Nursing Education in Evidence-Based PracticeTBLNCT07364994
Effectiveness of a Team-Based Learning Intervention on Evidence-Based Practice Competence Among Nursing Students.
A study testing Educational Intervention in people with Nursing Education in Evidence-Based Practice and Active Learning Methods and Life-skills Education, run by University of Modena and Reggio Emilia at 1 site in Italy.
Trial summary
The goal of this interventional study is to evaluate the effectiveness of a composite active learning strategy, integrating the Flipped Classroom model and Team-Based Learning (TBL), for improving Evidence-Based Practice (EBP) competence in second-year undergraduate nursing students. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Nursing Education in Evidence-Based Practice, Active Learning Methods and Life-skills Education, Evidence Based Nursing
- What is being tested?
- Educational Intervention
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 131 participants
- Where
- 1 siteItaly
- Study dates
- 15 Sep 2023to 22 Apr 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Being a Nursing Student
- Enrolled as a second-year student in the Bachelor of Nursing degree at the study site (University of Modena and Reggio Emilia, Modena campus) for the 2023-2024 academic year.
- Attended the first lecture of the course where the study was presented (or were otherwise fully informed about it).
- Provided written informed consent to participate in the research.
Who cannot join
- Not formally enrolled in the second year of the Nursing programme at the study site for the 2023-2024 academic year.
- Had already obtained recognition/validation of the academic credit for the specific Evidence-Based Practice (EBP) course unit before the study began.
- Were absent for the entire duration of the EBP educational module.
- Declined to give informed consent to participate in the research.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Effectiveness of a Team Based Learning Intervention on Evidence-Based Practice Competence Among Nursing Students: A Quasi-Experimental Study
The goal of this interventional study is to evaluate the effectiveness of a composite active learning strategy, integrating the Flipped Classroom model and Team-Based Learning (TBL), for improving Evidence-Based Practice (EBP) competence in second-year undergraduate nursing students.
The main questions it aims to answer are:
Read more
- Does the educational intervention significantly improve students' self-reported knowledge of EBP concepts?
- Does the educational intervention significantly improve students' self-reported skills in EBP processes (e.g., critical appraisal)?
- Does the educational intervention significantly improve students' attitudes towards EBP?
Participants, who were all second-year nursing students enrolled in a specific academic year, took part in a mandatory 64-hour EBP educational module. Their main tasks were:
- To complete a validated self-assessment questionnaire (the Evidence-Based Practice Competence Questionnaire, EBP-COQ) at baseline (March 2024) and immediately following the intervention (April 2024).
- To engage in the "Core EBP" module of the course (12 hours), which was delivered using a Team-Based Learning (TBL) strategy. This module comprised:
- Asynchronous individual preparatory study (Flipped Classroom phase) of provided scientific articles and lecture notes, conducted 1-2 weeks prior to each session.
- Participation in three in-person, 4-hour interactive sessions (12 contact hours total), following the structured TBL cycle of Readiness Assurance (iRAT and tRAT) and Team Application exercises.
Read the detailed description
- Background and Rationale Evidence-Based Practice (EBP) is a fundamental competency for healthcare professionals, integral to delivering high-quality, safe, and effective patient care. International nursing organisations and educational frameworks consistently mandate the integration of EBP competencies into undergraduate curricula. However, significant variability persists in how EBP is taught, with traditional, lecture-based methods often proving insufficient for developing the complex skills required for its application in clinical practice. Contemporary educational research advocates for active, student-centred learning strategies to effectively teach EBP. The Flipped Classroom (FC) model and Team-Based Learning (TBL) are two such pedagogies. FC facilitates preparatory acquisition of foundational knowledge, thereby liberating in-class time for higher-order learning activities. TBL provides a structured framework for applying knowledge through collaborative problem-solving, critical discussion, and peer feedback, which are essential for mastering EBP steps like critical appraisal and clinical integration. While the individual effectiveness of FC and TBL has been explored, there is a paucity of research evaluating a structured, composite intervention that sequentially combines these methodologies specifically to enhance EBP competence in nursing students within a European context. This study aims to address this gap.
