method, CBL is effective in teaching specialized courses to undergraduate students and increases students' satisfaction and self-confidence. CBL can be used as a new educational strategy in medical groups. Although a combination of both instructional lectures and case-based learning methods will be effective, more studies are required to assess learning, understanding, and retention of course content to further justify the use of this technique in larger classes and other fields. Abbreviations CBL: Case-based learning M(SD): Median (Standard Deviation) ANOVA : Analysis of Variance Declarations Acknowledgments The research protocol was approved by the deputy of Research and Technology of Ilam University of Medical Sciences. We also thank the students who participated in the study. Authors’ contributions All authors participated in all stages of the article. Funding Not applicable Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to the confidentiality of the participants but are available from the corresponding author on reasonable request. Ethics approval and consent to participate The ethics committee of Ilam University of Medical Sciences (IR.MEDILAM.REC.1398.034) approved the study. This study was carried out in accordance with the declaration of Helsinki. Participants entered the study voluntarily, consciously and with satisfaction after were provided with both verbal and written information about the study. In addition, informed consent was obtained from all subjects. Their information remained confidential. Consent for publication Not applicable. Competing interests The Authors declare that there is no conflict of interest. Author details 1 Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran 2 Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran 3 Non-Communicable Diseases Research Center, Bam University of Medical sciences, Bam, Iran. 4 Reseach Center of Prevention of Psychological Injuries, Ilam University of Medical Sciences, Ilam, Iran References Bambini D, Washburn J, Perkins R. Outcomes of clinical simulation for novice nursing students: Communication, confidence, clinical judgment. Nurs Educ Perspect. 2009;30(2):79–82. Pakpour V, Mehrdad N, Salimi S, Moghadam M. Nursing student satisfaction from Iran university of medical sciences clinical learning environment. Educational development of jundishapur.2016; 6(4): 356–363. Khalifehzadeh-Esfahani A, Moeini Z, Golshahi J. The effect of e-learning and lecture education on critical care nurses’ performance about cardiovascular medication. 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Cite Share Download PDF Status: Published Journal Publication published 21 Jan, 2023 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Major revision 03 Nov, 2022 Reviews received at journal 24 Oct, 2022 Reviews received at journal 21 Oct, 2022 Reviewers agreed at journal 21 Oct, 2022 Reviewers agreed at journal 21 Oct, 2022 Reviewers invited by journal 21 Oct, 2022 Editor assigned by journal 21 Oct, 2022 Editor invited by journal 10 Oct, 2022 Submission checks completed at journal 25 Jul, 2022 First submitted to journal 18 Jul, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-1870481","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":123736341,"identity":"ab71e826-e13e-4c5c-869a-3d15bc7fe1ab","order_by":0,"name":"Masoumeh Shohani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYFACHsYHHyokeNjYG4AcAwuitDAbzjhjI8fPcwCkRYIoLWzSvG1pxpIzEkA8IrTo9p89IDmD7XDihpvPr274USDBwN/enYBXi9mNvASDDzxALbdzym72AB0mcebsBgJaeAwSZ0iAtaQB2RJA7+QS0HL+jMFhHgOQw86k3fxDlJYDOYbNPAkg77Mfu02cLTdyjBlnHAAFcg7bbRkDCR7Cfjl/xvzHx3+gqDz+7OabP0C97b34tSABHgMwSaxyEGB/QIrqUTAKRsEoGEEAADLrTVFMPVkxAAAAAElFTkSuQmCC","orcid":"","institution":"1.Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran","correspondingAuthor":true,"prefix":"","firstName":"Masoumeh","middleName":"","lastName":"Shohani","suffix":""},{"id":123736342,"identity":"2e5158c9-7fd2-418a-bee7-ae4517fbbe61","order_by":1,"name":"Mohammadreza Bastami","email":"","orcid":"","institution":"1.Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran","correspondingAuthor":false,"prefix":"","firstName":"Mohammadreza","middleName":"","lastName":"Bastami","suffix":""},{"id":123736343,"identity":"0c979ad0-dbda-4ab6-bd26-5b0c6855d7d2","order_by":2,"name":"Leili Abedi Gheshlaghi","email":"","orcid":"","institution":"Assistant Professor of Epidemiology, Non-Communicable Diseases Research Center, Bam University of Medical sciences, Bam, Iran","correspondingAuthor":false,"prefix":"","firstName":"Leili","middleName":"Abedi","lastName":"Gheshlaghi","suffix":""},{"id":123736344,"identity":"9c9a835b-e7d1-4e57-889a-17ed37283ac2","order_by":3,"name":"Abbas Nasrollahi","email":"","orcid":"","institution":"Reseach Center of Prevention of Psychological Injuries, Ilam University of Medical Sciences, Ilam, Iran","correspondingAuthor":false,"prefix":"","firstName":"Abbas","middleName":"","lastName":"Nasrollahi","suffix":""}],"badges":[],"createdAt":"2022-07-18 14:44:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1870481/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1870481/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-023-04028-3","type":"published","date":"2023-01-21T18:26:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44717309,"identity":"ab6a8965-8b73-4d1c-8446-d46f8af2b695","added_by":"auto","created_at":"2023-10-16 18:33:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":339445,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1870481/v1/61a3a995-e1e7-4f13-8f9f-11e51d1bc8b8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effectiveness of CBL in teaching specialized courses to undergraduate nursing students","fulltext":[{"header":"Background","content":"\u003cp\u003eNowadays, one of the challenges of nursing and midwifery schools around the world is to train students who are able to think critically and provide comprehensive and complete care in different clinical situations (1). The fundamental philosophy behind nursing education is to prepare and train professional staff with high levels of problem-solving skills and critical thinking to take care of patients (2). However, the development of nursing