Effects of blended versus offline case-centered learning on academic performance and critical thinking ability among undergraduate nursing students：a cluster randomized controlled trial

Background: Educational reform, especially methods of teaching, has been a focus among nursing educators. This study explored the impact of blended versus offline case-centered learning on academic performance of Medical Nursing and critical thinking ability among undergraduate nursing students.Methods: A cluster randomized controlled study design was used, with assessments immediately before and one school year after the intervention. All the second-year undergraduate nursing students in two class were enrolled in this study by cluster sampling. The two classes of Medical Nursing were randomly allocated to either the experimental class, which undertook blended case-centered learning, or the control class, which undertook offline case-centered learning. The primary outcomes were academic performance consisting of final exam and process assessment, as well as the critical thinking ability assessed with the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV). The Mann-Whitney U test and the unpaired t test was subsequently used. ANCOVA analyses were also performed to examine the two teaching methods’ effect on academic performance and critical thinking.Results: Students in the experimental class showed a significantly higher improvement in academic performance of Medical Nursing than the control class. In addition, compared with the control class, the pre-post difference in competency in critical thinking self-confidence in the experimental class was significantly greater (p=0.037). In the experimental class, there was significant improvement compared with baseline in dimension of critical thinking self-confidence (p=0.022). In the control class, there was significant improvement compared with baseline in the total score (p=0.029) and two of the seven dimensions: truth-seeking (p=0.016) and systematicity (p=0.005).Conclusions: Use of the blended case-centered learning showed the promising results in promoting students’ academic performance. Both the blended and offline case-centered learning in this study were a suitable educational approach to improve the critical thinking ability of undergraduate nursing students. In the future, blended and offline case-centered learning could be implemented in other nursing subjects. Moreover, further efforts to improve teaching are warranted.