Effects of Concept Mapping and AI Dialogue on Flow and Learning Outcomes in Simulation-Based Learning

Change From Baseline in Critical Thinking Disposition Score

Critical thinking disposition will be assessed using a 6-item questionnaire adapted by Lin et al. from Chai et al. Each item is rated from 1 to 5. Total scores range from 6 to 30, with higher scores indicating a greater tendency to evaluate information, consider different perspectives, and use logical and analytical thinking. The change score will be calculated as the post-intervention score minus the baseline score.

Time frame: From baseline before the intervention to immediately after completion of all three simulation scenarios

Change From Baseline in Self-reported Communication Competence Score

Self-reported communication competence will be assessed using the 8-item Communication Competence Scale developed by Li (2013) for nursing students. The scale assesses communication with patients and family members, including initiating communication, establishing therapeutic relationships, using verbal and nonverbal communication, identifying key information, active listening, recognizing emotions, providing health guidance, and organizing communication content. Each item is rated from 1 to 5. Total scores range from 8 to 40, with higher scores indicating greater self-reported communication competence. The change score will be calculated as the post-intervention score minus the baseline score.

Time frame: From baseline before the intervention to immediately after completion of all three simulation scenarios

Change From Baseline in Learning Self-Efficacy Score

Learning self-efficacy will be assessed using the 8-item self-efficacy subscale of the Motivated Strategies for Learning Questionnaire. Each item is rated from 1 to 5. Total scores range from 8 to 40, with higher scores indicating greater confidence in successfully completing the learning tasks. The change score will be calculated as the post-intervention score minus the baseline score.

Time frame: From baseline before the intervention to immediately after completion of all three simulation scenarios

Change From Baseline in Flow Experience Score

Flow experience will be assessed using an 8-item questionnaire based on the Flow Experience Scale developed by Pearce et al. The questionnaire assesses perceived control, involvement, enjoyment, immersion, interest, altered perception of time, curiosity, and understanding of the learning activity. Each item is rated from 1 to 5. Total scores range from 8 to 40, with higher scores indicating a greater level of flow experience. The change score will be calculated as the post-intervention score minus the baseline score.

Time frame: From the baseline learning activity before the intervention to immediately after completion of all three simulation scenarios

Post-intervention Perceived Learning Objective Achievement Score

Perceived achievement of the learning objectives will be assessed using a researcher-developed 15-item questionnaire covering fever management (4 items), chest physiotherapy (6 items), and epilepsy care (5 items). Each item is rated from 1 to 5. Total scores range from 15 to 75, with higher scores indicating greater perceived achievement of the learning objectives.

Time frame: Immediately after each corresponding simulation scenario