Aug 2026· Journal of Educational Evaluation for Health Professions· Vol 23, pp.
24
· 0 citations
Medicine
TL;DR
Most studies found no significant differences between observer and active participant roles at Kirkpatrick Levels 1 and 2, but generalizability across all health professions and settings is limited.
Abstract
Purpose
This review examined the impact of learner role-active participant versus observer-on learning outcomes in healthcare simulation-based education using Kirkpatrick's evaluation model.
Methods
Five databases-PubMed, Scopus, Web of Science, ScienceDirect, and EBSCOhost-were searched for studies published from January 2018 to November 2024. Eligibility criteria, defined using the PICOS framework, targeted studies comparing learning outcomes between active participant and observer roles among health professions students and practitioners. Methodological quality was appraised using the Medical Education Research Study Quality Instrument, and findings were synthesized narratively. This review was registered in PROSPERO under registration number CRD42024611988.
Results
Of 648 records, 15 studies involving 1,799 participants met the inclusion criteria; role allocation was specifically reported for 644 active participants and 709 observers. Most studies were conducted in high-income countries (13/15) and nursing programs (11/15). At Kirkpatrick Level 1, most studies reported no statistically significant between-role differences, although an active participant advantage emerged for emotional arousal. At Level 2, knowledge, skills, and most attitudinal outcomes did not differ significantly between roles; active participant advantages were observed for technical skills at delayed follow-up, affective competencies in palliative care, and perceived learning transfer. No study assessed Levels 3 or 4.
Conclusion
Most studies found no significant differences between observer and active participant roles at Kirkpatrick Levels 1 and 2. Generalizability across all health professions and settings is limited. Pedagogically appropriate use of the observer role supports learning outcomes and may expand access to simulation-based education.
This systematic review aimed to identify the technology-supported learning approaches used in stoma care education for nursing students, evaluate their effects on learning outcomes, and examine their implementation characteristics, advantages, and limitations. Methods: The review was conducted in accordance with the PRISMA guidelines and registered in PROSPERO (CRD420261395533). A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, and DergiPark databases was conducted to identify studies published between 2016 and 2026. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools, while risk of bias was evaluated using Cochrane RoB 2 and ROBINS-I tools. Results: A total of 11 studies met the inclusion criteria. Identified interventions included simulation-based education, virtual reality (VR), serious game-based web applications, web-supported education, online/video-based learning, and digital presentation methods. Most studies reported positive effects on learning outcomes, particularly knowledge acquisition and skill development. Simulation-based interventions were found to improve self-efficacy, self-confidence, and communication skills. High-fidelity simulation and standardized patient applications appeared to be more effective than low-fidelity approaches. Serious game-based and web-supported approaches were associated with improved knowledge retention and greater student engagement. Follow-up assessments in a limited number of studies suggested that technology-supported interventions may contribute to long-term knowledge retention. Conclusion: Technology-supported learning approaches appear effective in improving nursing students’ stoma care knowledge and skills. However, larger multicenter studies with longer follow-up periods are needed to strengthen the evidence.
Zeynep Mete Merdin, Hülya Bulut· Journal of Gazi university h...· 0 citations
Technology-enhanced learning (TEL), including artificial intelligence (AI), virtual reality (VR), high-fidelity simulation (HFS), and gamification, is increasingly used in nursing education to address limitations in clinical training and support the development of students’ clinical reasoning skills. This review aimed to synthesize current evidence on the educational outcomes associated with AI, VR, HFS, and gamification in nursing education, and to identify the factors that facilitate or hinder their successful implementation.
A systematic review was conducted in accordance with PRISMA 2020 and registered in PROSPERO (CRD420251048860). Five electronic databases were searched for English-language studies published between 2015 and 2025. Studies were eligible if they involved undergraduate or postgraduate nursing students and evaluated AI, VR, HFS, or gamification in educational settings. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT 2018).
Forty studies met the inclusion criteria. HFS and VR were most frequently associated with improvements in knowledge, clinical judgment, and procedural skills. Gamification was associated with greater engagement, motivation, and knowledge retention. Evidence on AI was limited and preliminary, with a small number of studies suggesting possible benefits for critical thinking and problem-solving. Common barriers included technical problems, resource constraints, and inadequate faculty preparedness.
TEL methods appear to improve student learning and provide safe environments for practice. Successful integration of TEL into nursing education requires institutional support, evidence-based teaching strategies, and continuous faculty development. TEL should complement rather than replace traditional educational practices. Future research should examine the long-term impact of TEL on learning outcomes, its cost-effectiveness, and its implementation in resource-constrained settings.