- Study Design and Setting This is a quasi-experimental, single-centre study employing a pre-test/post-test design without a control group. The study was conducted within the Bachelor of Nursing degree programme at the University of Modena and Reggio Emilia (Modena site), Italy. The target population was the entire cohort of second-year nursing students enrolled in the academic year 2023-2024. This stage was selected as students begin to synthesise theoretical knowledge with clinical practice, representing a pivotal point for EBP skill development.
- Participant Recruitment and Ethical Considerations All eligible students were invited to participate. The study protocol, including participant information sheets and consent forms, was reviewed and approved by the Institutional Ethical Committee for Research (CEAR) of the University of Modena and Reggio Emilia prior to commencement. Participation was entirely voluntary, and written informed consent was obtained from all participants. Refusal to participate did not affect academic standing or access to the educational module. To ensure confidentiality and data protection, a strict anonymisation procedure was implemented. Participants created a unique personal code to link their pre- and post-intervention questionnaires, ensuring no directly identifiable data was stored with the research data.
- Detailed Description of the Educational Intervention The intervention was a dedicated, credit-bearing EBP module integrated into a broader 64-hour "Evidence-Based Nursing" course within the second-year curriculum. The experimental intervention specifically targeted the Core EBP module (12 contact hours), delivered exclusively using a Team-Based Learning (TBL) strategy. Teaching Team: The module was delivered by a single experienced academic with an established track record in EBP pedagogical research. Pedagogical Model: Team-Based Learning (TBL). Pre-Session (FC Phase): One to two weeks prior to each in-person session, students engaged with preparatory materials (e.g., selected scientific articles and specific lecture notes) hosted on the university's Moodle platform. In-Session (TBL Phase): The intervention consisted of three 4-hour sessions (12 contact hours total) conducted over a five-week period. Sessions were structured according to TBL principles:
- Readiness Assurance Process: Each session began with a 10-item multiple-choice Individual Readiness Assurance Test (iRAT), followed by the same test taken in permanent, instructor-formed teams (tRAT). Immediate feedback was provided via the Immediate Feedback Assessment Technique (IF-AT).
- Appeals Process: Teams could submit written justifications to challenge test questions, requiring consultation of the preparatory materials.
- Application-Focused Exercises: The majority of each session (2.5 to 3 hours) was dedicated to solving complex clinical cases. These exercises followed the "4 S" framework (Significant Problem, Same Problem, Specific Choice, and Simultaneous Report) to practice formulating PICO questions, bibliographic searching, appraising research articles, and integrating evidence into clinical decision-making.
- Outcome Measurement and Data Collection The primary outcome was the change in self-reported EBP competence, measured using the validated Italian version of the Evidence-Based Practice Competence Questionnaire (EBP-COQ). The instrument assesses three domains: Attitudes (13 items), Skills (6 items), and Knowledge (6 items), using a 5-point Likert scale. Data collection occurred at two time points:
- Pre-test (T0): Administration of the EBP-COQ during the recruitment and baseline phase on 4th March 2024.
- Post-test (T1): Administration of the EBP-COQ immediately following the final session on 22nd April 2024.
- Statistical Methods
Data analysis will be perform using statistical software (SPSS, version 27.0). Descriptive statistics will summarise participant characteristics. The primary analysis will involve paired-sample t-tests to compare mean scores for the total EBP-COQ and its three subscale scores (Attitudes, Skills, Knowledge) between T0 and T1. The threshold for statistical significance will beset at p < 0.05. To estimate the magnitude of change, Cohen's d effect sizes will be calculate for significant comparisons. Sensitivity analysis will be performed using Wilcoxon signed-rank test. The relationship between individual preparation (iRAT) and team gain (tRAT-iRAT) will be assessed via Spearman's correlation, to evaluate the collaborative learning impact. Data will be handle using a complete-case analysis strategy (listwise deletion).
- Conditions
- Nursing Education in Evidence-Based Practice, Active Learning Methods and Life-skills Education, Evidence Based Nursing, Evidence Based Programs in Schools, Nursing Education, Evidence Based Practice
- Being tested
- Educational Intervention
- Keywords
- Evidence-Based Practice, Nursing Education, Curriculum, Learning, Problem-Based Learning, Team-Based Learning, Flipped Classroom, Critical Thinking, Competency-Based Education, Active Learning, Self Efficacy
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Educational InterventionOther
Also called Composite Flipped Classroom and Team-Based Learning (FC-TBL) Programme for EBP
A structured, credit-bearing educational module on Evidence-Based Practice (EBP) integrated into a 64-hour course. The experimental intervention specifically targets the 'Core EBP' component (12 contact hours), delivered exclusively via Team-Based Learning (TBL) by an experienced academic facilitator with expertise in nursing research and EBP education.