education in recent decades has raised concerns about the quality of education in this field (3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNurses have found a gap between theory and clinical practice. Nursing education through active learning enhances the correlation between education and clinical practice. One of the proposed ways to close the gap between education and clinical practice is to change the traditional educational system to learning based on new methods (4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn fact, effective education requires comprehensive interaction in the teaching process and this interaction is very limited in lecture-based learning. Lecture-based learning methods are suitable for achieving the cognitive goals of lower levels of Bloom\u0026apos;s Taxonomy and are not suitable for teaching higher levels which include analysis, evaluation and synthesis and require a comprehensive involvement in learning (5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCase-based learning (CBL) is one of the strategies that enhances active learning in students and prepares them for clinical care. This method was first introduced at Harvard University and has recently been accepted as a teaching strategy and a means of problem-solving and decision-making by various academic fields, including nursing (6). CBL focuses on a well-designed clinical problem through which students identify, research, and link theory and practice to their learning needs. Due to the active participation of students, it increases students\u0026apos; ability to analyze and learn the clinical application of knowledge to treat the patient and can reflect the educational experience gained from cases or problems (7, 8).\u003c/p\u003e\n\u003cp\u003eIn a particular CBL method, a real situation is presented in the form of a scenario that requires problem-solving and decision-making. This method requires 45-90 minutes and only one case is raised in each session. The teacher presents the scenario and the students listen carefully and take notes, and students are given the opportunity to think about the case. The teacher then begins with an open-ended question: \u0026ldquo;What is the topic about?\u0026rdquo; and asks students to participate in discussions and, if necessary, the teacher provides additional information such as diagnostic tests, symptoms, etc. The role of the teacher in this method is initiating, mediating and facilitating the learning process and guides students towards the objectives of the session (9, 10). The CBL method can be used as one of the teaching methods for educational purposes, facilitating learning to work in clinical practice and problem-solving strategy (11).\u003c/p\u003e\n\u003cp\u003eIn addition to the importance of learning, one of the most important qualitative parameters in higher education is to pay attention to learners\u0026apos; satisfaction. The concept of learners\u0026apos; satisfaction is one of the issues that can challenge education providers and the process of education. Furthermore, determining the level of learners\u0026apos; satisfaction has always been an important criterion for measuring the efficiency of educational systems, because student satisfaction is one of the most important factors in the success of educational courses (12).\u003c/p\u003e\n\u003cp\u003eChoosing the right training method plays an important role in satisfaction and highlights the need for education providers to choose the appropriate training method more than ever. In fact, teaching is effective when learners are satisfied with the teaching method (13). Therefore, the use of novel and alternative educational methods seems necessary.\u003c/p\u003e\n\u003cp\u003eAlthough the CBL method is used in various academic fields, there is less scientific basis and evidence for its design, effects, and evaluation in nursing. Considering the experiences of researchers in nursing education and the importance of reducing the distance between theory and clinical practice, the present study was conducted to determine the effectiveness of the CBL method on the learning and satisfaction of nursing students in comparison with lecture-based learning.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and aim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis quasi-experimental study was conducted in 2019 in School of Nursing and Midwifery in Ilam to determine the effectiveness of CBL in teaching specialized nursing courses on the learning and satisfaction of nursing students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting and sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll 128 undergraduate nursing students in the 3rd, 4th, and 5th semesters of nursing who had selected the elderly/adult nursing unit and critical care nursing and were willing to participate in the study were enrolled in the study using a census method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstruments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection tools in this study included a demographic information questionnaire (age, gender, marital status and semester) and a researcher-made 20-item questionnaire to compare the features of the CBL method and lecture-based learning using 5-point Likert scale questions including strongly agree, agree, neither agree nor disagree, disagree and strongly disagree. Finally, a question was included to determine the level of satisfaction with the CBL method on a scale of 0 to 10. The face and content validity of the questionnaire was confirmed using valid scientific sources and consulting ten experts. The reliability of the tool based on the test-retest method and Cronbach\u0026apos;s alpha was 0.9.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and data\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einterventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, to compare students\u0026apos; learning and satisfaction with CBL and lecture-based learning, students were assigned into different groups based on semester. 