The effect of cooperative learning approach with concept maps on nursing students’ knowledge acquisition on symptom management in cancer patients: a randomized controlled trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomization was at the individual student level (not by class or school), and the intervention is not one-to-one tutoring.
    • "The study sample consisted of 90 s-year nursing students randomized into experimental (n=45) and control (n=45) groups." (p. 1)
    • Relevant Quotes: 1) "The study sample consisted of 90 s-year nursing students randomized into experimental (n=45) and control (n=45) groups." (p. 1) 2) "Students who met the inclusion criteria were randomly assigned to the intervention and control groups using simple randomization based on computer-generated random numbers." (p. 3) Detailed Analysis: Criterion C requires randomization at the class level (or stronger) to reduce contamination across students sharing instruction and peer interactions. The paper explicitly states that "nursing students" were randomized into experimental and control groups and that assignment used "simple randomization" with computer-generated random numbers, indicating an individual-level unit of randomization rather than intact classes or schools. The intervention is a group-based instructional approach (cooperative learning with concept maps), not a one-to-one tutoring intervention, so the tutoring exception does not apply. Final sentence: Criterion C is not met because participants were randomized individually rather than by class (or school/site).
  • E

    Exam-based Assessment

    • Outcomes were measured with a researcher-developed knowledge test rather than a widely recognized standardized exam.
    • "This test developed by the researchers according to the literature was created in two stages [16, 17]." (p. 3)
    • Relevant Quotes: 1) "This test developed by the researchers according to the literature was created in two stages [16, 17]." (p. 3) 2) "In the first stage, 20 questions were created by the researchers based on the expected course outcomes..." (p. 3) Detailed Analysis: Criterion E requires a standardized, widely recognized exam-based assessment rather than a bespoke instrument designed by the study team. The paper states that the primary knowledge outcome uses a "test developed by the researchers" and that the questions were created by the researchers. While the authors report content validity and reliability, the instrument is not presented as an externally standardized exam used broadly for comparable achievement measurement. Final sentence: Criterion E is not met because the main knowledge outcome is measured with a researcher-developed test, not a standardized exam.
  • T

    Term Duration

    • The intervention is described as a three-session program with a 4-week follow-up, which is shorter than one academic term from intervention start.
    • "To measure the retention of knowledge, the same test was administered again 4 weeks after the post-test." (p. 5)
    • Relevant Quotes: 1) "A three-session plan was implemented with the experimental group students." (p. 4) 2) "To measure the retention of knowledge, the same test was administered again 4 weeks after the post-test." (p. 5) Detailed Analysis: Criterion T requires that outcomes be measured at least one full academic term (typically about 3 to 4 months) after the intervention begins. The intervention is explicitly described as "a three-session plan" and the retention assessment is explicitly stated as occurring "4 weeks after the post-test." This documented follow-up window is materially shorter than a standard academic term, and the paper does not document a term- length interval from intervention start to outcome measurement. Final sentence: Criterion T is not met because the documented start-to- follow-up window is only on the order of weeks (4 weeks post-test), not a full academic term.
  • D

    Documented Control Group

    • The paper documents the control group’s size, condition (standard instruction), and baseline comparability information.
    • "The control group students received standard instruction (four hours of theoretical training on symptom management in cancer patients)." (p. 5)
    • Relevant Quotes: 1) "The study was completed with a total of 90 students, 45 in the experimental group and 45 in the control group." (p. 3) 2) "The control group students received standard instruction (four hours of theoretical training on symptom management in cancer patients)." (p. 5) 3) "There was no statistically significant relationship between the experimental and control groups when the distribution of age (p=0.341), gender (p=0.063), marital status (p=0.240), history of chronic disease (p=1.000), and family history of oncological disease (p=0.667) was compared (Table 1)." (p. 5) Detailed Analysis: Criterion D requires that the control group be well documented, including who is in it, what it receives, and baseline information enabling comparison. The paper reports the control group size (45), clearly describes the control condition as "standard instruction" with a stated duration, and reports baseline comparability across multiple characteristics (Table 1). This provides sufficient documentation to understand the control group and interpret comparisons. Final sentence: Criterion D is met because the control group’s condition, size, and baseline comparability information are clearly documented.