The intervention follows the structured TBL cycle across three in-person sessions of 4 hours each:
- Individual Preparation: Prior to sessions, students engage in self-directed study of preparatory scientific articles and lecture notes.
- Readiness Assurance Process: Each session begins with an Individual Readiness Assurance Test (iRAT) followed by a Team Readiness Assurance Test (tRAT) with immediate feedback.
- Appeals and Application: Following an appeals process, the majority of class time is dedicated to application-focused exercises where small, permanent teams solve complex clinical scenariosto support clinical decision-making.
| Study group | Role | What they receive |
|---|---|---|
| EBP Educational Intervention Arm | Experimental | Single cohort of second-year nursing students receiving the composite educational intervention. Receives: Other: Educational Intervention |
What is being measured
The primary outcome is the main question the study is designed to answer.
Overall Evidence-Based Practice Competence Score
The overall competence in Evidence-Based Practice (EBP) is measured using the validated Italian version of the Evidence-Based Practice Competence Questionnaire (EBP-COQ). This is a self-reported questionnaire consisting of 25 items rated on a 5-point Likert scale (1=Strongly Disagree to 5=Strongly Agree). The Overall Score is calculated as the sum of the scores from all 25 items. Total Score Range: 25 - 125. A higher total score indicates a higher self-perceived competence in EBP. The change in the Overall Score from baseline (T0) to post-intervention (T1) is the primary outcome.
Measured: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).
Secondary outcomes (3)
EBP Attitude Domain Score
Score for the Attitude domain of the Evidence-Based Practice Competence Questionnaire (EBP-COQ). This domain comprises 13 items assessing beliefs, perceptions, and values regarding the usefulness and application of EBP in nursing (e.g., "EBP helps in making clinical decisions"). The score is the sum of these 13 items (score range 13 - 65). A higher score indicates a more positive attitude towards EBP.
Measured: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).
EBP Skills/Competence Domain Score
Score for the Skills/Competence domain of the Evidence-Based Practice Competence Questionnaire (EBP-COQ). This domain comprises 6 items assessing the self-perceived ability to to perform key EBP steps like critically evaluating and applying research evidence (e.g., "I feel able to critically assess the quality of a scientific article"). The score is the sum of these 6 items (score range 6 - 30). A higher score indicates greater perceived skill in executing EBP processes.
Measured: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).
EBP Knowledge Domain Score
Score for the Knowledge domain of the Evidence-Based Practice Competence Questionnaire (EBP-COQ). This domain comprises 6 items assessing knowledge of key EBP principles and understanding of research methodologies (e.g., knowledge of PICO framework, levels of evidence, main study designs). The score is the sum of these 6 items (score range 6 - 30). A higher score indicates greater self-assessed knowledge of EBP concepts.
Measured: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Jan 2026
- Study start15 Sep 2023
- Primary completion22 Apr 2024
- Study completion22 Apr 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (30)Papers the sponsor has linked to this study.
- Other trials for Nursing Education in Evidence-Based PracticeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Not applicable
- Intervention model
- Single group
- Model description
- Quasi-experimental, single-cohort, pre-test/post-test design. All participants received the composite educational intervention (Flipped Classroom + Team-Based Learning). There was no concurrent control group.
- Masking
- None (open label)
- Enrolment
- 131 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Modena and Reggio Emilia
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Paola Ferri, University of Modena and Reggio Emilia
- Investigators
- Paola Ferri, MSc, Principal investigator, University of Modena and Reggio EmiliaTeresa Peduto, MSc, Study chair, Azienda Ospedaliero-Universitaria di ModenaAngela Contri, PhD, Study chair, University of Modena and Reggio Emilia
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07364994
- Sponsor's protocol ID
- FINE-EU-2026
- Acronym
- TBL
- Status last verified
- Dec 2025
- First submitted
- 15 Jan 2026
- Last updated
- 27 Jan 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: The Individual Participant Data (IPD) collected for this study contains detailed and sensitive personal information. To ensure the confidentiality and privacy of our participants in compliance with stringent EU and Italian data protection regulations (GDPR), the data will not be made publicly available. The data will be kept securely within the institutional responsibility of the University of Modena and Reggio Emilia for the purposes outlined in this protocol.
