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Cited by 15Education and Critical Thinking DevelopmentProblem and Project Based LearningInnovations in Medical Education

Impact of case-based learning on critical thinking dispositions in Chinese nursing education: a systematic review and meta-analysis

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Xiang, Yunlu, Liu, Dong, Liu, Liang, Liu, I-Chun, Wu, Lanka, Fan, Hao·2025·Frontiers in Medicine
DOI 10.3389/fmed.2025.1452051PMC PMC11956162
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Abstract

Background: Case-based learning (CBL) is recognized for its potential to enhance critical thinking in nursing education. This meta-analysis aimed to assess the impact of CBL alone or in combination with other methods on improving critical thinking dispositions among nursing students in China. Methods: A systematic search was conducted in databases including PubMed, Embase, Cochrane Library, CINAHL and China National Knowledge Infrastructure from inception of the databases through June 1, 2024. Studies that utilized the Chinese Version of Critical Thinking Dispositions Inventory (CTDI-CV) and compared CBL with traditional teaching methods were included. Random-effects models were used to pool the mean differences (MD) in critical thinking scores, and subgroup analyses were performed based on participant types and intervention methods. Results: Thirteen studies involving 1,396 participants were included. The pooled results indicated a significant improvement in critical thinking dispositions (MD = 26.39, 95% CI: 18.71 to 34.06). Subgroup analysis revealed that nursing interns and combinations of CBL with problem-based learning (PBL) reported higher improvements. Secondary outcomes showed significant gains in both theoretical knowledge and operational skills, with heterogeneity observed across studies ( I 2 > 79%). The Egger’s test ( p = 0.95) suggested no significant publication bias. Conclusion: CBL significantly enhances critical thinking among nursing students in China, particularly when integrated with PBL. Despite the observed heterogeneity, the findings support the incorporation of CBL into nursing curricula to foster critical analytical skills. Further research should explore the contextual factors that affect the variability in outcomes.

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  • Case-based learning improves critical thinking dispositions among Chinese nursing students, although effect sizes varied with implementation fidelity and case quality.

    “A systematic review and meta-analysis further reported that CBL improves critical thinking dispositions among Chinese nursing students, although effect sizes varied with implementation fidelity and case quality (12).”

    From The effectiveness of an integrated CBL and BOPPPS model in neurological nursing clinical teaching: a comparative study (2026) · cites this paper as [12]

    The Results and Discussion (no page numbers provided) report that CBL improved critical thinking dispositions among nursing students in China and that effects varied across studies. The Discussion suggests that variation in CBL implementation might contribute to heterogeneity, but it does not establish implementation fidelity as a cause; the passages do not identify case quality as a factor. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Xiang, Y., Liu, D., Liu, L., Liu, I.-C., Wu, L., & Fan, H.
Affiliations
  • Chongqing University of Education (CN)
  • Anshan Normal University (CN)
  • Yuan Ze University (TW)
  • Sanya University (CN)
Corresponding author
Fan, Hao
ORCID
Venue
Frontiers in Medicine
Publisher
Frontiers Media SA
Published
2025-03-17
Volume
12
Pages
1452051-1452051
ISSN
2296-858X (ISSN-L)
DOI
10.3389/fmed.2025.1452051
PMC
PMC11956162
OpenAlex
W4408526109
Cited by
15
References
3
Citations by year
2026: 12 · 2025: 3
FWCI
5.37
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Education › Education and Critical Thinking Development
  • Social Sciences › Education › Problem and Project Based Learning
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
case-based learning, critical thinking disposition, nursing education, nursing students, problem-based learning, nursing interns, nursing curriculum

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