Maha Besbes, Anaam Soloh, Mohammed Mustafa et al.· BMC Medical Education· 0 citations
Performance-based assessment (PBA) plays a pivotal role in evaluating allied health and nursing students' readiness for independent clinical practice. Despite its importance, training for clinical educators in PBA is often ad hoc and inconsistent. This scoping review aimed to map the landscape of existing PBA education programmes for allied health and nursing educators and describe their content, format and educational impact.
A scoping review was conducted based on Arksey and O'Malley's framework in accordance with the Joanna Briggs Institute scoping review guidance. Searches of five electronic databases and three grey literature collections were performed for publications from 2000 to 2025. Articles were included if they reported on design, implementation or evaluation of PBA educator programmes. Screening and data extraction were conducted independently by three reviewers using a standardized tool to chart programme characteristics, instructional strategies, outcome measures and educational impact. Data were synthesized descriptively.
Of 5,306 records screened, nine studies met inclusion criteria. Programme durations ranged from 1–15 h, primarily delivered via in-person workshops (n = 8/9). Instructional strategies frequently included interactive workshops, video-based simulation of student's performance and guided practice. Outcome measures focused on educators' self-reported confidence, knowledge gains and rating accuracy, with most studies reporting improvements.
Results indicated that interactive, simulation-based workshops enhance educators' assessment skills, knowledge and confidence. However, important gaps remain regarding optimal programme length, pedagogical frameworks, translational of training into the work environment and longitudinal outcomes.
Standardized, evidence-informed training is needed to ensure reliable PBA practices and maintain the integrity of competency-based education.
L. Alpine, M. O’Grady, Julie Broderick et al.· Higher Education, Skills and...· 0 citations
Virtual simulation has become an increasingly used pedagogical approach in nursing education, particularly since the COVID-19 pandemic. Despite rapid uptake across diverse modalities, a comprehensive map of the evidence covering the post-pandemic surge is lacking. This scoping review systematically maps evidence on virtual simulation in nursing education, identifying technology types, educational applications, research designs, outcome measures, and knowledge gaps to inform future practice and research. A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported using the PRISMA-ScR checklist; the protocol was retrospectively registered on the Open Science Framework. PubMed, CINAHL (via EBSCOhost), Web of Science Core Collection, and Scopus were searched on 15 January 2026 for English-language peer-reviewed primary research published between January 2019 and December 2025. Two reviewers independently screened records and extracted data, with a third reviewer adjudicating disagreements. Findings were synthesised using descriptive statistics and descriptive categorisation of the extracted data. Of 5,990 records retrieved, 198 studies were included. Publications rose sharply, increasing from two studies in 2019 to 82 in 2025, with almost two-thirds appearing in 2024–2025 (64.6%). Studies originated predominantly from South Korea (21.2%), the USA (18.7%), and China, Taiwan (11.1%). Interactive immersive virtual reality and 360-degree/180-degree video virtual reality together accounted for 63.1% of studies, followed by screen-based virtual simulation (23.7%); augmented reality accounted for a smaller share (4.0%). Quasi-experimental designs (27.8%) and randomised controlled trials (22.7%) predominated. Self-confidence/self-efficacy (44.4%), knowledge acquisition (42.4%) and satisfaction (39.4%) were the most frequently measured outcomes. Favourable findings were commonly reported for these outcomes among the included studies; however, this review did not chart the direction or magnitude of effects, and no methodological quality appraisal was undertaken. Virtual simulation has been implemented across a broad range of nursing education contexts, and the mapped studies predominantly reported positive learning outcomes; however, limited longitudinal follow-up, geographic concentration in East Asia, small samples, and inconsistent outcome measures constrain the evidence base and warrant standardised, multi-site research. Not applicable.