Publications
Ramos-Morcillo AJ, Fernandez-Salazar S, Leal-Costa C, Ruzafa-Martinez M. Evidence-based practice nurses' competency: Spanish national survey and establishment of a scale of the EBP-COQ-Prof(c). J Nurs Manag. 2021 May;29(4):794-804. doi: 10.1111/jonm.13220. Epub 2020 Dec 20.
PubMed 33259110Tlili MA, Aouicha W, Tarchoune S, Sahli J, Ben Dhiab M, Chelbi S, Mtiraoui A, Ajmi T, Ben Rejeb M, Mallouli M. Predictors of evidence-based practice competency among Tunisian nursing students. BMC Med Educ. 2022 Jun 2;22(1):421. doi: 10.1186/s12909-022-03487-4.
PubMed 35655300Straus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based Medicine E-Book: How to Practice and Teach EBM; Elsevier Health Sciences: Amsterdam, The Netherlands, 2018.
Stichler JF, Fields W, Kim SC, Brown CE. Faculty knowledge, attitudes, and perceived barriers to teaching evidence-based nursing. J Prof Nurs. 2011 Mar-Apr;27(2):92-100. doi: 10.1016/j.profnurs.2010.09.012.
PubMed 21420041Skela-Savic B, Gotlib J, Panczyk M, Patelarou AE, Bole U, Ramos-Morcillo AJ, Finotto S, Mecugni D, Jarosova D, Patelarou E, Dolezel J, Ruzafa-Martinez M. Teaching evidence-based practice (EBP) in nursing curricula in six European countries-A descriptive study. Nurse Educ Today. 2020 Nov;94:104561. doi: 10.1016/j.nedt.2020.104561. Epub 2020 Aug 27.
PubMed 32905986Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2. doi: 10.1136/bmj.312.7023.71. No abstract available.
PubMed 8555924Ruzafa-Martinez M, Fernandez-Salazar S, Leal-Costa C, Ramos-Morcillo AJ. Questionnaire to Evaluate the Competency in Evidence-Based Practice of Registered Nurses (EBP-COQ Prof(c)): Development and Psychometric Validation. Worldviews Evid Based Nurs. 2020 Oct;17(5):366-375. doi: 10.1111/wvn.12464. Epub 2020 Oct 22.
PubMed 33089629Ruzafa-Martinez M, Molina-Rodriguez A, Perez-Munoz V, Leal-Costa C, Ramos-Morcillo AJ. Effectiveness of the flipped classroom methodology on the learning of evidence-based practice of nursing students: Quasi-experimental design. Nurse Educ Today. 2023 Sep;128:105878. doi: 10.1016/j.nedt.2023.105878. Epub 2023 Jun 18.
PubMed 37352765Ruzafa-Martinez M, Lopez-Iborra L, Moreno-Casbas T, Madrigal-Torres M. Development and validation of the competence in evidence based practice questionnaire (EBP-COQ) among nursing students. BMC Med Educ. 2013 Feb 7;13:19. doi: 10.1186/1472-6920-13-19.
PubMed 23391040Patelarou AE, Mechili EA, Ruzafa-Martinez M, Dolezel J, Gotlib J, Skela-Savic B, Ramos-Morcillo AJ, Finotto S, Jarosova D, Smodis M, Mecugni D, Panczyk M, Patelarou E. Educational Interventions for Teaching Evidence-Based Practice to Undergraduate Nursing Students: A Scoping Review. Int J Environ Res Public Health. 2020 Aug 31;17(17):6351. doi: 10.3390/ijerph17176351.
PubMed 32878256Parmelee D, Michaelsen LK, Cook S, Hudes PD. Team-based learning: a practical guide: AMEE guide no. 65. Med Teach. 2012;34(5):e275-87. doi: 10.3109/0142159X.2012.651179. Epub 2012 Apr 4.
