title: Case-based learning and simulation: useful tools to enhance nurses' education? Nonrandomized controlled trial.
abstract: OBJECTIVE
  To compare skills acquired by undergraduate nursing students enrolled in a medical-surgical course. To compare skills demonstrated by students with no previous clinical practice (undergraduates) and nurses with clinical experience enrolled in continuing professional education (CPE).
  
  
  METHODS
  In a nonrandomized clinical trial, 101 undergraduates enrolled in the "Adult Patients 1" course were assigned to the traditional lecture and discussion (n = 66) or lecture and discussion plus case-based learning (n = 35) arm of the study; 59 CPE nurses constituted a comparison group to assess the effects of previous clinical experience on learning outcomes.
  
  
  METHODS
  Scores on an objective structured clinical examination (OSCE), using a human patient simulator and cases validated by the National League for Nursing, were compared for the undergraduate control and intervention groups, and for CPE nurses (Student's t test).
  
  
  RESULTS
  Controls scored lower than the intervention group on patient assessment (6.3 ± 2.3 vs 7.5 ± 1.4, p = .04, mean difference, -1.2 [95% confidence interval (CI) -2.4 to -0.03]) but the intervention group did not differ from CPE nurses (7.5 ± 1.4 vs 8.8 ± 1.5, p = .06, mean difference, -1.3 [95% CI -2.6 to 0.04]). The CPE nurses committed more "rules-based errors" than did undergraduates, specifically patient identifications (77.2% vs 55%, p = .7) and checking allergies before administering medication (68.2% vs 60%, p = .1).
  
  
  CONCLUSIONS
  The intervention group developed better patient assessment skills than the control group. Case-based learning helps to standardize the process, which can contribute to quality and consistency in practice: It is essential to correctly identify a problem in order to treat it. Clinical experience of CPE nurses was not associated with better adherence to safety protocols.
  
  
  CONCLUSIONS
  Case-based learning improves the patient assessment skills of undergraduate nursing students, thereby preparing them for clinical practice.
authors.affiliation: Lecturer, School of Nursing, University of Girona, Girona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Raurell-Torredà
authors.forename: Josep
authors.initials: J
authors.lastname: Olivet-Pujol
authors.forename: Àngel
authors.initials: À
authors.lastname: Romero-Collado
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Malagon-Aguilera
authors.forename: Josefina
authors.initials: J
authors.lastname: Patiño-Masó
authors.forename: Alícia
authors.initials: A
authors.lastname: Baltasar-Bagué
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004508:Education, Nursing, Baccalaureate / Q000379:methods*; D004509:Education, Nursing, Continuing; D004521:Educational Measurement / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009730:Nursing Assessment; D015402:Nursing Education Research; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education* / Q000706:statistics & numerical data; D016544:Patient Simulation; D013527:Perioperative Nursing / Q000193:education*; D018794:Problem-Based Learning; D013338:Students, Nursing / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Assessment; case method; case study; case-based learning; nontechnical skills; nurse education; nursing students; objective structured clinical examination; simulation