The effect of collaborative learning approach on nursing students’ knowledge and skill learning for enteral nutrition: a randomized controlled study

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Students (not intact classes/schools) were randomized to groups, so class-level randomization was not used.
    • "The study sample comprised 90 first-year nursing students who were randomly assigned to the experimental (n=45) and control (n=45) groups."
    • Relevant Quotes: 1) "The study sample comprised 90 first-year nursing students who were randomly assigned to the experimental (n=45) and control (n=45) groups." (p. 1) 2) "Participants were assigned to the experimental and control groups by the researcher using an online randomization software (https://www.randomizer.org/)." (p. 3) Detailed Analysis: Criterion C requires randomization at the class level (or a stronger level such as school/site), to reduce contamination between students who share the same classroom context, unless the intervention is clearly one-to-one tutoring/personal teaching. The paper explicitly states that individual "nursing students" were randomly assigned to experimental and control groups, and it further specifies that "the researcher" performed assignment using online randomization software. The intervention is a collaborative learning approach delivered in the course context, not one-to-one tutoring. This means the unit of randomization is the student, not the intact class (or school/site). Final: Criterion C is not met because randomization was conducted at the student level rather than the class (or school/site) level.
  • E

    Exam-based Assessment

    • The primary knowledge outcome used a researcher-prepared test, not a widely recognized standardized exam.
    • "The relevant test was prepared by the researchers by reviewing the literature [2, 5, 7]."
    • Relevant Quotes: 1) "The relevant test was prepared by the researchers by reviewing the literature [2, 5, 7]." (p. 4) 2) "The test was graded out of 100." (p. 4) Detailed Analysis: Criterion E requires exam-based assessment using a standardized, widely recognized exam (e.g., national/state exams or established standardized achievement tests), rather than an instrument created for the study. The paper explicitly states that the enteral nutrition knowledge test was "prepared by the researchers." While the authors describe expert review and internal consistency, this still describes a researcher-developed instrument rather than a pre-existing, widely-used standardized exam. Final: Criterion E is not met because the primary knowledge outcome is measured using a researcher-prepared test rather than a standardized exam-based assessment.
  • T

    Term Duration

    • Outcomes were measured over about six weeks from start to latest follow-up, which is shorter than a full academic term.
    • "This study was conducted in the spring semester of the 2023–2024 academic year between 15 May and 28 June 2024."
    • Relevant Quotes: 1) "This study was conducted in the spring semester of the 2023–2024 academic year between 15 May and 28 June 2024." (p. 4) 2) "At the end of the application, the students were asked to complete the ‘Knowledge Test for Enteral Nutrition’ as a post-test (31 May 2024)." (p. 5) 3) "To measure the retention of the knowledge level, the same test was applied again 4 weeks after the post-test (28 June 2024)." (p. 5) Detailed Analysis: Criterion T requires that outcomes be measured at least one full academic term after the intervention begins (typically approximately 3 to 4 months), to ensure effects are not only immediate short-term gains. The paper provides explicit dates indicating the study ran from 15 May 2024 to 28 June 2024, with a post-test on 31 May 2024 and a retention test 4 weeks later on 28 June 2024. From the start (15 May 2024) to the last outcome measurement (28 June 2024) is roughly 6 weeks, which is far shorter than a term. Final: Criterion T is not met because the follow-up from intervention start to the latest measurement is substantially shorter than one academic term.
  • D

    Documented Control Group

    • The control condition and baseline characteristics are described, including time/resources for control and demographic comparability.
    • "With the control group of students, standard course procedures were followed."
    • Relevant Quotes: 1) "With the control group of students, standard course procedures were followed." (p. 5) 2) "After the pre-test, students received 4 h of theory, 2 h of skill demonstration, and 16 h of hands-on laboratory training on nutritional needs related to enteral nutrition." (p. 5) 3) "No statistically significant differences were observed between the experimental and control groups with respect to the distribution of participants’ demographic characteristics, and the groups were found to be homogeneous in terms of gender (p>0.05) (Table 1)." (p. 5) Detailed Analysis: Criterion D requires a well-documented control group, including what the control received and information demonstrating baseline comparability (e.g., demographics and/or baseline performance). The paper explicitly describes the control group as receiving "standard course procedures" and provides concrete details on the control group’s instructional inputs (theory hours, skill demonstration, and laboratory training). The paper also reports that there were no statistically significant demographic differences between groups and points to Table 1. Final: Criterion D is met because the control condition and group baseline comparability are described with sufficient detail for interpretation.

