This study was a mixed method research including quantitative and qualitative assessment. This study was obtained the ethical approval from the Ethics Committee of XXX.
Cluster sampling was used to select 30 full-time grade 3 students majoring in nursing at a nursing school. The students had completed nursing foundation, health assessment, and nursing courses in various specialties. The students were randomly divided into a control group and an experimental group. Based on the principle of voluntary participation, three grade 2 clinical medicine major students and three students with a grade 3 pharmacy major were also recruited into the experimental group.
“Clinical Critical Thinking Training” is the core nursing course in our hospital, with 2 credits, including 28 hours of theoretical courses and 20 hours of experimental courses, totaling 48 hours. Experimental classes are 4 hours per class, once a week, for 5 consecutive weeks with simulated cases designed by instructors from the nursing, clinical medicine, and pharmacy departments. Case scenarios focused on patients in gynecology, pediatrics, and intensive care units. The same teaching materials, simulation cases, and instructors were used in the two groups. Students in each group were randomly divided into three teams, with six members in each team, including one physician, one responsible nurse, one auxiliary nurse, one clinical pharmacist, one patient family member, and one observer. The responsible nurse was the team leader, responsible for the organization, coordination, division of labor, and cooperation within the team. The control group used conventional simulation teaching, in which nursing students acted as the physicians and clinical pharmacists involved in the case. The experimental group adopted SIPE, and each team had one student majoring in clinical medicine and one student majoring in pharmacy.
Using Biggs's 3P model as the theoretical framework, this course practice was divided into “presage, process, and product.” The problem-based learning (PBL) method was used to cultivate students’ clinical critical thinking, team communication, and cooperation abilities. In the first experimental course, teams became acquainted through team training, and faculty introduced the experimental course. For the three experimental classes in the middle, instructors prepared three scenarios following the gynecology, pediatrics, and intensive care units. The teachers of the three experimental classes in the middle prepared three scenarios in order according to the adult department, the gynecology and pediatrics department, and the intensive care unit, and released them to the students on the teaching platform in advance. The faculty introduced these scenarios for students on the teaching platform in advance. Each team could discuss the cases in advance. For the last experimental class, the instructor prepared three scenarios at the same time but did not introduce them in advance. Three teams drew lots to simulate the demonstration. The SIPE program design framework is shown in Fig. 1.
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Figure 1. The flowchart of simulated interprofessional education program. This curriculum was designed based on the theoretical framework of the Biggs's 3P model, which included three steps as “presage, process, and product.”
Preparation for learning was divided into introductory and implementation parts. Introductory preparation was carried out in the first experimental class, which mainly introduced the experimental course objective, content, and arrangement, team structure, and the importance of team cooperation. The case analysis and the discussion of the four cores of team cooperation (leadership, effective communication, mutual support, and situation monitoring) were used to improve students’ understanding of the team and strengthen students’ sense of team. Through the paper chain game, the length of the paper chain made by each team is compared, and the team cooperation is simulated, so that students can understand the importance of the close connection and effective cooperation of the medical team.
Before the last four experimental classes, implementation preparation was carried out, including instructor and student preparation. The interprofessional teaching team comprises one instructor from clinical medicine, one instructor from nursing, and one instructor from the pharmacy who jointly formulated teaching objectives, determined simulated cases, set situational questions, and issued cases and tasks through the teaching platform. Instructors in the experimental center were responsible for the layout of simulated case scenarios, providing instruments and equipment commonly used in treatment and nursing, and setting the conditions of the SimMan 3G high simulation person according to the case. Students needed to be familiar with the theoretical knowledge and operational skills related to the case and to discuss the case within the team.
Each case was set up as a “three-station” simulation scenario, namely, the health assessment at admission, the evaluation of the implementation of the diagnosis and treatment plan, and the health guidance at discharge. Each scenario included 5–10 minutes of preparation before the simulation and 15–20 minutes of case simulation. According to the requirements of scenario simulation, the time ratio between simulation and guiding feedback is 1:2 or 1:3 , and so feedback took place for 30–40 minutes. According to case scenarios and situational problems, team members made an overall assessment of the patients according to their professional focus, shared the assessment results, and jointly formulated examination, treatment, and nursing plans. All students should closely observe the changes in the patient’s condition, communicate in a timely manner, and cooperate with team members. Also, they need to comprehensively use the theoretical knowledge and techniques that they have mastered to ensure the correct response and treatment to promote the recovery of patients. The whole simulation process is recorded, and the instructor does not give any hints but can adjust the situation randomly according to the simulation.