3rd, 4th and 5th semester students chose \u0026ldquo;Adult and Geriatric Nursing\u0026rdquo; 2 and 3 and \u0026ldquo;Critical Care Nursing\u0026rdquo; courses, respectively. Accordingly, based on the experience of researchers as lecturers, two topics were selected for teaching based on CBL and lecture-based learning for each group of students, respectively. Thus, the topics MI and heart failure for 3rd semester students, stroke and multiple sclerosis for 4th semester students, and acute and chronic kidney failure were adopted for 5th semester students. The topics of each group were presented based on CBL and lecture-based learning in one session, respectively, and each topic took about 45 minutes.\u0026nbsp;Kaddoura\u0026nbsp;method was used for CBL which includes five steps of case presentation, presentation of different questions by the teacher, creating a free and comfortable atmosphere for learners, participation of all learners in discussions and summarization of contents by the teacher (6). Thus, first the objectives of teaching and then a specific case was presented and the symptoms of the disease and its clinical manifestations were described to the students and the diagnostic tests including graphs and related blood and urine tests were explained and the students were asked to diagnose the disease. All students were asked to take an active part in the discussions. Then, the disease was diagnosed step by step based on the guidance and participation of students, and at each stage, the symptoms and treatment methods of the disease were discussed at the beginning of the session, and these symptoms and care were matched to that specific case. Various questions were constantly asked about the presented case, and the students gradually became familiar with this case of disease. This situation lasted for 45 minutes and at the end, the final conclusion was made by the lecturer. In the second part of the session, the teacher taught the second topic to the students for 45 minutes based on lecture-based learning. At the end of the session, students were asked to complete the study questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethics committee of Ilam University of Medical Sciences (IR.MEDILAM.REC.1398.034) approved the study.\u0026nbsp;This study was carried out in accordance with the declaration of Helsinki.\u0026nbsp;Participants entered the study voluntarily, consciously and with satisfaction after\u0026nbsp;were provided with both verbal and written information about the study. In addition,\u0026nbsp;\u003cstrong\u003einformed consent was obtained from all subjects.\u003c/strong\u003e \u0026nbsp;Their information remained confidential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter completing the questionnaires, the extracted data were entered into SPSS Statistics 22. Significance level was considered P\u0026lt;0.05. Descriptive statistics were reported as mean (standard deviation) for quantitative variables and as frequency (percentage) for qualitative variables.\u003c/p\u003e\n\u003cp\u003eChi-square test was used to examine the relationship between the features of the CBL method in each of the questions based on gender, marital status and semester. Independent t-test was used to examine the relationship between the mean score of students\u0026apos; satisfaction and gender and marital status based on the CBL method. However, ANOVA test was used to examine the relationship between satisfaction score and semester. The normality of quantitative variables was evaluated using Kolmogorov-Smirnov test.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e128 nursing students participated in this present study. The mean (standard deviation) age of students was 23.3 (4.1) years. About 67% (86 students) were male and the rest were female. More than two thirds of the students (113 students, 88%) were single. In the present study, 5th semester students (52 students, 40.1%), 3rd semester students (43 students, 33.9%) and 4th semester students (32 students, 25.2%) had the highest participation, respectively.\u003c/p\u003e \u003cp\u003eFrom the viewpoint of students, the most important features of the CBL method were respectively being closer to reality (86%), higher student comprehension (82%), high coverage of study objectives (81%), applicability of this method (81%) and less classroom monotony (81%) compared to the lecture-based learning (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There was no significant difference between the features of the CBL based on gender in each of the questions except questions 5 and 13 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There was a significant relationship between gender and the feature of being closer to reality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.03); 68 (80%) male students and 41 (97.6%) female students stated that the CBL method has been closer to reality compared to the lecture-based learning. About 60% (52 students) of male students and 62% (26 students) of female students stated that the CBL method increased the students' self-confidence compared to the lecture-based learning (p\u0026thinsp;\u0026lt;\u0026thinsp;0.03).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that there was no significant difference between the features of the CBL method in each of the questions based on the semester (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Furthermore, there was no significant difference between variables of gender and marital status with the features of CBL method in each of the questions (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eOverall, more than two thirds of the students (81.3%) found the CBL method better than the lecture-based learning. The mean (standard deviation) score of student satisfaction with the CBL method was 9.1 (1.1%), which indicates high level of student satisfaction with this method. There was no significant relationship between gender and marital status and mean score of student satisfaction with the CBL method (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Moreover, 4th semester students were more satisfied with the CBL method compared to other students (P\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of the frequency (percentage) of the features of the CBL method compared to lecture-based learning from the viewpoint of nursing students of Ilam University of Medical Sciences\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003cp\u003eCBL versus lecture-based learning\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eagree and strongly agree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eneither agree nor disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003edisagree and strongly disagree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Covers objectives well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(5.