• Level 2 Criteria

  • S

    School-level RCT

    • Randomization was not conducted at the school/site level; it was done among students within one university program.
    • "The study population comprised 116 students enrolled in the Fundamentals of Nursing Course II during the spring term of the 2023–2024 academic year in the nursing department of a university’s Faculty of Health Sciences."
    • Relevant Quotes: 1) "The study population comprised 116 students enrolled in the Fundamentals of Nursing Course II during the spring term of the 2023–2024 academic year in the nursing department of a university’s Faculty of Health Sciences." (p. 3) 2) "Participants were assigned to the experimental and control groups by the researcher using an online randomization software (https://www.randomizer.org/)." (p. 3) Detailed Analysis: Criterion S requires school-level (or site-level) randomization, meaning entire institutions or implementation sites are randomly assigned to conditions. The quoted text describes a single university course cohort, and it specifies that participants (students) were assigned to conditions. There is no evidence of multiple schools/sites being randomized. Final: Criterion S is not met because assignment occurred at the student level within one site, not via school/site-level randomization.
  • I

    Independent Conduct

    • The authors/researchers carried out core trial activities with no clear independent evaluation team or blinded outcome assessment.
    • "Aysun Acun and Rahime Aksoy Bulgurcu conducted the survey, data collection, and visualization."
    • Relevant Quotes: 1) "Participants were assigned to the experimental and control groups by the researcher using an online randomization software (https://www.randomizer.org/)." (p. 3) 2) "During this session, researchers also observed the students’ level of completion of the enteral feeding procedures and the skills they developed while performing them." (p. 5) 3) "Aysun Acun and Rahime Aksoy Bulgurcu conducted the survey, data collection, and visualization." (p. 9) Detailed Analysis: Criterion I requires that study conduct (especially implementation, measurement, and analysis) be independent from the intervention’s designers/implementers, typically through an external evaluation team, to reduce risk of bias. The paper indicates that the researcher assigned participants and that researchers observed students during implementation. The authors’ contributions section states that both named authors conducted survey work and data collection. The paper does not describe an independent evaluation team, independent data collectors, or blinded assessors. Final: Criterion I is not met because the paper does not document independent conduct of the evaluation.
  • Y

    Year Duration

    • The study duration is far shorter than 75% of an academic year, and T is not met, so Y cannot be met.
    • "This study was conducted in the spring semester of the 2023–2024 academic year between 15 May and 28 June 2024."
    • Relevant Quotes: 1) "This study was conducted in the spring semester of the 2023–2024 academic year between 15 May and 28 June 2024." (p. 4) 2) "To measure the retention of the knowledge level, the same test was applied again 4 weeks after the post-test (28 June 2024)." (p. 5) Detailed Analysis: Criterion Y requires that outcomes be measured at least 75% of an academic year after the intervention begins. Additionally, per the ERCT instructions, if Criterion T is not met then Criterion Y is not met. The study window is explicitly stated as 15 May to 28 June 2024, and the follow-up is 4 weeks after the post-test. This is far shorter than an academic year and also fails the term-duration requirement. Final: Criterion Y is not met because the outcome tracking is far shorter than 75% of an academic year (and Criterion T is also not met).
  • B

    Balanced Control Group

    • Both groups received substantial instructional time and lab practice; the main contrast is collaborative versus individual practice rather than a clear one-sided resource increase.
    • "The control group also spent 14 h practicing skills in the laboratory."
    • Relevant Quotes: 1) "After the pre-test was administered, the theoretical lectures were given as three separate lectures within the scope of 45-minute lecture periods in the classroom environment (15 May 2024)." (p. 4) 2) "This session was conducted in laboratory conditions, lasting a total of 14 h over four consecutive days (first, second, and third days: 4 h; fourth day: 2 h), with each class lasting 45 min." (p. 5) 3) "After the pre-test, students received 4 h of theory, 2 h of skill demonstration, and 16 h of hands-on laboratory training on nutritional needs related to enteral nutrition." (p. 5) 4) "The control group also spent 14 h practicing skills in the laboratory. However, unlike the experimental group, this was done through individual practice rather than collaborative learning." (p. 5) Detailed Analysis: Criterion B compares the nature, quantity, and quality of resources (time, materials, staffing/support) in intervention and control, and asks whether outcomes could be explained by extra resources rather than the intervention itself (unless the extra resources are explicitly the treatment variable). The paper reports substantial training time for both groups. The experimental group received classroom lectures and 14 hours of lab work, with collaborative groupwork as the key delivery mode. The control group received theory, skill demonstration, hands-on lab training, and also "14 h practicing skills in the laboratory," but with individual practice rather than collaborative learning. While some elements are described differently across groups (and some time components may not be perfectly symmetric or perfectly additive), there is no clear evidence that the experimental group received a large, one-sided increase in time/budget/materials versus the control group. The clearest stated difference is the learning method (collaborative vs individual practice). Final: Criterion B is met because the control group appears to receive broadly comparable instructional inputs, and the primary contrast is the collaborative learning approach rather than an obvious confounding increase in resources.

