Effects of an integrated CBL-OSCE model on clinical judgment among undergraduate nursing students: a quasi-experimental study

Abstract Background: Developing robust clinical judgment is a core outcome of undergraduate nursing education. Although case-based learning (CBL) and the Objective Structured Clinical Examination (OSCE) are widely used, evidence regarding the educational impact of an integrated CBL-OSCE model in nursing practicum training remains limited. Methods: A quasi-experimental study was conducted among 123 senior undergraduate nursing students allocated by natural classes to either an experimental group receiving an integrated CBL-OSCE intervention (n = 62) or a control group receiving traditional skills training (n = 61). Outcomes included course performance, the Lasater Clinical Judgment Rubric (LCJR), and a self-reported Clinical Reasoning and Reflection Scale. Independent t-tests and repeated-measures ANOVA were performed. Results: Compared with controls, the experimental group achieved significantly higher final examination scores (93.09 ± 4.71 vs. 90.11 ± 5.19, P = 0.001, Cohen’s d = 0.61) and overall course scores (94.87 ± 2.83 vs. 92.86 ± 3.77, P = 0.001, d = 0.60). A significant time × group interaction was observed for LCJR total score (F(1,121) = 10.652, P = 0.001, η² = 0.081), with the experimental group demonstrating larger improvements across all LCJR dimensions, particularly interpreting (η² = 0.503) and responding (η² = 0.494). Self-reported clinical reasoning improved significantly within both groups, though without between-group differences (P > 0.05). Conclusion: The integrated CBL-OSCE model led to greater gains in clinical judgment and practical performance than traditional skills training. Embedding CBL throughout instructional activities and aligning assessments with OSCE principles appears to support the development of higher-order decision-making abilities in nursing students.