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

    • Randomization was at the individual student level rather than at the class (or school) level, and the intervention was not one-to-one tutoring.
    • "Participants were assigned to the experimental and control groups by the researcher using an online randomization software (https://www.randomizer.org/)." (PDF p. 7)
    • 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." (PDF p. 6) 2) "A total of 90 students who agreed to participate in the study and completed the “Student Group Characteristics Form,” “Enteral Nutrition Knowledge Test,” and “Self-Directed Learning Skills Scale” were included in the research." (PDF p. 7) 3) "Participants were assigned to the experimental and control groups by the researcher using an online randomization software (https://www.randomizer.org/)." (PDF p. 7) Detailed Analysis: ERCT criterion C requires randomization at the class level (or stronger, e.g., school/site level) to reduce contamination, unless the intervention is explicitly one-to-one tutoring/personal teaching. The paper describes a single university course cohort and states that participants (students) were assigned by the researcher using an online randomizer. There is no indication that intact classes/sections or schools/sites were randomized. The intervention (collaborative learning / Jigsaw technique) is a group- based classroom method rather than one-to-one tutoring, so the tutoring exception does not apply. Final: Criterion C is not met because the unit of randomization was individual students rather than classes (or schools), with no tutoring exception.
  • E

    Exam-based Assessment

    • The main learning outcome was measured using a researcher-prepared knowledge test rather than a widely recognized standardized exam.
    • "Knowledge Test on Enteral Nutrition: The relevant test was prepared by the researchers by reviewing the literature [2,5,7]." (PDF p. 7)
    • Relevant Quotes: 1) "Knowledge Test on Enteral Nutrition: The relevant test was prepared by the researchers by reviewing the literature [2,5,7]." (PDF p. 7) 2) "In this study, the knowledge test and descriptive characteristics form belonging to the students were used only in this study. They were created by the researchers." (PDF p. 20) Detailed Analysis: ERCT criterion E requires exam-based assessment using standardized, widely recognized tests (e.g., national/state exams or established standardized achievement measures). The key question is whether the academic outcome measure is a standardized external exam versus a bespoke instrument. The paper explicitly states the enteral nutrition knowledge test was prepared/created by the researchers and used only in this study, which indicates a custom instrument rather than a standardized exam. Although the study also uses a published "Self-Directed Learning Skills Scale", that scale is not an external standardized exam of educational achievement in the sense required by ERCT criterion E. Final: Criterion E is not met because the primary knowledge outcome was measured with a researcher-created test, not a standardized exam.
  • T

    Term Duration

    • Outcomes were measured over roughly 6 weeks from the start of the study, which is shorter than one academic term.
    • "This study was conducted in the spring semester of the 2023-2024 academic year between 15 May and 28 June 2024." (PDF p. 9)
    • Relevant Quotes: 1) "This study was conducted in the spring semester of the 2023-2024 academic year between 15 May and 28 June 2024." (PDF p. 9) 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)." (PDF p. 10) 3) "To measure the retention of the knowledge level, the same test was applied again 4 weeks after the post-test (28 June 2024)." (PDF p. 10) Detailed Analysis: ERCT criterion T requires outcome measurement at least one full academic term (typically ~3–4 months) after the intervention begins. The paper gives explicit dates showing the study ran from 15 May 2024 to 28 June 2024, with a post-test on 31 May 2024 and a follow-up test on 28 June 2024. Even using the final follow-up test, the elapsed time from the study start is about 6 weeks, which is well below a term. Final: Criterion T is not met because the longest reported follow-up is only about 6 weeks after the start, not a full academic term.
  • D

