From film to simulation: Mixed-methods study of learner-driven artificial intelligence-generated ethical dilemma...

We aimed to develop and implement the Film-Based, Artificial Intelligence (AI)-Generated Interactive Ethical Dilemma Role-Play Simulation program and evaluate its effects on nursing students' biomedical ethics awareness, critical thinking disposition, empathy and program satisfaction.

Although AI-based educational tools enhance interactivity and realism, their application in ethics-focused education remains limited.

A mixed-methods design was used with a quasi-experimental nonequivalent control group pretest-posttest element and a qualitative thematic analysis based on structured debriefing data.

The program was developed through literature review, expert consultation, film selection and learner-driven AI-supported scenario development. Participants were 50 s- and third-year nursing students. The experimental group completed a four-session, two-week program incorporating film viewing, theoretical lectures, critical reflection, learner-driven scenario development supported by AI, role-play and debriefing, whereas the control group only viewed the films. Data were collected from March to April 2025 and analyzed using descriptive statistics, independent t-tests, nonparametric tests and thematic analysis.

The experimental group demonstrated significantly greater improvements in biomedical ethics awareness, critical thinking disposition and empathy than the control group. Significant pre-post improvements were also observed. Program satisfaction was high. The qualitative analysis identified three themes: experiencing emotional immersion and empathy, enhancing ethical sensitivity and value reflection and reflecting on the nursing role and strengthening professional identity.

The program effectively enhanced ethical awareness, critical thinking and empathy among nursing students. Therefore, integrating film-based learning, AI-generated scenarios and interactive role-play simulations is a feasible and engaging strategy for ethics education.