PubMed 22471941Pendoni, R., Motta, P. C., Bozzetti, M., & Marcomini, I. (2024). Effectiveness of EBPEPU (evidence-based practice educational program in undergraduate nursing education): a before-after study. Teaching and Learning in Nursing, 19(3), 225-228. https://doi.org/10.1016/j.teln.2024.02.017
Palese A, Gonella S, Brugnolli A, Mansutti I, Saiani L, Terzoni S, Destrebecq A, Zannini L, Grassetti L, Dimonte V; SVIAT TEAM. Nursing students' interprofessional educational experiences in the clinical context: findings from an Italian cross-sectional study. BMJ Open. 2019 Mar 20;9(3):e025575. doi: 10.1136/bmjopen-2018-025575.
PubMed 30898820Mariano C. NURSING EMERGING. ANA Nursing: Scope and Standards of Practice, (2015) 3rd Edition. Beginnings. 2016 Apr;36(2):5, 32-4.
PubMed 27305802Malik G, McKenna L, Griffiths D. Endeavoring to Contextualize Curricula Within an EBP Framework: A Grounded Theory Study. West J Nurs Res. 2018 Dec;40(12):1765-1784. doi: 10.1177/0193945917753589. Epub 2018 Jan 22.
PubMed 29357759
Study at a glance
From the registry record, last updated by the sponsor on 27 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effectiveness of a Team Based Learning Intervention on Evidence-Based Practice Competence Among Nursing Students: A Quasi-Experimental Study
- ClinicalTrials.gov ID
- NCT07364994
- Acronym / sponsor ID
- TBL / FINE-EU-2026
- Conditions
- Nursing Education in Evidence-Based Practice, Active Learning Methods and Life-skills Education, Evidence Based Nursing, Evidence Based Programs in Schools, Nursing Education, Evidence Based Practice
- Keywords
- Evidence-Based Practice, Nursing Education, Curriculum, Learning, Problem-Based Learning, Team-Based Learning, Flipped Classroom, Critical Thinking
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 131 participants (actual)
- Lead sponsor
- University of Modena and Reggio EmiliaUniversity, hospital or other
- Study start
- 15 Sep 2023 (actual)
- Primary completion
- 22 Apr 2024 (actual)
- Study completion
- 22 Apr 2025 (actual)
- First posted
- 23 Jan 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this interventional study is to evaluate the effectiveness of a composite active learning strategy, integrating the Flipped Classroom model and Team-Based Learning (TBL), for improving Evidence-Based Practice (EBP) competence in second-year undergraduate nursing students.
The main questions it aims to answer are:
- Does the educational intervention significantly improve students' self-reported knowledge of EBP concepts?
- Does the educational intervention significantly improve students' self-reported skills in EBP processes (e.g., critical appraisal)?
- Does the educational intervention significantly improve students' attitudes towards EBP?
Participants, who were all second-year nursing students enrolled in a specific academic year, took part in a mandatory 64-hour EBP educational module. Their main tasks were:
- To complete a validated self-assessment questionnaire (the Evidence-Based Practice Competence Questionnaire, EBP-COQ) at baseline (March 2024) and immediately following the intervention (April 2024).
- To engage in the "Core EBP" module of the course (12 hours), which was delivered using a Team-Based Learning (TBL) strategy. This module comprised:
- Asynchronous individual preparatory study (Flipped Classroom phase) of provided scientific articles and lecture notes, conducted 1-2 weeks prior to each session.
- Participation in three in-person, 4-hour interactive sessions (12 contact hours total), following the structured TBL cycle of Readiness Assurance (iRAT and tRAT) and Team Application exercises.
Detailed description
- Background and Rationale Evidence-Based Practice (EBP) is a fundamental competency for healthcare professionals, integral to delivering high-quality, safe, and effective patient care. International nursing organisations and educational frameworks consistently mandate the integration of EBP competencies into undergraduate curricula. However, significant variability persists in how EBP is taught, with traditional, lecture-based methods often proving insufficient for developing the complex skills required for its application in clinical practice. Contemporary educational research advocates for active, student-centred learning strategies to effectively teach EBP. The Flipped Classroom (FC) model and Team-Based Learning (TBL) are two such pedagogies. FC facilitates preparatory acquisition of foundational knowledge, thereby liberating in-class time for higher-order learning activities. TBL provides a structured framework for applying knowledge through collaborative problem-solving, critical discussion, and peer feedback, which are essential for mastering EBP steps like critical appraisal and clinical integration. While the individual effectiveness of FC and TBL has been explored, there is a paucity of research evaluating a structured, composite intervention that sequentially combines these methodologies specifically to enhance EBP competence in nursing students within a European context. This study aims to address this gap.
