Comparative Case Learning in Undergraduate Nursing Students

NCT07829965 | Not Yet Recruiting

• 1 other identifier: AICU-NET-CASECOMP-2026
• Study Type: interventional
• Target: 360
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled educational trial compares two ways of teaching undergraduate nursing students to reason through clinical cases. Both study arms receive the same eight training cases, the same total instructional time, and the same individualized feedback on their answers. Students in the comparative-case arm study the training cases in matched pairs and explicitly write both the finding that changes the recommended first action and the general principle it illustrates. Students in the individual-case arm reason through and justify each training case on its own, with the same content and time. Four baseline cases are completed before training, and eight new transfer cases are completed seven days after training (acceptance window Day 5-9). The single primary outcome is a 0-100 reasoned clinical decision transfer score at Day 7, derived from two independent, blinded raters. The trial targets 360 randomized nursing students (Years 1-4) at a single site, and the primary analysis will estimate the between-group difference in transfer score adjusted for baseline performance, class year, and session block. The study evaluates whether making the decision-relevant contrast between paired cases explicit improves near transfer of clinical reasoning under matched content and time; it does not involve real patients or clinical interventions, and it does not produce direct conclusions about real-world patient safety or general clinical competence.

Conditions

Clinical Reasoning in Nursing Education

Keywords

Clinical Judgment; Case-Based Learning; Nursing Education; Analogical Reasoning

Outcome Measures

Primary Outcomes (1)

• Reasoned Clinical Decision Transfer Score

  Composite 0-100 score on eight new (untrained) clinical cases at Day 7, integrating each case's priority-approach and reasoning on a 0-3 rubric (0-24 raw total), averaged across two independent, arm-blinded raters and rescaled to 0-100. Higher scores indicate better transfer of reasoned clinical decision-making to novel cases.

  Day 7 post-training (acceptance window: Day 5-9)

Secondary Outcomes (3)

• Rate of Appropriate Initial Approach on New Cases

  Day 7 post-training (acceptance window: Day 5-9)

• Rate of Delayed Help-Seeking in Emergent Cases

  Day 7 post-training (acceptance window: Day 5-9)

• Rate of Unnecessary Emergency Escalation in Non-Emergent Cases

  Day 7 post-training (acceptance window: Day 5-9)

Study Arms (2)

Comparative Case Learning (Arm K)

EXPERIMENTAL

Students study the same eight training cases as paired comparisons (four pairs), writing their priority approach for each case plus two short comparison responses per pair (the case-deciding difference and its general principle). Same total content and time as the control arm.

Behavioral: Comparative Case Learning Educational Package

Individual Case Reasoning (Arm B)

ACTIVE COMPARATOR

Students study the same eight training cases one at a time on separate pages, writing their priority approach and reasoning for each case individually. Same total content and time as the comparative arm; no side-by-side comparison questions.

Behavioral: Individual Case Reasoning Educational Package

Interventions

Comparative Case Learning Educational Package BEHAVIORAL

Printed, coded booklets presenting the same eight training cases as four paired comparisons. For each pair, students write their priority approach to each case plus the case-deciding difference and its general principle (four response fields per pair, \~20 words each, 6 minutes per pair). Same clinical content, response burden, and individual case feedback as the active comparator.

Comparative Case Learning (Arm K)

Individual Case Reasoning Educational Package BEHAVIORAL

Printed, coded booklets presenting the same eight training cases one at a time on separate pages. For each case, students write their priority approach and a short rationale in two response fields (\~20 words each, 3 minutes per case). Same clinical content, response burden, and individual case feedback as the experimental arm, without paired comparison prompts.

Individual Case Reasoning (Arm B)

Eligibility Criteria

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

You may qualify if:

• Currently enrolled undergraduate nursing student (1st through 4th year)
• Age 18 years or older
• Sufficient Turkish reading and comprehension ability to complete study materials
• Willing and able to provide written informed consent

You may not qualify if:

• Does not provide informed consent
• Prior participation in the pilot study for this research
• Prior exposure to the clinical case scenarios used in this study

Sponsors & Collaborators

• Agri Ibrahim Cecen University: lead

Study Sites (1)

Ağrı İbrahim Çeçen Üniversitesi, Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü

Ağrı, Turkey (Türkiye)

Location

Related Publications (6)

• Anil Kumar DA, Azlan NR, Davies H, Massey D, Strickland K. Methodological approaches to assessing clinical reasoning in simulation-based education: An integrative review. Nurse Educ Today. 2026 Dec;167:107222. doi: 10.1016/j.nedt.2026.107222. Epub 2026 Jun 5.

  PMID: 42275957 BACKGROUND

• Vickers AJ, Altman DG. Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ. 2001 Nov 10;323(7321):1123-4. doi: 10.1136/bmj.323.7321.1123. No abstract available.

  PMID: 11701584 BACKGROUND

• Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan AW, Michie S. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014 Mar 7;348:g1687. doi: 10.1136/bmj.g1687.

  PMID: 24609605 BACKGROUND

• Alfieri L, Nokes-Malach TJ, Schunn CD. Learning through case comparisons: a meta-analytic review. Educ Psychol. 2013;48(2):87-113. doi:10.1080/00461520.2013.775712.

  BACKGROUND

• Gentner D, Loewenstein J, Thompson L. Learning and transfer: a general role for analogical encoding. J Educ Psychol. 2003;95(2):393-408. doi:10.1037/0022-0663.95.2.393.

  BACKGROUND

• Tanner CA. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 2006 Jun;45(6):204-11. doi: 10.3928/01484834-20060601-04.

  PMID: 16780008 BACKGROUND

Related Links

• Resuscitation Council UK - The ABCDE Approach (updated July 2024)
• Nursing and Midwifery Council - The Code (professional safety principles; not a substitute for Turkey's scope-of-practice regulation)
• CONSORT-SPIRIT - CONSORT 2025 and SPIRIT 2025 statements and checklists
• World Medical Association - Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants (2024 revision)
• ICMJE - Recommendations: Clinical Trials Registration

Study Officials

• Burcu Demir Gökmen

  Ağrı İbrahim Çeçen Üniversitesi

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Volkan Gökmen

CONTACT

+90 532 739 0938; vgokmen@agri.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: Two-arm parallel educational RCT with 1:1 individual randomization within class-level and session blocks (permuted block sizes of 4 and 6).

Study Record Dates

• First Submitted: September 15, 2026
• First Posted: September 21, 2026
• Study Start: October 1, 2026
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): February 1, 2027
• Last Updated: September 23, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)