Effects of unfolding case-based simulation in obstetrics and gynecology internships on caring ability and caring...

Obstetrics and gynecology (OBGYN) internships are emotionally demanding and require nursing students to integrate specialty competence with sustained caring. Evidence on whether unfolding case-based simulation can improve both caring ability and caring behaviors during OBGYN internships remains limited.

We conducted a prospective, controlled quasi-experimental study in the OBGYN ward of Shanghai Sixth People's Hospital from June 2024 to March 2025. Final-year undergraduate nursing interns (n = 106) completed a 4-week rotation and were allocated by individual-level lot drawing within naturally occurring rotation cohorts to a control group receiving conventional preceptorship (n = 47) or an intervention group receiving conventional preceptorship plus unfolding case-based simulation (n = 59). Primary outcomes were end-of-rotation Caring Ability Inventory (CAI) and Caring Behaviors Inventory (CBI) scores, analyzed using analysis of covariance with group as the fixed factor and the corresponding baseline score as a covariate. Secondary outcomes included end-of-rotation specialty assessments and teaching satisfaction.

Baseline characteristics and baseline CAI and CBI scores were comparable between groups. After adjustment for baseline scores, the intervention group had significantly higher end-of-rotation CAI and CBI total and dimension scores than the control group (all P < 0.001). The intervention group also achieved higher specialty assessment scores and overall teaching satisfaction than the control group (both P < 0.001).

Adding unfolding case-based simulation to conventional OBGYN preceptorship was associated with substantial short-term improvements in nursing students' caring ability and caring behaviors, alongside better specialty performance and teaching satisfaction. Further studies using multicenter designs, delayed follow-up, and objective behavioral assessments are needed to determine whether these gains are sustained and transferable to real clinical practice.