- Study Design and Setting This is a quasi-experimental, single-centre study employing a pre-test/post-test design without a control group. The study was conducted within the Bachelor of Nursing degree programme at the University of Modena and Reggio Emilia (Modena site), Italy. The target population was the entire cohort of second-year nursing students enrolled in the academic year 2023-2024. This stage was selected as students begin to synthesise theoretical knowledge with clinical practice, representing a pivotal point for EBP skill development.
- Participant Recruitment and Ethical Considerations All eligible students were invited to participate. The study protocol, including participant information sheets and consent forms, was reviewed and approved by the Institutional Ethical Committee for Research (CEAR) of the University of Modena and Reggio Emilia prior to commencement. Participation was entirely voluntary, and written informed consent was obtained from all participants. Refusal to participate did not affect academic standing or access to the educational module. To ensure confidentiality and data protection, a strict anonymisation procedure was implemented. Participants created a unique personal code to link their pre- and post-intervention questionnaires, ensuring no directly identifiable data was stored with the research data.
- Detailed Description of the Educational Intervention The intervention was a dedicated, credit-bearing EBP module integrated into a broader 64-hour "Evidence-Based Nursing" course within the second-year curriculum. The experimental intervention specifically targeted the Core EBP module (12 contact hours), delivered exclusively using a Team-Based Learning (TBL) strategy. Teaching Team: The module was delivered by a single experienced academic with an established track record in EBP pedagogical research. Pedagogical Model: Team-Based Learning (TBL). Pre-Session (FC Phase): One to two weeks prior to each in-person session, students engaged with preparatory materials (e.g., selected scientific articles and specific lecture notes) hosted on the university's Moodle platform. In-Session (TBL Phase): The intervention consisted of three 4-hour sessions (12 contact hours total) conducted over a five-week period. Sessions were structured according to TBL principles:
- Readiness Assurance Process: Each session began with a 10-item multiple-choice Individual Readiness Assurance Test (iRAT), followed by the same test taken in permanent, instructor-formed teams (tRAT). Immediate feedback was provided via the Immediate Feedback Assessment Technique (IF-AT).
- Appeals Process: Teams could submit written justifications to challenge test questions, requiring consultation of the preparatory materials.
- Application-Focused Exercises: The majority of each session (2.5 to 3 hours) was dedicated to solving complex clinical cases. These exercises followed the "4 S" framework (Significant Problem, Same Problem, Specific Choice, and Simultaneous Report) to practice formulating PICO questions, bibliographic searching, appraising research articles, and integrating evidence into clinical decision-making.
- Outcome Measurement and Data Collection The primary outcome was the change in self-reported EBP competence, measured using the validated Italian version of the Evidence-Based Practice Competence Questionnaire (EBP-COQ). The instrument assesses three domains: Attitudes (13 items), Skills (6 items), and Knowledge (6 items), using a 5-point Likert scale. Data collection occurred at two time points:
- Pre-test (T0): Administration of the EBP-COQ during the recruitment and baseline phase on 4th March 2024.
- Post-test (T1): Administration of the EBP-COQ immediately following the final session on 22nd April 2024.
- Statistical Methods
Data analysis will be perform using statistical software (SPSS, version 27.0). Descriptive statistics will summarise participant characteristics. The primary analysis will involve paired-sample t-tests to compare mean scores for the total EBP-COQ and its three subscale scores (Attitudes, Skills, Knowledge) between T0 and T1. The threshold for statistical significance will beset at p < 0.05. To estimate the magnitude of change, Cohen's d effect sizes will be calculate for significant comparisons. Sensitivity analysis will be performed using Wilcoxon signed-rank test. The relationship between individual preparation (iRAT) and team gain (tRAT-iRAT) will be assessed via Spearman's correlation, to evaluate the collaborative learning impact. Data will be handle using a complete-case analysis strategy (listwise deletion).