• Level 2 Criteria

  • S

    School-level RCT

    • The study was conducted in a single university setting and randomized individual students rather than randomizing schools or sites.
    • "Students who met the inclusion criteria were randomly assigned to the intervention and control groups..." (p. 3)
    • Relevant Quotes: 1) "The research was carried out ... in the nursing department of the faculty of health sciences of a university." (p. 2) 2) "Students who met the inclusion criteria were randomly assigned to the intervention and control groups using simple randomization..." (p. 3) Detailed Analysis: Criterion S requires school-level (or site-level) randomization, meaning whole schools or equivalent educational sites are randomized. The trial was conducted within one university department and randomized individual students into intervention and control groups. There is no evidence that multiple schools/sites were randomized. Final sentence: Criterion S is not met because randomization occurred at the student level within a single site rather than across schools/sites.
  • I

    Independent Conduct

    • The paper does not document independent third-party conduct separate from the intervention designers and study team.
    • "Researchers created six concept maps based on the literature and course outcomes [16, 17]." (p. 3)
    • Relevant Quotes: 1) "This form, developed by the researchers, includes questions about the sociodemographic characteristics of the students..." (p. 3) 2) "This test developed by the researchers according to the literature was created in two stages [16, 17]." (p. 3) 3) "Researchers created six concept maps based on the literature and course outcomes [16, 17]." (p. 3) 4) "The educational intervention was delivered by a faculty member who holds a doctoral degree in Internal Medicine Nursing." (p. 5) Detailed Analysis: Criterion I requires that the evaluation be conducted independently from the designers/providers of the intervention, typically through external implementation and/or external data collection and analysis. The paper indicates that the researchers developed key study instruments and also created the concept maps used in the intervention, while the educational intervention was delivered by a faculty member. The paper does not provide a clear statement that an independent third party (separate from the intervention designers and study team) conducted data collection and/or analysis. Final sentence: Criterion I is not met because independent third-party conduct is not clearly documented.
  • Y

    Year Duration

    • Outcomes were not tracked for at least 75% of an academic year, and since T is not met, Y is not met by rule.
    • "To measure the retention of knowledge, the same test was administered again 4 weeks after the post-test." (p. 5)
    • Relevant Quotes: 1) "A three-session plan was implemented with the experimental group students." (p. 4) 2) "To measure the retention of knowledge, the same test was administered again 4 weeks after the post-test." (p. 5) Detailed Analysis: Criterion Y requires outcome measurement at least 75% of an academic year after the intervention begins. The described intervention and follow-up schedule is short (sessions plus a 4-week follow-up), far less than an academic year. Additionally, per the ERCT dependency rule, if criterion T is not met then criterion Y is not met. Final sentence: Criterion Y is not met because the study duration is far shorter than an academic year and T is not met.
  • B

    Balanced Control Group

    • The paper reports equal instructional time across groups, and the main added inputs (concept maps and cooperative activities) are integral to the intervention rather than a separable resource confound.
    • "The duration allocated for the educational sessions was equal across groups." (p. 5)
    • Relevant Quotes: 1) "Each group was given a concept map prepared under the relevant heading." (p. 4) 2) "In the first session, each group member was asked to make individual preparations within the topics and concept map." (p. 5) 3) "The control group students received standard instruction (four hours of theoretical training on symptom management in cancer patients)." (p. 5) 4) "Students were not given any additional resources for preparation or practice." (p. 5) 5) "The training content was standardized using a structured presentation, and the same topic content was provided to both the experimental and control groups." (p. 5) 6) "The duration allocated for the educational sessions was equal across groups." (p. 5) Detailed Analysis: Criterion B compares the nature, quantity, and quality of resources (time, materials, staffing support) provided to intervention and control conditions, and asks whether any added resources are either balanced or explicitly integral to the treatment definition. The control condition is described as standard instruction with a stated duration ("four hours"). The paper also explicitly states that the topic content was standardized and that "the duration allocated" for sessions was "equal across groups," which directly supports balance of scheduled instructional time. The experimental group received concept maps and cooperative learning activities, including an explicit expectation of "individual preparations." These inputs (concept maps, cooperative structure, and related preparation) are the defining elements of the instructional approach being evaluated, rather than an unrelated add-on such as extra tutoring hours or additional paid services. The paper does not document a separate, non-integral increase in budget or instructional time that would need to be matched in the control group. Final sentence: Criterion B is met because scheduled instructional time is stated to be equal across groups and the additional materials/activities are integral to the intervention being tested.

