Preferences For Case-based Learning Program With Undergraduate Nursing Students Based On The Discrete Choice Experiment

Objective:To explore undergraduate nursing students’ preferences for case based learning(CBL)programs based on the discrete choice experiment,so as to provide reference suggestions for nursing educators in developing student-centered CBL programs.Methods:In this study,a discrete selection experiment was used,including four stage:(1)literature review,qualitative interviews,focus group and expert consultation,and ranking were used to determine the attributes and levels of nursing undergraduate students’ preference for CBL programs.(2)The D-Efficient Design was used to generate choice sets in the Ngene software.In order to reduce the cognitive burden on students,these choice sets were randomly divided into versions.After a pilot test,the final questionnaire survey was determined.(3)The survey was carried out using a combination of face-to-face and online survey from September 2022 to December2022.(4)In Stata 15.0 software,a discrete choice experimental model was used to analyze undergraduate nursing students preferences for CBL programs.Results:1.Six key attributes affecting the selection of CBL programs for nursing undergraduates were identified,namely ‘provider’,‘group size’,‘case form’,‘case delivery form’,‘teacher feedback’ and ‘case content’.2.A total of 36 choice sets were generated in this study,and the survey was randomly divided into three versions,with 12 choice sets in each version.The pilot test results showed that the questionnaire had good understanding and acceptability and can be used for formal investigation.3.In this study,a total of 300 undergraduate nursing students were surveyed.After excluding invalid responses,the CBL programs preference of 227 undergraduate nursing students was analyzed.The results were following:(1)The six attributes included in this study had a significant impact on the undergraduate nursing students’ preferences for CBL programs.The attribute-level that has the greatest influence on the undergraduate nursing students’ preference for CBL programs was "provider-combine of university teacher and clinical nurse"(β1.646[SE,0.114]).Undergraduate nursing students would be 3.527 times(OR =3.527)more likely to participate a CBL program with the provider composed of university teacher and clinical nurse than a CBL program with the provider composed of clinical nurse.Followed by "group size-9-11"(β1.407[SE,0.108])and "case form-video"(β1.223[SE,0.098]),and "case content"(β0.293[SE,0.090])lowest extent.(2)Subgroup analysis showed that undergraduate nursing students with different grade,university level and clinical experience had specific CBL program preferences.(3)In a series of scenario simulations,the ideal scenario was "provider composed of university teacher and clinical nurse,group size 9-11,video case modality,unfolding delivery,adequate feedback,and fragmented case content",whose preference score was the highest(6.121),and the probability of the optimal scenario was the highest(0.279).Conclusion1.The provider-combine of university teacher and clinical nurse is the attribute level that have the greatest impact on the CBL program preferences among nursing undergraduate students.When applying CBL programs,promoting the active cooperation between university teacher and clinical nurse may be an effective measure to optimize the effectiveness of CBL and improve the critical thinking ability of nursing undergraduates.In the future,it is necessary to further explore new models of nursing teacher team construction to improve students’ engagement and learning effectiveness.2.The team number can directly affect the engagement and perceived academic pressure of nursing undergraduate students.This study determined that the group size9-11 is the ideal number for nursing undergraduate students to balance engagement and academic pressure.3.In the process of CBL teaching,nursing undergraduate students pay more attention to case form than case content,and multimedia case form is more popular with nursing undergraduate students.The multimedia case form is a key link in developing CBL programs in nursing courses in the future.In addition,how to design a CBL program that matches students’ grades,clinical internship experience,and teaching platforms is a key consideration for nursing teachers.