Study design
- Primary purpose
- Other
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
- Model description
- Quasi-experimental, single-cohort, pre-test/post-test design. All participants received the composite educational intervention (Flipped Classroom + Team-Based Learning). There was no concurrent control group.
| Arm | Type | Receives |
|---|---|---|
| EBP Educational Intervention Arm | Experimental | Other: Educational InterventionSingle cohort of second-year nursing students receiving the composite educational intervention. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Being a Nursing Student
- Enrolled as a second-year student in the Bachelor of Nursing degree at the study site (University of Modena and Reggio Emilia, Modena campus) for the 2023-2024 academic year.
- Attended the first lecture of the course where the study was presented (or were otherwise fully informed about it).
- Provided written informed consent to participate in the research.
Key exclusion criteria (4 listed)
- Not formally enrolled in the second year of the Nursing programme at the study site for the 2023-2024 academic year.
- Had already obtained recognition/validation of the academic credit for the specific Evidence-Based Practice (EBP) course unit before the study began.
- Were absent for the entire duration of the EBP educational module.
- Declined to give informed consent to participate in the research.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Educational InterventionAlso: Composite Flipped Classroom and Team-Based Learning (FC-TBL) Programme for EBPA structured, credit-bearing educational module on Evidence-Based Practice (EBP) integrated into a 64-hour course. The experimental intervention specifically targets the 'Core EBP' component (12 contact hours), delivered exclusively via Team-Based Learning (TBL) by an experienced academic facilitator with expertise in nursing research and EBP education. The intervention follows the structured TBL cycle across three in-person sessions of 4 hours each: * Individual Preparation: Prior to sessions, students engage in self-directed study of preparatory scientific articles and lecture notes. * Readiness Assurance Process: Each session begins with an Individual Readiness Assurance Test (iRAT) followed by a Team Readiness Assurance Test (tRAT) with immediate feedback. * Appeals and Application: Following an appeals process, the majority of class time is dedicated to application-focused exercises where small, permanent teams solve complex clinical scenariosto support clinical decision-making. | Other | EBP Educational Intervention Arm |
Primary outcome
Overall Evidence-Based Practice Competence Score
Time frame: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).
The overall competence in Evidence-Based Practice (EBP) is measured using the validated Italian version of the Evidence-Based Practice Competence Questionnaire (EBP-COQ). This is a self-reported questionnaire consisting of 25 items rated on a 5-point Likert scale (1=Strongly Disagree to 5=Strongly Agree). The Overall Score is calculated as the sum of the scores from all 25 items. Total Score Range: 25 - 125. A higher total score indicates a higher self-perceived competence in EBP. The change in the Overall Score from baseline (T0) to post-intervention (T1) is the primary outcome.
3 secondary outcomes
EBP Attitude Domain Score
Time frame: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).
EBP Skills/Competence Domain Score
Time frame: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).
EBP Knowledge Domain Score
Time frame: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Jan 2026.
- Background: PubMed 33259110Ramos-Morcillo AJ, Fernandez-Salazar S, Leal-Costa C, Ruzafa-Martinez M. Evidence-based practice nurses' competency: Spanish national survey and establishment of a scale of the EBP-COQ-Prof(c). J Nurs Manag. 2021 May;29(4):794-804. doi: 10.1111/jonm.13220. Epub 2020 Dec 20.
- Background: PubMed 35655300Tlili MA, Aouicha W, Tarchoune S, Sahli J, Ben Dhiab M, Chelbi S, Mtiraoui A, Ajmi T, Ben Rejeb M, Mallouli M. Predictors of evidence-based practice competency among Tunisian nursing students. BMC Med Educ. 2022 Jun 2;22(1):421. doi: 10.1186/s12909-022-03487-4.
- BackgroundStraus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based Medicine E-Book: How to Practice and Teach EBM; Elsevier Health Sciences: Amsterdam, The Netherlands, 2018.
- Background: PubMed 21420041Stichler JF, Fields W, Kim SC, Brown CE. Faculty knowledge, attitudes, and perceived barriers to teaching evidence-based nursing. J Prof Nurs. 2011 Mar-Apr;27(2):92-100. doi: 10.1016/j.profnurs.2010.09.012.
