title: A comparison of educational strategies for the acquisition of nursing student's performance and critical thinking: simulation-based training vs. integrated training (simulation and critical thinking strategies).
abstract: BACKGROUND
  There is a need to change the focus of nursing education from traditional teacher-centered training programs to student-centered active methods. The integration of the two active learning techniques will improve the effectiveness of training programs. The objective of this study is to compare the effects of the integrated training (simulation and critical thinking strategies) and simulation-based training on the performance level and critical thinking ability of nursing students.
  
  
  METHODS
  The present quasi-experimental study was performed in 2014 on 40 students who were studying practical nursing principles and skills course in the first half of the academic year in Shiraz University of Medical Sciences. Students were randomly divided into control (n = 20) and experimental (n = 20) groups. After training students through simulation and integrated education (simulation and critical thinking strategies), the students' critical thinking ability and performance were evaluated via the use of California Critical Thinking Ability Questionnaire B (CCTST) and Objective Structured Clinical Examination (OSCE) comprising 10 stations, respectively. The external reliability of the California Critical Thinking questionnaire was reported by Case B.to be between 0.78 and 0.80 and the validity of OSCE was approved by 5 members of the faculty. Furthermore, by using Split Half method (the correlation between odd and even stations), the reliability of the test was approved with correlation coefficient of 0.66. Data were analyzed using t-test and Mann-Whitney test. A significance level of 0.05 was considered to be statistically significant.
  
  
  RESULTS
  The mean scores of the experimental group performance level were higher than the mean score of the control group performance level. This difference was statistically significant and students in the experimental group in OSCE stations had significantly higher performance than the control group (P <0.001). However, the mean scores obtained for the critical thinking did not increase before and after the intervention.
  
  
  CONCLUSIONS
  The results showed that, the students' performance level was increased by the application of integrated training (simulation and critical thinking strategies).
authors.affiliation: Department of E-learning, Virtual School, Center of Excellence for e-Learning in Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. nzarifsanaee@gmail.com.
authors.forename: Nahid
authors.initials: N
authors.lastname: Zarifsanaiey
authors.affiliation: Quality improvement in clinical teaching Research Center, Education Development Center, Shiraz University of Medical Sciences, Sina- Sadra Halls Complex, Neshat Ave, Shiraz, Iran.
authors.forename: Mitra
authors.initials: M
authors.lastname: Amini
authors.affiliation: Fatemeh (P.B.U.H) College of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Farideh
authors.initials: F
authors.lastname: Saadat
mesh_terms: D002140:California; D002983:Clinical Competence / Q000592:standards*; D004508:Education, Nursing, Baccalaureate / Q000592:standards*; D004521:Educational Measurement; D006801:Humans; D015402:Nursing Education Research; D018794:Problem-Based Learning / Q000379:methods*; D015203:Reproducibility of Results; D000066908:Simulation Training / Q000379:methods*; D013338:Students, Nursing / Q000523:psychology*; D013850:Thinking
keywords: Critical Thinking Strategies; Level of Performance; Nursing Students; Simulation