This study provided an opportunity for nursing doctoral students with experience in both courses and CEs at Xiangya School of Nursing, Central South University, to voice their perspectives about the doctoral program. A convergent parallel mixed-methods design was employed to obtain students’ views on teaching methods, course content, and credits for the course, as well as on the purpose and content of CEs.
This study identified several specific experiences with regard to course curricula from nursing doctoral students, including teaching methods, course content, and credit allocation. Students believed that different teaching methods have their own advantages, and faculty should select appropriate teaching methods according to the different categories of courses. Consistent with previous studies, students generally acknowledged that online lectures overcame the constraints of time and space, while in-person lectures enhanced students’ attention and participation in the course [24, 25]. Indeed, as studies for nursing undergraduates revealed, the integration of multiple teaching methods and flexible switching was the best way to improve students’ learning efficiency [26]. We speculated that nursing doctoral students are no exception. Thus, strengthening the development of mixed teaching in nursing doctoral programs is of great significance in inspiring students’ learning initiative and enhancing the quality of education.
Some of the course content did not meet the expectations of the students. Some recommendations included, first, increasing the number of interdisciplinary courses. Nursing is an integrated discipline that draws knowledge from various disciplines, including biomedicine, sociology, and humanities [27]. This integrated nature of nursing requires interdisciplinary nursing talents who possess a diverse skill set to solve intricate problems [28]. In the United States, a report by the Institute of Medicine (IOM) on the Future of Nursing emphasized the importance of interdisciplinary collaboration and recommended expanding research opportunities for nurses [29]. American nursing doctoral programs have long included interdisciplinary courses covering multiple disciplines, such as natural and social sciences, economics, and culture [30]. In contrast, interdisciplinary nursing education in China lags behind [31], and the interdisciplinary courses provided by its nursing doctoral programs urgently need to cultivate interdisciplinary nursing talents.
Second, adapting statistics and Nursing Philosophy and Theory courses to the practical characteristics of the nursing discipline is essential for the identification and resolution of problems within the realm of nursing [32]. Statistics, as a long-standing core element of nursing doctoral courses, must be continuously enriched to correspond with the mounting complexity of nursing research [30]. However, the majority of nursing doctoral students in China, including those from Xiangya School of Nursing, Central South University, are currently enrolled in statistics courses intended for the clinical medicine profession, which lacks a specific focus on nursing research [33]. As a result, doctoral students are unable to learn targeted statistical methods to analyze nursing phenomena in statistics courses. For the same reason, some doctoral students argued that the content of the Nursing Philosophy and Theory course is overly philosophical and does not sufficiently incorporate practical aspects of the nursing discipline, making it difficult to understand. Previous scholars have proposed that, in nursing research, philosophy is a valuable tool for revealing research hypotheses, thereby enhancing understanding and promoting nursing practice [34]. Therefore, it is essential for both statistics and Nursing Philosophy and Theory courses to be rooted in the practical aspects of nursing, explaining concrete knowledge using scientific studies and clinical cases to facilitate comprehension for nursing students.
Third, doctoral students need to participate in various courses organized by different national and international nursing schools. Collaboration, collegiality, and the sharing of resources is considered necessary to create internationalized learning opportunities for doctoral students [35]. The Nursing Education Xchange system (NEXus) in the United States involving over 20 universities, including the University of San Francisco, Washington State University, and the University of Northern Colorado, offers 160 nursing doctoral courses and exemplifies an effective national resource-sharing model [36]. However, international collaborative courses are currently limited to nursing undergraduates and are primarily concentrated in countries like the United States, the Australia, and Japan [37–39]. Hence, in addition to establishing a nursing doctoral course resource sharing system in China, international collaborative courses for doctoral programs should also be conducted to promote knowledge and experience sharing among nursing doctoral students around the world.
