Digital Microlearning for Patient-Safety Readiness in Nursing Students

NCT07367906 | Completed

• 1 other identifier: Digital Microlearning-2026
• Study Type: interventional
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial evaluated whether a seven-day, patient-safety-focused digital microlearning program improved sustained clinical error recognition and the transfer of safety learning among second-year nursing students entering surgical clinical practice. Ninety students were randomly assigned in a 1:1 ratio to digital microlearning plus standard education or standard education alone. Outcomes were assessed at baseline, immediately after the intervention, at the end of the first week of surgical clinical practice, and at the end of the seventh week of surgical clinical practice. Weekly ecological momentary assessment prompts examined safety-oriented behavior during clinical practice. Blinded performance tasks assessed objective clinical transfer, and an explanatory qualitative component explored how and under what conditions students applied the learning in practice.

Conditions

Nursing Education; Medical Education; Patient Safety

Keywords

Digital microlearning; Nursing students; Patient safety awareness; Clinical error recognition; Surgical clinical practice; Educational intervention; Mixed methods; Randomized controlled trial; Clinical decision-making

Outcome Measures

Primary Outcomes (1)

• Clinical Error Recognition Performance at Clinical Week 7 (T3)

  Clinical error recognition was assessed using alternate scenario-based forms drawn from an expert-reviewed bank of 15 retained surgical patient-safety scenarios. Each assessment form contained 10 scored scenarios covering patient identification, medication safety, documentation, deterioration, falls, and escalation. Each response was scored 1 for correct identification of the safety error and 0 for an incorrect or absent identification. The form score was converted to a 0-100 scale as (number correct/10) × 100, yielding scores in 10-point units; higher scores indicate better clinical error recognition. Alternate forms used patients, clinical cues, and action sequences distinct from the intervention scenarios. T3 was the principal endpoint; T0, T1, and T2 measurements described the outcome trajectory.

  Baseline before the program (T0), immediately after completion of the seven-day intervention (T1), end of the first week of surgical clinical practice (T2), and end of the seventh week of surgical clinical practice (T3; principal endpoint).

Secondary Outcomes (7)

• Clinical Decision-Making Under Stress

  Baseline before the program (T0), immediately after completion of the seven-day intervention (T1), end of the first week of surgical clinical practice (T2), and end of the seventh week of surgical clinical practice (T3).

• Patient Safety Awareness

  Baseline before the program (T0), immediately after completion of the seven-day intervention (T1), end of the first week of surgical clinical practice (T2), and end of the seventh week of surgical clinical practice (T3).

• Clinical Practice Readiness

  Baseline before the program (T0), immediately after completion of the seven-day intervention (T1), end of the first week of surgical clinical practice (T2), and end of the seventh week of surgical clinical practice (T3).

• Clinical Self-Confidence

  Baseline before the program (T0), immediately after completion of the seven-day intervention (T1), end of the first week of surgical clinical practice (T2), and end of the seventh week of surgical clinical practice (T3).

• EMA Behavioral Transfer Index

  Weekly during surgical clinical practice, weeks 1 through 7.

Other Outcomes (2)

• Intervention Fidelity

  Throughout the seven-day intervention and summarized immediately after intervention completion (T1).

• Unintended Effects and Access Burdens

  Weekly during surgical clinical practice, weeks 1 through 7, and at the end of the seventh clinical week (T3).

Study Arms (2)

Digital Microlearning Intervention Group

EXPERIMENTAL

Participants received a seven-day patient-safety-focused digital microlearning program in addition to standard education before surgical clinical practice.

Behavioral: Digital Microlearning Program on Patient Safety

Control Group Standard Education

NO INTERVENTION

Participants received the existing undergraduate curriculum without additional digital microlearning. Standard education consisted of two two-hour surgical patient-safety lectures and a written guideline. Participants then completed seven weeks of routine surgical clinical practice, one day per week, with the same usual supervision as the intervention group. The control condition was not attention matched.

