The effectiveness of an integrated CBL and BOPPPS model in neurological nursing clinical teaching: a comparative study

May combine two claims.

Case-based learning stimulates learning initiative, promotes deep integration of theoretical knowledge with clinical practice, and cultivates clinical thinking and problem-solving abilities.

“By engaging students in the analysis, discussion, and reflection of authentic clinical cases, Case-Based Learning (CBL) effectively stimulates learning initiative. This process not only promotes deep integration of theoretical knowledge with clinical practice but also cultivates essential clinical thinking and problem-solving abilities (10).”

• cites [10] Bird, 2017, Using small case-based learning groups as a setting for teaching medical students how to provide and receive peer feedback, Med Sci Educ sourcePartly supported

  The section ‘Case-based learning sessions as a setting for teaching peer feedback’ (page unavailable) describes student-led inquiry into the biosciences underlying structured clinical cases. It does not establish that CBL stimulates learning initiative, produces deep integration of theory with clinical practice, or develops clinical thinking and problem-solving abilities; the paper focuses on peer-feedback training. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Evidence suggests that the BOPPPS model improves teaching efficiency and offers marked advantages over traditional instruction in course satisfaction, teacher-student interaction, and the enhancement of clinical analytical abilities.

“Evidence suggests that this student-centered model not only improves teaching efficiency but also offers marked advantages over traditional instruction in terms of course satisfaction, teacher-student interaction, and the enhancement of clinical analytical abilities (7, 32).”

• cites [7] Chen, 2022, Effect of the BOPPPS model combined with case-based learning versus lecture-based learning on ophthalmology education for five-year paediatric undergraduates in Southwest China, BMC Med Educ sourcePartly supported

  The Results (page not provided) report higher course satisfaction and perceived analytical skills for BOPPPS combined with case-based learning than for lecture-based learning. The Discussion (page not provided) describes greater emphasis on teacher–student interaction, but the study does not isolate the effect of BOPPPS alone or establish improved teaching efficiency. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [32] Xu, 2023, Application of the hybrid BOPPPS teaching model in clinical internships in gynecology, BMC Med Educ sourcePartly supported

  The Results section (Table 4; page unavailable) reports higher satisfaction-related ratings in the hybrid BOPPPS group than in the traditional-instruction group, including perceived improvement in case analysis ability. The Discussion describes more opportunities for trainee doctors to interact with a teaching administrator, but does not establish a comparative advantage in teacher–student interaction. The paper also does not report a measure of teaching efficiency. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The BOPPPS model is a closed-loop instructional design framework based on constructivist theory, dividing classroom teaching into six modules: Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary.

“This model is a closed-loop instructional design framework based on constructivist theory (14), dividing classroom teaching into six modules: Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary.”

• cites [14] Liu, 2022, Assessment of the effectiveness of BOPPPS-based hybrid teaching model in physiology education, BMC Med Educ sourcePartly supported

  The Background and Methods (Table 1; page not specified) identify BOPPPS and list the six modules. The paper does not describe it as a closed-loop instructional design framework based on constructivist theory; the Background instead says classical BOPPPS is relatively weak at establishing feedback connections. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

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).”

• cites [12] Xiang, 2025, Impact of case-based learning on critical thinking dispositions in Chinese nursing education: a systematic review and meta-analysis, Front Med (Lausanne) sourcePartly supported

  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)

  Experimental — accuracy not yet measured

May combine two claims.

Integrated CBL-BOPPPS designs have shown favourable results in ophthalmology, oral and maxillofacial surgery, and general nursing education.

“Integrated CBL–BOPPPS designs have shown favourable results in ophthalmology, oral and maxillofacial surgery, and general nursing education (7, 18, 19).”

• cites [7] Chen, 2022, Effect of the BOPPPS model combined with case-based learning versus lecture-based learning on ophthalmology education for five-year paediatric undergraduates in Southwest China, BMC Med Educ sourceSupported
• cites [18] Gao, 2024, Research on the application of CBL combined with BOPPPS teaching mode in oral and maxillofacial surgery teaching: a randomized controlled study, Sci Rep sourceSupported
• cites [19] Polit, 2006, The content validity index: Are you sure you know what’s being reported? Critique and recommendations, Res Nurs Health sourceNot checked — no full text of the source

The quote only partly states this claim.

The experimental group showed a statistically significant within-group improvement in theoretical assessment scores from pre- to post-internship (78.95 ± 6.73 to 87.62 ± 5.38; p < 0.001).

“In contrast, the experimental group showed a substantial and statistically significant improvement, achieving a mean post-internship score of 87.62 ± 5.38.”

The quote only partly states this claim.

The control group showed no significant within-group change in theoretical assessment scores from pre- to post-internship (79.32 ± 6.45 to 78.45 ± 6.72; p = 0.493).

“Following the 4-week internship, the control group’s score changed marginally to 78.45 ± 6.72, a non-significant within-group change.”

May combine two claims.

