{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:52:09Z","timestamp":1791525129979,"version":"4.3.4"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study compared educational outcomes between nursing students receiving a CDIO-guided case-based and gamified teaching program and those receiving conventional teaching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      This two-class quasi-experimental study included 140 nursing students from two classes between March and June 2025. Classes were assigned by lottery to the intervention (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f65) or control (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f75) group. The intervention integrated progressive cases, microlectures, teamwork, board games, and escape-room simulation, whereas the control received traditional lectures and Small Private Online Course self-study. Self-directed learning, critical thinking, and learning engagement were assessed before and after the course. Post-course outcomes included theoretical performance, cardiopulmonary resuscitation performance, course performance, and teaching evaluation. Analysis of covariance, Welch\u2019s t tests, and Holm correction were applied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The intervention class had higher adjusted post-course scores for self-directed learning (mean difference, 7.68; 95% CI, 3.29\u201312.07), critical thinking (15.27; 95% CI, 11.53\u201319.00), and learning engagement (7.06; 95% CI, 1.82\u201312.30). It also achieved higher theoretical, cardiopulmonary resuscitation, course, and teaching-evaluation scores. Students generally found the activities engaging, although some reported nervousness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The program was associated with improved educational outcomes, but intervention and class effects could not be separated. Multicenter studies with multiple classes per arm are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1958746","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:34:59Z","timestamp":1791524099000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Educational outcomes of CDIO-guided progressive case-based learning and gamification in undergraduate critical care nursing: an exploratory two-class quasi-experimental study"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiang","family":"Ma","sequence":"first","affiliation":[{"name":"School of Nursing, Guilin Medical University","place":["Guilin, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Nursing, Guilin Medical University","place":["Guilin, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aifang","family":"Yu","sequence":"additional","affiliation":[{"name":"School of Nursing, Guilin Medical University","place":["Guilin, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.profnurs.2022.11.010","article-title":"The AACN essentials journey","volume":"46","author":"Barnes","year":"2023","journal-title":"J Prof Nurs"},{"key":"ref2","first-page":"474","volume-title":"National Standards for Teaching Quality of Undergraduate Programs in Regular Institutions of Higher Learning","year":"2018"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1505588","DOI":"10.3389\/fmed.2025.1505588","article-title":"Comparison of the conceive-design-implement-operate model and lecture-based learning in teaching the \"healthcare-associated infections\" course","volume":"12","author":"Chen","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"258","DOI":"10.4103\/jehp.jehp_710_21","article-title":"Case-based learning: A 'case' for restructuring anatomy education in Indian nursing curriculum","volume":"11","author":"Das","year":"2022","journal-title":"J Educ Health Promot"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e36725","DOI":"10.2196\/36725","article-title":"Simulation-based learning supported by technology to enhance critical thinking in nursing students: protocol for a scoping review","volume":"11","author":"Stenseth","year":"2022","journal-title":"JMIR Res Protoc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"102752","DOI":"10.1016\/j.nepr.2020.102752","article-title":"Does problem-based learning in nursing education empower learning?","volume":"44","author":"Compton","year":"2020","journal-title":"Nurse Educ Pract"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1111\/jocn.15599","article-title":"Team-based learning in nursing education: a scoping review","volume":"30","author":"Considine","year":"2021","journal-title":"J Clin Nurs"},{"key":"ref8","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-05561-9","volume-title":"Rethinking Engineering Education: The CDIO Approach","author":"Crawley","year":"2014"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/03043797.2020.1704361","article-title":"Scholarly development of engineering education\u2014the CDIO approach","volume":"45","author":"Edstr\u00f6m","year":"2020","journal-title":"Eur J Eng Educ"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"105829","DOI":"10.1016\/j.nedt.2023.105829","article-title":"Effects of an online training program on cardiovascular health behavior modification on nursing students' health education competency","volume":"127","author":"Dong","year":"2023","journal-title":"Nurse Educ Today"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s12909-023-04200-9","article-title":"Application of flipped classroom based on CDIO concept combined with mini-CEX evaluation model in the clinical teaching of orthopedic nursing","volume":"23","author":"Su","year":"2023","journal-title":"BMC Med Educ"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e421","DOI":"10.3109\/0142159X.2012.680939","article-title":"The effectiveness of case-based learning in health professional education. 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