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. It is more interesting.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Increases students' comprehension.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104(81.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. More cooperation and participation from students.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100(78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. It is closer to reality.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109(85.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Increases students' motivation to learn.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69(53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(19.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Facilitates students' learning.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84(65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(5.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Information is well organized.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61(47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. It is more practical.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. The learned material has higher persistence.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71(55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Increases students' visualization power.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77(61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(17.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Most nursing courses can be offered through CBL method.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86(67.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(8.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13- Increases students' self-confidence.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(16.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Reduces class monotony.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Makes students think deeply.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. There is possibility for more questions and answers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81(63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(10.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. If this method is used in clinical practice, it will be more efficient.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. Students' information is well assessed and evaluated.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76(59.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(8.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. Summarizing the contents is easy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(14.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. In general, CBL method is better than lecture-based learning.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between student satisfaction score and demographic variables based on CBL method\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSatisfaction\u003c/p\u003e \u003cp\u003eM(SD)*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value**\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003egender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.2(0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEducational Semester\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.1(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.4(0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.8(1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Median (Standard Deviation)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** Using independent t-test and one-way analysis of variance (ANOVA)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eStudent-centered learning strategies have been developed to improve the learning process that focus on active and independent learning (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). CBL, as a student-centered learning method, provides students with a learning environment similar to actual practice (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNumerous studies have been performed to evaluate the effectiveness of CBL compared to the lecture-based learning, which have shown different results. Some performed better with CBL (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), some with lecture-based learning (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and some studies showed no difference between the two methods (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The difference in results may be due to the way CBL is performed and the sample size of the studies.\u003c/p\u003e \u003cp\u003eIn this study, more than two thirds of the students (81.3%) found the CBL method generally better than the lecture-based learning, which is similar to the findings of other studies. Ma et al. cited CBL as an effective learning strategy which motivates students to learn, solve problems, and master knowledge in a better way than lecture-based learning (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Sangam et al. also cited CBL as a teaching-learning method that is more effective in promoting and maintaining knowledge. The results of their study showed that the mean scores of the CBL group were significantly higher than the lecture-based learning group (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, from the viewpoint students, the most important features of the CBL method were respectively being closer to reality (86%), higher student comprehension (82%), high coverage of study objectives (81%), applicability of this method (81%) and less classroom monotony (81%) compared to the lecture-based learning.