- Background: PubMed 32905986Skela-Savic B, Gotlib J, Panczyk M, Patelarou AE, Bole U, Ramos-Morcillo AJ, Finotto S, Mecugni D, Jarosova D, Patelarou E, Dolezel J, Ruzafa-Martinez M. Teaching evidence-based practice (EBP) in nursing curricula in six European countries-A descriptive study. Nurse Educ Today. 2020 Nov;94:104561. doi: 10.1016/j.nedt.2020.104561. Epub 2020 Aug 27.
- Background: PubMed 8555924Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2. doi: 10.1136/bmj.312.7023.71. No abstract available.
- Background: PubMed 33089629Ruzafa-Martinez M, Fernandez-Salazar S, Leal-Costa C, Ramos-Morcillo AJ. Questionnaire to Evaluate the Competency in Evidence-Based Practice of Registered Nurses (EBP-COQ Prof(c)): Development and Psychometric Validation. Worldviews Evid Based Nurs. 2020 Oct;17(5):366-375. doi: 10.1111/wvn.12464. Epub 2020 Oct 22.
- Background: PubMed 37352765Ruzafa-Martinez M, Molina-Rodriguez A, Perez-Munoz V, Leal-Costa C, Ramos-Morcillo AJ. Effectiveness of the flipped classroom methodology on the learning of evidence-based practice of nursing students: Quasi-experimental design. Nurse Educ Today. 2023 Sep;128:105878. doi: 10.1016/j.nedt.2023.105878. Epub 2023 Jun 18.
- Background: PubMed 23391040Ruzafa-Martinez M, Lopez-Iborra L, Moreno-Casbas T, Madrigal-Torres M. Development and validation of the competence in evidence based practice questionnaire (EBP-COQ) among nursing students. BMC Med Educ. 2013 Feb 7;13:19. doi: 10.1186/1472-6920-13-19.
- Background: PubMed 32878256Patelarou AE, Mechili EA, Ruzafa-Martinez M, Dolezel J, Gotlib J, Skela-Savic B, Ramos-Morcillo AJ, Finotto S, Jarosova D, Smodis M, Mecugni D, Panczyk M, Patelarou E. Educational Interventions for Teaching Evidence-Based Practice to Undergraduate Nursing Students: A Scoping Review. Int J Environ Res Public Health. 2020 Aug 31;17(17):6351. doi: 10.3390/ijerph17176351.
- Background: PubMed 22471941Parmelee D, Michaelsen LK, Cook S, Hudes PD. Team-based learning: a practical guide: AMEE guide no. 65. Med Teach. 2012;34(5):e275-87. doi: 10.3109/0142159X.2012.651179. Epub 2012 Apr 4.
- BackgroundPendoni, R., Motta, P. C., Bozzetti, M., & Marcomini, I. (2024). Effectiveness of EBPEPU (evidence-based practice educational program in undergraduate nursing education): a before-after study. Teaching and Learning in Nursing, 19(3), 225-228. https://doi.org/10.1016/j.teln.2024.02.017
- Individual participant dataSharing planned: No. The Individual Participant Data (IPD) collected for this study contains detailed and sensitive personal information. To ensure the confidentiality and privacy of our participants in compliance with stringent EU and Italian data protection regulations (GDPR), the data will not be made publicly available. The data will be kept securely within the institutional responsibility of the University of Modena and Reggio Emilia for the purposes outlined in this protocol.
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Enrolling by invitation
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Paola Ferri, MSc principal investigator
University of Modena and Reggio Emilia
Teresa Peduto, MSc study chair
Azienda Ospedaliero-Universitaria di Modena
Angela Contri, PhD study chair
University of Modena and Reggio Emilia
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Educational Intervention in people with Nursing Education in Evidence-Based Practice and Active Learning Methods and Life-skills Education, run by University of Modena and Reggio Emilia at 1 site in Italy.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 27 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Overall Evidence-Based Practice Competence Score (time frame: Baseline (T0, pre-intervention) and Post-intervention (T1, at the completion of the educational module, approximately 2 months after baseline).). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07364994, which also lists 30 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Jan 2026.