The study was a single-centre, two-group, non-randomized quasi-experimental study with a pre-test/post-test design.

“This was a single-centre, two-group, non-randomized quasi-experimental study with a pre-test/post-test design.”

May combine two claims.

Complete blinding of all parties was not feasible, and residual performance and detection bias cannot be excluded.

“Complete blinding of all parties was not feasible, and residual performance and detection bias cannot be excluded.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

BOPPPS and CBL are theoretically complementary: BOPPPS provides the structural scaffold, while CBL supplies authentic clinical cases that anchor each phase in concrete reasoning.

“The two models are theoretically complementary: BOPPPS provides the structural scaffold (clear objectives, diagnostic pre-assessment, participatory activity, and closed-loop post-assessment and feedback), while CBL supplies authentic clinical cases that anchor each phase in concrete reasoning.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All 86 distributed questionnaires were returned and valid, yielding a 100% effective response rate.

“All 86 distributed questionnaires were returned and valid, yielding a 100% effective response rate.”

May combine two claims.

Evidence on integrated CBL-BOPPPS in neurological nursing remains scarce, and prior reports seldom quantify effect sizes or address the limitations of non-randomized allocation.

“However, evidence in neurological nursing—where time-critical decision-making is paramount—remains scarce, and prior reports seldom quantify effect sizes or address the limitations of non-randomized allocation.”

May combine two claims.

Theory examinations were machine-/blind-scored against a fixed answer key by graders unaware of group allocation; OSCE examiners and the data analyst were blinded to allocation; OSCE candidates were identified only by code.

“To reduce assessor bias, theory examinations were machine−/blind-scored against a fixed answer key by graders unaware of group allocation; OSCE examiners and the data analyst were also blinded to allocation, and OSCE candidates were identified only by code.”

Probably not a substantial claim: may not pass S3 (load-bearing).

No outcome data were missing.

“Missing data were handled by complete-case analysis; no outcome data were missing.”

May combine two claims.

The traditional lecture-based learning model, due to its singular methodology, lack of interactivity, and limited practicality, fails to fully engage students' initiative and restricts their comprehensive development, often resulting in suboptimal teaching quality, academic performance, and student evaluations.

“Due to its singular methodology, lack of interactivity, and limited practicality, this model fails to fully engage students’ initiative and restricts their comprehensive development, often resulting in suboptimal teaching quality, academic performance, and student evaluations (9).”

• cites [9] El Sadik, 2021, Improvement in student performance and perceptions through a flipped anatomy classroom: shifting from passive traditional to active blended learning, Anat Sci Educ sourceNot checked — no full text of the source

May combine two claims.

Participants were allocated to the experimental or control group by internship batch rather than by randomization; no allocation sequence, concealment, or randomization procedure was used.

“Participants were allocated to the experimental or control group by internship batch rather than by randomization; consequently, no allocation sequence, concealment, or randomization procedure was used, and the design does not constitute a randomized controlled trial.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A Bonferroni-corrected significance threshold of α = 0.05/7 = 0.007 was applied to the seven CTDI-CV subscales to control the family-wise error rate.

“For the seven CTDI-CV subscales, a Bonferroni-corrected significance threshold of α = 0.05/7 = 0.007 was applied to control the family-wise error rate.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The research was conducted in compliance with the Declaration of Helsinki.

“The research was conducted in compliance with the Declaration of Helsinki.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The BOPPPS teaching model was initially developed to improve teaching effectiveness and instructor skills for teacher training.

“The BOPPPS teaching model, also known as the guided learning interactive efficiency-enhancing teaching method, was initially developed to improve teaching effectiveness and instructor skills for teacher training (13).”

• cites [13] Yang, 2019, The effect of microteaching combined with the BOPPPS model on dental materials education for predoctoral dental students, J Dent Educ sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The CTDI-CV had an internal consistency (Cronbach's α) of 0.91 in this sample.

“The internal consistency (Cronbach’s α) of the total scale in this sample was 0.91.”

Classified as probably not a substantial claim. May combine two claims.

Three clinical nursing instructors with over 5 years of neurological nursing experience, bachelor's degrees or higher, and charge nurse positions received specialized training in BOPPPS and CBL facilitation to ensure standardized implementation.

“Faculty preparation: three clinical nursing instructors with over 5 years of neurological nursing experience, bachelor’s degrees or higher, holding positions of charge nurse or above, and possessing rich clinical teaching experience were selected. They received specialized training in the BOPPPS teaching model and CBL facilitation to ensure standardized implementation.”

May combine two claims.

Baseline demographic and academic characteristics were comparable between groups, with no statistically significant differences in gender, age, educational background, or pre-internship basic nursing theory scores (p > 0.05).

“No statistically significant differences were found between the two groups in general characteristics such as gender, age, educational background, or pre-internship basic nursing theory scores (p > 0.05), indicating comparability.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was reported in accordance with the TREND statement for non-randomized evaluations.

“The study was reported in accordance with the TREND statement for non-randomized evaluations (completed checklist provided as Supplementary material).”