\u003c/p\u003e \u003cp\u003eMost previous studies reported that CBL is a powerful tool and educational strategy that improves students' problem-solving abilities, independent learning skills, and ability to prepare for exams, and is a self-directed learning approach (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs learning environment plays a crucial role in determining students' satisfaction and readiness to learn, CBL creates a positive learning environment, encourages students to actively discuss and participate in the learning process (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and creates an effective learning environment for students and gives them the opportunity to learn through active sharing (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Obviously, active participation in the discussion and readiness to respond are signs of positive effect of this method in increasing students' self-confidence, which is one of the results of this study and other studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, the results of this study show that students' satisfaction with this learning method is high, which has led to improved motivation, satisfaction and participation in students. According to other results, this method increases motivation to learn and helps the students to master the necessary knowledge (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In fact, according to the results of the study, this method reduces the monotony of the classroom. Increasing students' attendance and interest in classes is one of the positive effects of this method (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe important point is to use this method as an educational strategy in clinical disciplines that enables students to gain clinical competence through case analysis (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In fact, CBL focuses on a well-designed clinical problem through which students identify, research, and link theory and practice to their learning needs (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a study by Ma et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), 90.6% of students stated that CBL helped them with clinical problem-solving skills, learning skills, and help them prepare for the examination, and improved their understanding of the subject. CBL helped them develop their clinical thinking in their diagnosis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of the study showed that as a teaching-learning method, CBL is effective in teaching specialized courses to undergraduate students and increases students' satisfaction and self-confidence. CBL can be used as a new educational strategy in medical groups. Although a combination of both instructional lectures and case-based learning methods will be effective, more studies are required to assess learning, understanding, and retention of course content to further justify the use of this technique in larger classes and other fields.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCBL:\u003c/strong\u003e Case-based learning\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eM(SD):\u0026nbsp;\u003c/strong\u003eMedian (Standard Deviation)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eANOVA\u003c/strong\u003e: Analysis of Variance\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research protocol was approved\u0026nbsp;by the deputy of Research and Technology of Ilam University of Medical Sciences. We also thank the students who participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in all stages of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to the confidentiality of the participants but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethics committee of Ilam University of Medical Sciences (IR.MEDILAM.REC.1398.034) approved the study. This study was carried out in accordance with the declaration of Helsinki. Participants entered the study voluntarily, consciously and with satisfaction after were provided with both verbal and written information about the study. In addition, \u003cstrong\u003einformed consent was obtained from all subjects.\u003c/strong\u003e Their information remained confidential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors declare that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran\u003c/p\u003e\n\u003cp\u003e2\u0026nbsp;Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran\u003c/p\u003e\n\u003cp\u003e3 Non-Communicable Diseases Research Center, Bam University of Medical sciences,\u0026nbsp;Bam, Iran.\u003c/p\u003e\n\u003cp\u003e4 Reseach Center of Prevention of Psychological Injuries, Ilam University of Medical Sciences, Ilam, Iran\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBambini D, Washburn J, Perkins R. Outcomes of clinical simulation for novice nursing students: Communication, confidence, clinical judgment. Nurs Educ Perspect. 2009;30(2):79\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePakpour V, Mehrdad N, Salimi S, Moghadam M. Nursing student satisfaction from Iran university of medical sciences clinical learning environment. Educational development of jundishapur.2016; 6(4): 356\u0026ndash;363.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhalifehzadeh-Esfahani A, Moeini Z, Golshahi J. The effect of e-learning and lecture education on critical care nurses\u0026rsquo; performance about cardiovascular medication. Iranian Journal of Cardiovascular Nursing. 2018; 7(2): 14\u0026ndash;21. (Persian)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwartzstein RM, Roberts DH. Saying goodbye to lectures in medical school - paradigm shift or passing fad? N Engl J Med.2017; 377(7): 605\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaezi A, Azizian F, Kopayehzadeh J. Survey compare team based learning and lecture teaching method, on learning-teaching process nursing student's, in Surgical and Internal Diseases course. The Journal of Medical Education and Development. 2015;10(3):246\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaddoura MA. Critical thinking skills of nursing students in lecture-based teaching and case-based learning. Int J Scholarsh Teach Learn. 