Efficacy of the Socialization, Externalization, Combination, and Internalization model in clinical nursing education:...

In recent years, the Socialization, Externalization, Combination, and Internalization (SECI) model has gained widespread application in clinical nursing courses across China. Despite its prevalence, a comprehensive and quantitative evaluation of its outcomes remains unaddressed.

To systematically assess the efficacy of the SECI model in Chinese clinical nursing education.

A stepwise method was used by searching four databases (China National Knowledge Infrastructure [CNKI], Wanfang Database, Chinese Scientific Journals Database [VIP], and SinoMed) to retrieve published papers in Chinese examining the application of the SECI model in clinical nursing education. The time frame for the searches included all literature before March 31, 2025. The investigators independently completed study selection, data extraction, quality assessment and analysis of all included studies. Review Manager (RevMan, version 5.4) was used to analyze the data. The methodological quality of the included studies was evaluated using the Cochrane Risk of Bias 2 (Cochrane RoB 2) tool. The risk of bias assessment, meta-analysis, and heterogeneity testing were conducted using RevMan version 5.4 software. The 95% Prediction Intervals (PIs) were calculated with R software (version 4.3.1). The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

A total of five randomized controlled trials conducted in China were included in the systematic review and meta-analysis, consisting of 340 participants (163 in the SECI model group and 177 in the control group). The meta-analysis revealed that the theoretical knowledge scores (SMD = 1.44, 95% CI: 0.80-2.08, P < 0.001; 95% PI: -0.02 - 2.90), skill scores (SMD = 2.88, 95% CI: 1.08-4.68, P = 0.002; 95% PI: -0.67 - 6.43), overall competence (SMD = 0.87, 95% CI: 0.63-1.12, P < 0.001; 95% PI: 0.41-1.34), professional commitment (SMD = 0.77, 95% CI: 0.40-1.13, P < 0.001), and teaching satisfaction (SMD = 2.61, 95% CI: 1.81-3.42, P < 0.001) were significantly higher in the SECI model group than in the control group. Sensitivity analysis confirmed the results of our meta-analysis were reliable. The evidence grades of the results regarding theoretical knowledge scores and overall competence were rated as low, while those for skill scores, professional commitment, and teaching satisfaction were rated as very low.

Based on low- to very-low-certainty evidence, the SECI model may improve students' theoretical knowledge scores, skill scores, overall competence, professional commitment, and teaching satisfaction compared with control conditions that did not employ the SECI framework. Considering the limitations inherent in the studies included in this review, further robust randomized controlled trials are necessary across diverse educational contexts to validate these findings.