BOPPPS model with virtual simulation system for otorhinolaryngology head and neck surgery nursing interns: a quasi-experimental study

Clinical training in surgical nursing faces limitations in safety and consistency. A virtual simulation system addresses safety but lacks pedagogical structure. Integrating it with the bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary (BOPPPS) model may enhance learning outcomes for surgical nursing interns.

This study employed a mixed-methods approach combining a quasi-experimental design with qualitative research. It was conducted among 120 nursing interns, who were assigned to either an intervention group (n = 60) or a control group (n = 60). The control group received traditional teaching methods, while the intervention group received the BOPPPS model with virtual simulation system. Outcome assessors and data analysts were blinded to group assignment to minimize bias. After the rotation, the two groups were compared in terms of objective learning outcomes including internship performance (theoretical, operational, and clinical practice scores), self-directed learning ability, and humanistic care ability; in addition, teaching satisfaction was also assessed. SPSS 25.0 was used for statistical analysis. Qualitative data were collected through semi-structured interviews and analyzed using thematic analysis.

Baseline comparisons showed no significant differences between the two groups in age, gender, etc. (P > 0.05 for all). After the intervention, the intervention group showed significantly higher internship performance than the control group (total scores: 94.86 ± 1.28 vs. 90.29 ± 1.62, P < 0.05, d = 3.12, 95% CI: 2.53 to 3.71). The intervention group also showed superior self-directed learning ability (total scores: 106.35 ± 16.08 vs. 99.57 ± 19.93, P = 0.043, d = 0.37, 95% CI: 0.01 to 0.73) and higher humanistic care competency (total scores: 203.08 ± 27.52 vs. 187.92 ± 38.71, P = 0.013, d = 0.46, 95% CI: 0.09 to 0.82). In addition, teaching satisfaction was significantly higher in the intervention group (98.3% vs. 86.7%; χ² = 6.54, P = 0.038). Qualitative analysis of the new teaching model conducted with 14 nursing interns identified five key themes: (1) stimulating learning interest; (2) enhancing self-directed learning ability; (3) improving expressive skills and humanistic care capabilities; (4) strengthening clinical thinking and mastery of nursing skills; (5) suggestions for improving this teaching model.

Beyond improving teaching satisfaction, the BOPPPS model with virtual simulation system was associated with superior improvements in objective learning outcomes such as theoretical knowledge, practical skills, self-directed learning ability, and humanistic care competency among otorhinolaryngology head and neck surgery nursing interns.