Interventions

Digital Microlearning Program on Patient Safety BEHAVIORAL

A structured, mobile-optimized digital microlearning program delivered asynchronously over seven consecutive days. Participants completed one scenario-based module per day, lasting approximately 3-5 minutes. Each module included a surgical patient-safety scenario, a pause to identify the risk, a forced-choice retrieval question, corrective feedback, and a cue-action takeaway. Content covered patient identification, medication safety, documentation omissions, deterioration cues, falls and other safety risks, prioritization, escalation, and clinical decision-making under stress.

Digital Microlearning Intervention Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Second-year undergraduate nursing students enrolled in the Faculty of Health Sciences, Department of Nursing
• Registered for the relevant surgical nursing course
• Preparing to begin their first surgical clinical placement
• Aged 18 years or older
• Willing and able to provide written informed consent

You may not qualify if:

• Previous failure or repetition of the relevant surgical nursing course
• Previous surgical clinical practice experience
• Previous professional nursing or healthcare work experience
• Concurrent participation in another patient-safety education study
• Inability to complete the baseline assessment before randomization

Sponsors & Collaborators

• Agri Ibrahim Cecen University: lead

Study Sites (1)

Agri Ibrahim Cecen University Faculty of Health Sciences

AĞRI, Merkez, 04100, Turkey (Türkiye)

Location

Related Publications (4)

• Hopewell S, Chan AW, Collins GS, Hrobjartsson A, Moher D, Schulz KF, Tunn R, Aggarwal R, Berkwits M, Berlin JA, Bhandari N, Butcher NJ, Campbell MK, Chidebe RCW, Elbourne D, Farmer A, Fergusson DA, Golub RM, Goodman SN, Hoffmann TC, Ioannidis JPA, Kahan BC, Knowles RL, Lamb SE, Lewis S, Loder E, Offringa M, Ravaud P, Richards DP, Rockhold FW, Schriger DL, Siegfried NL, Staniszewska S, Taylor RS, Thabane L, Torgerson D, Vohra S, White IR, Boutron I. CONSORT 2025 explanation and elaboration: updated guideline for reporting randomised trials. BMJ. 2025 Apr 14;389:e081124. doi: 10.1136/bmj-2024-081124.

  PMID: 40228832 BACKGROUND

• De Gagne JC, Park HK, Hall K, Woodward A, Yamane S, Kim SS. Microlearning in Health Professions Education: Scoping Review. JMIR Med Educ. 2019 Jul 23;5(2):e13997. doi: 10.2196/13997.

  PMID: 31339105 BACKGROUND

• Lee SE, Morse BL, Kim NW. Patient safety educational interventions: A systematic review with recommendations for nurse educators. Nurs Open. 2022 Jul;9(4):1967-1979. doi: 10.1002/nop2.955. Epub 2021 May 28.

  PMID: 34047058 BACKGROUND

• World Health Organization. Patient safety curriculum guide: Multi-professional edition. Geneva: WHO; 2011.

  BACKGROUND

Related Links

• World Health Organization resources providing background information on patient safety principles relevant to the study protocol.

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Participants and educators could not be masked to the educational intervention. Allocation labels were removed from the T3 objective-transfer materials. Raters of the Objective Structured Clinical Examination safety station, transfer vignette, and standardized escalation task remained blinded to group allocation until scoring was completed. The primary analysis was independently reproduced using coded group labels before the allocation key was applied.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: Participants were randomly assigned in a 1:1 ratio to digital microlearning plus standard education or standard education alone and were followed in parallel from baseline through the seventh week of surgical clinical practice. A computer-generated sequence using randomly varying block sizes of four and six was stratified by sex. Sequentially numbered, opaque, sealed envelopes were opened only after written consent and completion of the baseline assessment.

Study Record Dates

• First Submitted: January 13, 2026
• First Posted: January 26, 2026
• Study Start: February 10, 2026
• Primary Completion: April 30, 2026
• Study Completion: April 30, 2026
• Last Updated: September 9, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)