At the end of each simulation, the instructor used three steps to guide the students to review and reflect. First, the students were asked about the experience of the simulation teaching so that the students could fully express and share their emotions. Second, the students watched a video, focusing on the key scenarios, and were asked open questions, such as “What do you think what happened,” “How did you think of,” “What will you do next time”. This helped students to think about the causes, effects, and shortcomings of their behavior and mutually evaluate the performance of each role in the team. Third, students were helped to summarize their learning experience by reviewing key learning points and asking questions about relevant knowledge in simulation scenarios. Later, the instructor evaluated students’ personal performance and the team’s overall performance, focusing on clinical critical thinking and team communication and cooperation, and looking at the nursing specialty students’ cognitive skills, emotional attitudes, communication strategies, and cooperative attitudes. This study aimed to evaluate whether the condition-based correct nursing diagnosis and nursing measures were put forward, whether students thought independently, and whether their communication was effective. Also, we wanted to analyze the application of communication skills and whether the team reached consensus and mutual support. Finally, the instructors pointed out the strengths and weaknesses of students’ performance and offered suggestions for improvement.
This study used a quantitative survey and a qualitative interview for evaluation. The California Critical Thinking Disposition Inventory (CCTDI)  and Assessment of Interprofessional Team Collaboration in Student Learning Scale (AITCS-II student)  were used to assess the experimental and control groups before and after the experiment. Qualitative evaluation uses semi-structured interviews to obtain information on students’ participation experience and is conducted after the course.
The California Critical Thinking Disposition Inventory (CCTDI): The Scale was developed by Facione et al. . The characteristics of seven aspects of critical thinking are measured: truth-seeking, open-mindedness, systematicity, self-confidence, inquisitiveness, maturity, and analyticity. In China, there is Chinese version of the CCTDI with a total of 70 items , and a 6-point Likert scale is used, ranging from 1 (strongly agree) to 6 (strongly disagree), with a total score of 70–420. The higher the score, the stronger the critical thinking. A score of 40 or more indicates an upbeat personality on that scale; a total score of 280 or above shows positive general critical thinking tendencies. The total content validity index (CVI) and Cronbach's α coefficient of the scale were 0.89 and 0.90.
Assessment of Interprofessional Team Collaboration in Student Learning Scale (AITCS-II Student): The Scale was developed by Orchard et al.  based on the first version of the Assessment of Interprofessional Team Collaboration Scale (AITCS). The Likert grade 5 scoring method was adopted: “never” = 1, “rarely” = 2, “occasionally” = 3, “most of the time” = 4, “always” = 5. Cronbach’s α coefficient of the scale was 0.961, and the Cronbach’s α coefficient of each dimension was 0.719–0.938. The scale’s total score was 16–80, and the mean score was ≥ 4, indicating good cross-major cooperative learning ability .
After the course, the students’ experience of participating in the course was investigated through semi-structured interviews. The teaching effect was evaluated in multiple ways and from various angles. According to the students’ performance in the guided feedback session, six suitable interviewees were selected.
Interprofessional Education Collaborative  outlines interprofessional core competencies in five themes: roles and responsibilities, ethical practice, conflict resolution, communication, collaboration, and teamwork, and states that one or more themes should be considered when designing interprofessional activities. We formulated an interview outline based on these situations: (1) How do you view each role within the team and its responsibilities? (2) Do you believe you are meeting the standard of professional practice expected of your role and fulfilling its responsibilities? (3) Have you encountered disagreements in achieving your team's work goals? If so, how was it resolved? (4) Talk about your response to the course, such as your gains, lack of interprofessional case design, and suggestions for course improvement.
The scale data were entered using EpiData3.1 software, and SPSS 26.0 software was used for t-test analysis, and the test level was α = 0.05. Semi-structured interviews used thematic analysis to process data.