• Level 3 Criteria

  • R

    Reproduced

    • No independent peer-reviewed replication of this specific RCT was found as of the ERCT check date.
    • Relevant Quotes: 1) (No statement in the paper indicates that this specific trial has been independently replicated by another research team.) Detailed Analysis: Criterion R requires an independent replication of the same study, or a clearly intended reproduction of the same intervention and evaluation design, conducted by a different research team and published in a peer-reviewed outlet. The paper reports one single-site RCT in a university nursing program. The paper does not describe any replication, and web-based searching by title and DOI did not identify any peer-reviewed replication studies by other author teams as of 2026-03-03. Given the publication date (29 January 2026), the absence of replication evidence at this time is not surprising. Final: Criterion R is not met because independent replication evidence for this specific study was not found.
  • A

    All-subject Exams

    • Criterion E is not met and the study does not assess all core subjects with standardized exams.
    • "In the study, data were collected using the ‘Descriptive Characteristics Form for the Student Group,’ ‘Knowledge Test on Enteral Nutrition,’ and ‘Self-Directed Learning Skills Scale.’"
    • Relevant Quotes: 1) "In the study, data were collected using the ‘Descriptive Characteristics Form for the Student Group,’ ‘Knowledge Test on Enteral Nutrition,’ and ‘Self-Directed Learning Skills Scale.’" (p. 4) 2) "The relevant test was prepared by the researchers by reviewing the literature [2, 5, 7]." (p. 4) Detailed Analysis: Criterion A requires standardized exam-based assessment across all main subjects, and it depends on Criterion E being met. If E is not met (no standardized exam-based academic outcome), then A cannot be met. This study assesses a domain-specific enteral nutrition knowledge test and a self-directed learning scale, and it does not report standardized exams across all subjects. Final: Criterion A is not met because Criterion E is not met and the outcomes are not all-subject standardized exams.
  • G

    Graduation Tracking

    • The study reports only short-term follow-up (4 weeks) and does not track participants until graduation; Y is also not met.
    • "To measure the retention of the knowledge level, the same test was applied again 4 weeks after the post-test (28 June 2024)."
    • Relevant Quotes: 1) "To measure the retention of the knowledge level, the same test was applied again 4 weeks after the post-test (28 June 2024)." (p. 5) 2) "This study was conducted in the spring semester of the 2023–2024 academic year between 15 May and 28 June 2024." (p. 4) Detailed Analysis: Criterion G requires tracking participants through graduation from the relevant educational stage. Per ERCT instructions, if Criterion Y is not met then Criterion G is not met. The paper’s latest outcome measurement is a retention test 4 weeks after the post-test, within a study window ending 28 June 2024. There is no indication of longer-term tracking using academic records, program completion, or graduation outcomes. A web-based search for follow-up publications by the same authors reporting longer-term outcomes for this cohort did not identify any graduation-tracking follow-up as of 2026-03-03. Final: Criterion G is not met because the study does not track students until graduation (and Criterion Y is not met).
  • P

    Pre-Registered

    • The trial was registered on the date the study began (and not clearly before study start), so it does not meet pre-registration.
    • "The study was registered in the ClinicalTrials.gov system on the date the students began the study and was assigned the registration number NCT06412835."
    • Relevant Quotes: 1) "The study was registered in the ClinicalTrials.gov system on the date the students began the study and was assigned the registration number NCT06412835." (p. 1) 2) "The study’s ClinicalTrials registration date is May 2024, and the study’s start date is May 8, 2024." (p. 4) Detailed Analysis: Criterion P requires that the full protocol be pre-registered before the study begins (i.e., before data collection starts), including hypotheses, methods, and planned analyses. The paper explicitly states the study was registered "on the date the students began the study," which does not satisfy a strict pre-registration requirement. The paper also states the registration date is May 2024 and the study start date is May 8, 2024, which does not demonstrate a clearly earlier registration. An attempt was made to verify the ClinicalTrials.gov record dates directly online, but the record details (e.g., first posted/first submitted) could not be retrieved in this environment; therefore, the evaluation relies on the paper’s explicit statements about timing. Final: Criterion P is not met because the paper reports registration at study start rather than clearly before data collection began.