• Level 3 Criteria

  • R

    Reproduced

    • No independent peer-reviewed replication of this specific trial was found.
    • Relevant Quotes: 1) (No statements in the paper indicate that this specific RCT has been independently replicated.) (p. 1-9) Detailed Analysis: Criterion R requires that the specific study (or its core experimental claim using the same intervention) be replicated independently by a different research team in a peer-reviewed outlet. The paper reports one single-site RCT and does not claim that it is a replication study. A web search for independent replications of this specific trial (same cohort and intervention package as described here) did not identify a clear, direct replication available as of the ERCT check date. Final sentence: Criterion R is not met because independent replication of this specific study was not identified.
  • A

    All-subject Exams

    • E is not met (no standardized exams), and the outcomes are not all-subject standardized exams.
    • "The study data were collected using the “Personal Information Form”, the “Knowledge Test on Symptom Management in Cancer Patients”, and the “Self-Directed Learning Scale”." (p. 1)
    • Relevant Quotes: 1) "The study data were collected using the “Personal Information Form”, “Knowledge Test on Symptom Management in Cancer Patients”, and “Self-Directed Learning Scale”." (p. 1) 2) "This test developed by the researchers according to the literature was created in two stages [16, 17]." (p. 3) Detailed Analysis: Criterion A requires standardized exam-based assessment across all main subjects, and it also depends on criterion E being met. The outcomes here are a researcher-developed knowledge test focused on symptom management and a self-directed learning scale, not standardized exams across core subjects. Since criterion E is not met, criterion A is automatically not met by the ERCT dependency rule. Final sentence: Criterion A is not met because E is not met and the study does not assess all core subjects via standardized exams.
  • G

    Graduation Tracking

    • The study does not track participants until graduation, and since Y is not met, G is not met by rule.
    • "To measure the retention of knowledge, the same test was administered again 4 weeks after the post-test." (p. 5)
    • Relevant Quotes: 1) "To measure the retention of knowledge, the same test was administered again 4 weeks after the post-test." (p. 5) Detailed Analysis: Criterion G requires tracking participants until graduation from the relevant educational stage. The only follow-up described in the paper is a knowledge retention test administered 4 weeks after the post-test, which is far short of graduation tracking. Additionally, per the ERCT dependency rule, if criterion Y is not met then criterion G is not met. A web search for follow-up publications by the same author team that track this cohort to graduation did not identify any such follow-up paper available as of the ERCT check date. Final sentence: Criterion G is not met because the study follows students only to a short (4-week) follow-up and does not track to graduation.
  • P

    Pre-Registered

    • The paper reports a ClinicalTrials.gov registration with a stated registration date before the study period, supporting prospective registration.
    • "Trial registration Clinical trial number: NCT06695702, date of the registration: November 11, 2024." (p. 1)
    • Relevant Quotes: 1) "Trial registration Clinical trial number: NCT06695702, date of the registration: November 11, 2024." (p. 1) 2) "The research was carried out between 11.25.2024 and 01.03.2025..." (p. 2) 3) "The study was prospectively registered at ClinicalTrials.gov prior to participant recruitment. The registration number is NCT06695702." (p. 8) Detailed Analysis: Criterion P requires that the study protocol be registered before data collection begins. The paper provides a ClinicalTrials.gov identifier and an explicit registration date (November 11, 2024). The reported research period begins later (11.25.2024). The paper also explicitly states the study was "prospectively registered ... prior to participant recruitment." Collectively, these statements support that registration occurred before recruitment/data collection. Final sentence: Criterion P is met because the paper provides a registry ID and date consistent with prospective registration before the reported study period.