May combine two claims.

Case-based learning enhances the learning experience and equips students with the competencies required for clinical practice.

“Recent studies have confirmed that this model can enhance the learning experience while equipping students with the competencies required for clinical practice (11).”

• cites [11] Yao, 2023, Case-based learning interventions for undergraduate nursing students in a theoretical course: a review of design, implementation, and outcomes, J Prof Nurs sourceNot checked — no full text of the source

May combine two claims.

The satisfaction questionnaire had content validity (I-CVI 0.80-1.00; S-CVI/Ave 0.88), Cronbach's α of 0.86, and two-week test-retest reliability of 0.84.

“Content validity was established by a panel of five nursing-education experts; the item-level content validity index (I-CVI) ranged from 0.80 to 1.00 and the scale-level CVI (S-CVI/Ave) was 0.88. Reliability was supported by a Cronbach’s α of 0.86 and a two-week test–retest reliability of 0.84 (n = 20 in a pilot sample).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The parametric and non-parametric results were concordant.

“Because some variables in this modest sample did not strictly meet normality assumptions, all primary comparisons were corroborated with non-parametric tests (Wilcoxon signed-rank for within-group and Mann–Whitney U for between-group comparisons); the parametric and non-parametric results were concordant, and exact Mann–Whitney results for the principal outcomes are reported in the table footnotes”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study protocol received review and approval from the Institutional Review Board, and written informed consent was obtained from all participants.

“The study protocol received review and approval from the Institutional Review Board (IRB) of the Second Affiliated Hospital of Anhui Medical University (approval no. 2024-LW-035), and written informed consent was obtained from all participants.”

Classified as probably not a substantial claim.

The theoretical complementarity of CBL and BOPPPS is the mechanism proposed for the observed gains.

“This theoretical complementarity is the mechanism we propose for the observed gains.”

May combine two claims.

The evaluation period was relatively short, assessing only immediate post-internship effects without tracking long-term retention or transfer to practice.

“The evaluation period was relatively short, assessing only immediate post-internship effects without tracking long-term retention or transfer to practice.”

May combine two claims.

The study is single-center with a sample size of 86 students, which may limit the generalizability of the results.

“It is also a single-center study with a sample size of only 86 students, which may limit the generalizability of the results.”

Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

Mann-Whitney U tests were concordant with the independent-samples t-tests for the teaching satisfaction comparisons.

“Mann–Whitney U tests were concordant.”

May combine two claims.

The non-randomized, quasi-experimental design with allocation by internship batch limits causal inference and is susceptible to selection and temporal confounding.

“Foremost, the non-randomized, quasi-experimental design with allocation by internship batch limits causal inference and is susceptible to selection and temporal confounding”

Probably not a substantial claim: may not pass S3 (load-bearing).

The use of a self-developed satisfaction questionnaire may introduce subjective bias despite acceptable validity evidence.

“The use of a self-developed satisfaction questionnaire may introduce subjective bias despite acceptable validity evidence.”

• AssumptionRests on an assumption: The self-developed satisfaction questionnaire has acceptable validity evidence.

Classified as probably not a substantial claim.

Because the design was non-randomized and single-centre, the results should be regarded as promising but preliminary.

“Because the design was non-randomized and single-centre, these results should be regarded as promising but preliminary.”

Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

Mann-Whitney U tests were concordant with the independent-samples t-tests for the CTDI-CV comparisons.

“Mann–Whitney U tests were concordant.”

May combine two claims.

Outcome assessors were blinded, but instructors and students were not, leaving residual performance and detection bias.

“Although outcome assessors were blinded, instructors and students were not, leaving residual performance and detection bias.”

May combine two claims.

The integrated CBL-BOPPPS model is associated with significantly greater gains in both theoretical knowledge and OSCE-assessed clinical skills compared to traditional LBL.

“the integrated CBL–BOPPPS model is indeed associated with significantly greater gains in both theoretical knowledge and OSCE-assessed clinical skills compared to traditional LBL”

May combine two claims.

The integrated CBL and BOPPPS model was associated with improved mastery of theoretical knowledge, clinical practical ability, and critical thinking disposition, and with higher learning satisfaction among neurological nursing interns.

“the integrated CBL and BOPPPS model, which embeds CBL within each phase of the BOPPPS framework, was associated with improved mastery of theoretical knowledge, clinical practical ability, and critical thinking disposition, and with higher learning satisfaction among neurological nursing interns”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

The integration ensures that the structural rigor of BOPPPS prevents discussion drift sometimes seen in pure CBL, while authentic neurological cases prevent BOPPPS from becoming a mere mechanical checklist, thereby narrowing the gap between theoretical knowledge and life-saving clinical actions.

“the integration ensures that the structural rigor of BOPPPS prevents the “discussion drift” sometimes seen in pure CBL, while the authentic neurological cases prevent the BOPPPS model from becoming a mere mechanical checklist, thereby optimally narrowing the gap between theoretical knowledge and life-saving clinical actions.”