Additionally, in support of the findings of previous studies on the allocation of course credits [9, 10], we found that Chinese students expected higher compulsory course credits. A cross-sectional study in China revealed that the proportion of credits dedicated to compulsory nursing courses was relatively low, accounting for only 36.36% of the total credits [9]. Thus, the nursing doctoral program should consider making appropriate adjustments to the credit allocation system by, for instance, increasing the percentage of compulsory courses or converting some elective courses into compulsory ones.
The findings of our study suggested that CEs’ content should be more distinctive and focused on the application of knowledge. On the one hand, CEs’ content in doctoral programs is typically determined independently by the faculty at each school, lacking a standardized outline [16]. Consequently, there is potential for content conflict between CEs and other training phases in doctoral programs such as thesis proposal [40]. On the other hand, as mentioned above, nursing is a practical discipline [32], which highlights the significance of assessing doctoral students’ practical abilities when addressing scientific research challenges. Future efforts in CEs’ content design should prioritize the assessment of practical application abilities based on scientific research knowledge.
Clearly understanding the purpose of CEs is critical to further optimizing CEs’ content effectively. Results from our study revealed that students were confused about the purpose of current CEs. Actually, the confusion surrounding CEs’ purpose is a pressing global issue, because doctoral educators and students in various nursing schools have different understandings of and requirements from CEs [41, 42]. CEs were recently introduced as an exploratory training phase of Chinese nursing doctoral programs, where this confusion may be even more pronounced. Hence, it is imperative for both China and other countries to establish standardized criteria or guidelines for CEs to oversee and promote their effective development.
Although students were generally confused about the purpose of CEs, they also had their own views about them. A significant majority of students believed that CEs were meant to supervise their acquisition of scientific knowledge, with only 10% believing its purpose was to disqualify underperforming students. One possible reason is that the number of nursing doctoral programs in China is relatively limited, and admissions are complex and rigorous, including both application and examination [43]. Presumably, the elimination of the doctoral qualification at CEs will exert great pressure on students and potentially lead to a reduction in the number of doctoral admissions. By contrast, In the United States, it is a common phenomenon to determine the qualification of doctoral students based on CE scores, and the average elimination rate is 10–25% [43]. The United States has a large number of doctoral programs and follows open application-based admissions, requiring strict CEs, which serve as an opportunity for doctoral students to further ascertain their qualification and interest in pursuing the profession [44, 16]. Consequently, CEs influencing disqualification is not particularly suitable for doctoral programs in China. We recommend that Chinese nursing doctoral educators design CEs in accordance with the Chinese educational environment.
This study has important implications for research, practice, and policy in the development of nursing doctoral courses and CEs. Regarding the courses, nursing educators should regularly collect feedback from doctoral students about their experiences of teaching methods, course content, and credit allocation and, subsequently, implement targeted improvements. Similarly, by exploring their experiences with CEs, we gained a clearer understanding of the introduction of CEs in Chinese nursing doctoral programs, emphasizing the clarity and optimization of their purpose and content. However, the seamless integration of CEs into Chinese nursing doctoral programs demands continuous investigation and research. Future research should consider gathering experiences and feedback from teachers, administrators, and students to explore opportunities for optimizing both the course and CE design. Finally, this study may facilitate comparisons with similar programs in other regions or continents, providing a reference for the nursing doctoral education programs that are undergoing initial reform.
Limitations and strengths
Some limitations of this study should be noted. Although steps were taken to establish the content validity of the questionnaire, external validity and reliability estimates were not determined. More effective standardized instruments are needed to evaluate students’ experiences in the future. With a mere representation of 2 males among the total of 20 participants, the inclusion of a male perspective was severely limited. Nonetheless, gender bias was unintentional because all students were volunteers. The sample size was small because this study was conducted in a single nursing school. Despite these limitations, the study has undeniable strengths. First, it represents the first exploration of Chinese nursing doctoral students’ experiences of their courses and CEs. Second, the convergent parallel mixed-methods design compensated for a lack of a qualitative or quantitative study design, providing valuable insights to enhance our overall understanding of the students’ experiences of courses and CEs [45]. Finally, our study focused on first-year doctoral students who had recently completed their coursework and CEs, thereby minimizing recall and response biases as much as possible.