Han Dong, Chen Zhou, Li-Chun Xing et al.· BMC Nursing· 0 citations
This study aims to examine the implementation patterns, technology integration, learning outcomes, student engagement, and sustainability factors of blended learning (BL) in health professions education (HPE) between 2020 and 2024 across diverse pedagogical and educational contexts. Despite the increasing adoption of BL in HPE, the existing literature lacks a comprehensive, theory-informed synthesis of implementation patterns, technology integration, the relationship between student engagement and learning outcomes, and sustainability factors across disciplines and educational settings. This study employed a Systematic Literature Review (SLR) following the PRISMA 2020 guidelines. The review was conducted using the Scopus database and included studies published between January 2020 and December 2024. A total of 41 peer-reviewed empirical studies were selected from an initial pool of 65 records through rigorous title and abstract screening, followed by full-text eligibility assessment. Data were synthesised narratively, and the findings were organised thematically according to five research questions using an integrated theoretical framework encompassing constructivism, cognitive load theory, multimedia learning theory, and self-regulated learning theory. The findings revealed that 58.5% of the included studies implemented general BL approaches, whereas 41.5% adopted established pedagogical frameworks. Technology integration primarily involved multimedia resources (53.7%), digital assessment platforms (43.9%), and video conferencing tools (43.9%). Overall, BL demonstrated high effectiveness, with 86% of the reported learning outcome measures indicating positive results. Structured active engagement exhibited the strongest positive association with learning outcomes (r ≈ 0.55–0.75). The main challenges included substantial resource requirements and difficulties in student self-regulation, whereas instructional design support emerged as the most important facilitating factor. These findings suggest that although BL is highly effective in HPE, its long-term sustainability depends on transitioning from ad hoc implementation to institutionally supported, theory-driven instructional design. Accordingly, educators and higher education institutions should prioritise intentional pedagogical design and sustained institutional support to ensure the effective and sustainable implementation of blended learning in health professions education.
Mira Istiana, Eveline Siregar, T. Iriani et al.· Jurnal Paedagogy· 0 citations
INTRODUCTION
Problem-based learning (PBL) is a student-centred, self-directed learning approach that has been widely adopted in medical education. Although many studies have investigated the effectiveness of PBL, few have synthesised the existing evidence. The purpose of this scoping review was to explore the characteristics of PBL applied in dental education, particularly comparing its effectiveness with other pedagogical approaches through Kirkpatrick's four-level evaluation model.
MATERIALS AND METHODS
The authors applied the Arksey and O'Malley framework to undertake a scoping review. The search was conducted on 31 December 2024 in PubMed, Web of Science, EBSCO, and other databases, including all English-language publications from January 1990 to December 2024 with no restrictions on study design or country of origin. Outcomes were classified using Kirkpatrick's four-level model (Reaction, Learning, Behaviour, Results). Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered on the Open Science Framework (OSF).
RESULTS
A systematic search identified 2 754 records. After deduplication and screening, 245 papers underwent full-text evaluation, and 106 studies involving 15 675 students were included. Hybrid PBL (hPBL) was the most frequently adopted strategy (57.5%), followed by modified PBL (mPBL, 22.6%) and traditional PBL (tPBL, 17.0%). Of 256 individual outcome measures synthesised, 62.1% were at the reaction level, 30.9% at the learning level, and only 7.0% at the behaviour and results levels combined. PBL consistently enhanced student satisfaction, with 100% of satisfaction outcomes (20 of 20) favouring PBL and reaction-level evaluations showing an 86.8% superiority rate. At the learning level, 69.6% of outcomes significantly favoured PBL, particularly in clinical reasoning and long-term knowledge retention; 26.6% showed no significant difference; and 3.8% favoured non-PBL approaches. Among PBL strategies, mPBL demonstrated the highest learning-level superiority rate (78.6%), followed by tPBL (70.0%) and hPBL (63.4%). The mean MERSQI score was 9.42 out of 18 (SD = 1.93), reflecting generally limited methodological quality.
DISCUSSION
A pronounced satisfaction-performance disconnect was identified: An 86.8% reaction superiority rate contrasted with a 69.6% learning superiority rate-a 17.2 percentage-point gap. Comparator-stratified analysis revealed that single-group studies reported higher reaction superiority (90.7%) than studies with control groups (82.2%), whereas at the learning level this gap largely disappeared (70.8% vs. 69.1%). Nearly half (49.7%) of all reaction-level outcomes relied on vague or unstandardised constructs. Over half of included studies (51.9%) evaluated only a single Kirkpatrick level, predominantly reaction-only assessments, precluding within-study linkages between satisfaction, knowledge acquisition, and clinical behaviour change.
CONCLUSION
PBL consistently enhanced student satisfaction and preference. Its impact on academic performance was less definitive, with many comparative studies showing no significant difference on standardised examinations when PBL was compared with traditional methods. However, PBL demonstrated clear advantages in applied clinical competencies, long-term knowledge retention, and professional practice outcomes. Modified PBL showed the highest learning-level superiority rates, suggesting that enhancing PBL with targeted pedagogical innovations may yield greater gains than hybridisation with lectures alone. Future research should prioritise comparative studies with robust designs, longitudinal outcome tracking, and assessments aligned with PBL's problem-solving objectives.
Zhuoyi Liao, Zhen Chen, Hongbo Zhang et al.· European journal of dental e...· 0 citations