2011;5(2):1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahajan R, Badyal DK, Gupta P, Singh T. Cultivating lifelong learning skills during graduate medical training. Indian Pediatr. 2016; 53:797\u0026ndash;804.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamat SK, Marathe PA, Patel TC, Shetty YC, Rege NN. Introduction of case based teaching to impart rational pharmacotherapy skills in undergraduate medical students. Indian J Pharmacol. 2012; 44:634\u0026ndash;638. 8. Tayem YI. The impact of small group case-based learning on traditional pharmacology teaching. Sultan Qaboos Univ Med J. 2013; 13:115\u0026ndash;120.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames H, Al Khaja KA, Sequeira RP. Effective use of real-life events as tools for teaching-learning clinical pharmacology in a problem-based learning curriculum. Indian J Pharmacol. 2015; 47:316\u0026ndash;321.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStjernquist M, Crang Svalenius E. Applying the case method for teaching within the health professions: Teaching the students. Educ Health. 2007;20(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLauretta L, Debra J, Kim U. Case study: A bridge across the paradigms. 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J Taibah Univ Med Sc. 2021;16(4):558e564.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGade S, Chari S. Case-based learning in endocrine physiology: an approach toward self-directed learning and the development of soft skills in medical students. AJP Adv Physiol Educ. 2013; 37: 356e360.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams B. Case based learning - a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med J. 2005; 22: 577e581.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaur G, RehncyJ, Kahal KS, Singh J, Sharma V, Matreja Ps, Grewal H. Case-Based Learning as an Effective Tool in Teaching Pharmacology to Undergraduate Medical Students in a Large Group Setting. Journal of Medical Education and Curricular Development. 2020; 7: 1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLean SF. Case-Based Learning and its application in medical and health-care fields: a review of worldwide literature. J Med Educ Curric Dev. 2016; 3: 39\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CBL, effectiveness, teaching-learning, lecture-based learning, nursing students","lastPublishedDoi":"10.21203/rs.3.rs-1870481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1870481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCase-based learning (CBL) is an effective teaching-learning strategy that provides a learning environment similar to actual practice. The present study was conducted to determine the effectiveness of CBL in teaching specialized nursing courses on the learning and satisfaction of nursing students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis quasi-experimental study was conducted in 2019 in School of Nursing and Midwifery in Ilam and all 128 undergraduate nursing students in the 3rd, 4th, and 5th semesters of nursing who had selected \u0026ldquo;Adult and Geriatric Nursing\u0026rdquo; and \u0026ldquo;Critical Care Nursing\u0026rdquo; courses were enrolled in the study using a census method. Data collection tools included a demographic information questionnaire and a researcher-made questionnaire consisting of 20 questions based on the Likert scale. Data analysis was performed using SPSS Statistics 22.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMore than two thirds of the students (81.3%) found the CBL method better than lectures. 60% of male students and 62% of female students stated that the CBL method increased their self-confidence compared to the traditional lecture-based learning (p\u0026thinsp;\u0026lt;\u0026thinsp;0.03). Students were very satisfied with the CBL method (9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 out of 10). There was no significant relationship between gender-related features and marital status, and the mean score of students' satisfaction with the CBL method (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, 4th semester students were more satisfied than other students (P\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe results show that as a novel teaching-learning technique, CBL is effective in teaching specialized nursing courses and increases students' satisfaction and self-confidence.\u003c/p\u003e","manuscriptTitle":"The effectiveness of CBL in teaching specialized courses to undergraduate nursing students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-07-29 18:34:23","doi":"10.21203/rs.3.rs-1870481/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-11-03T06:37:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-24T06:05:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-22T00:54:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1b0b4ad0-033c-4427-88b2-cbeb2a809789","date":"2022-10-21T10:45:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6cbd5ac4-d0af-406f-a7e1-c31c9e43b5e0","date":"2022-10-21T09:07:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-10-21T09:04:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-10-21T08:56:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-10-10T17:16:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-07-25T11:33:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2022-07-18T14:29:43+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":"5e6f28a1-af08-419c-b623-73e53b63b63e","owner":[],"postedDate":"July 29th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T18:30:02+00:00","versionOfRecord":{"articleIdentity":"rs-1870481","link":"https://doi.org/10.1186/s12909-023-04028-3","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2023-01-21 18:26:05","publishedOnDateReadable":"January 21st, 2023"},"versionCreatedAt":"2022-07-29 18:34:23","video":"","vorDoi":"10.1186/s12909-023-04028-3","vorDoiUrl":"https://doi.org/10.1186/s12909-023-04028-3","workflowStages":[]},"version":"v1","identity":"rs-1870481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1870481","identity":"rs-1870481","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}