    Documented Control Group

    • The paper documents what the control group received and reports baseline demographics and baseline scores for both groups.
    • "With the control group of students, standard course procedures were followed. After the pre-test, students received 4 hours of theory, 2 hours of skill demonstration, and 16 hours of hands-on laboratory training on nutritional needs related to enteral nutrition." (PDF p. 10)
    • Relevant Quotes: 1) "With the control group of students, standard course procedures were followed. After the pre-test, students received 4 hours of theory, 2 hours of skill demonstration, and 16 hours of hands-on laboratory training on nutritional needs related to enteral nutrition." (PDF p. 10) 2) "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)." (PDF p. 12) 3) "Table 2 Pre-test, post-test and follow-up test knowledge scores of students in the control and experimental groups" (PDF p. 13) Detailed Analysis: ERCT criterion D requires a well-documented control group, including (a) what the control received and (b) baseline information enabling comparisons (e.g., demographics and baseline performance). The paper provides a concrete description of the control condition and time components (theory, skill demonstration, and hands-on lab training). It also reports baseline demographic comparability (Table 1 statement) and presents baseline (pre-test) and subsequent knowledge outcomes for both groups (Table 2). Final: Criterion D is met because the control condition and baseline characteristics/performance are described and reported in the paper.

• Level 2 Criteria

  • S

    School-level RCT

    • The study randomized individual students within one university program rather than randomizing schools or sites.
    • "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." (PDF p. 6)
    • 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." (PDF p. 6) 2) "Participants were assigned to the experimental and control groups by the researcher using an online randomization software (https://www.randomizer.org/)." (PDF p. 7) Detailed Analysis: ERCT criterion S requires school-level (site/institution-level) randomization, meaning multiple schools/sites are randomized to intervention vs control. The paper describes a single university course cohort and indicates allocation of participants (students) into two groups by the researcher. There is no description of multiple schools/sites or school-level assignment. Final: Criterion S is not met because assignment occurred at the student level within a single institution, not at the school/site level.
  • I

    Independent Conduct

    • The authors appear to have implemented and evaluated the study themselves, with no stated independent third-party conduct.
    • "Aysun ACUN and Rahime AKSOY BULGURCU conducted the survey, data collection, and visualization." (PDF p. 20)
    • Relevant Quotes: 1) "Participants were assigned to the experimental and control groups by the researcher using an online randomization software (https://www.randomizer.org/)." (PDF p. 7) 2) "Aysun ACUN and Rahime AKSOY BULGURCU made significant contributions to writing the original manuscript and data analysis." (PDF p. 20) 3) "Aysun ACUN and Rahime AKSOY BULGURCU conducted the survey, data collection, and visualization." (PDF p. 20) Detailed Analysis: ERCT criterion I requires independent conduct, meaning the evaluation is performed by a third party independent of the intervention designers, reducing risks of implementation and measurement bias. The paper indicates the researcher performed allocation, and the author contribution statement indicates the authors conducted data collection and analysis. No external evaluation team, independent test administrators, or independent oversight is described. Final: Criterion I is not met because the study conduct and evaluation are attributed to the author team rather than an independent evaluator.
  • Y

    Year Duration

    • The study duration is far shorter than 75% of an academic year, and criterion T is not met.
    • "This study was conducted in the spring semester of the 2023-2024 academic year between 15 May and 28 June 2024." (PDF p. 9)
    • Relevant Quotes: 1) "This study was conducted in the spring semester of the 2023-2024 academic year between 15 May and 28 June 2024." (PDF p. 9) 2) "To measure the retention of the knowledge level, the same test was applied again 4 weeks after the post-test (28 June 2024)." (PDF p. 10) Detailed Analysis: ERCT criterion Y requires outcome measurement at least 75% of one academic year after the intervention begins. Per the ERCT rules provided for this task, if criterion T is not met then criterion Y is not met. The dates show the entire study window runs from mid-May to late June 2024 (about 6 weeks), with the longest stated follow-up being a 4-week retention test. Final: Criterion Y is not met because the study duration is only weeks (and criterion T is not met).
  • B

    Balanced Control Group

    • The intervention changes the learning method, but the paper describes substantial training for both groups and does not show a clear unbalanced addition of time/budget to the intervention group.
    • "The control group also spent 14 hours practicing skills in the laboratory." (PDF p. 10)
    • Relevant Quotes: 1) "With the experimental group of students, a three-session application was planned." (PDF p. 9) 2) "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)." (PDF p. 9) 3) "This session was conducted in laboratory conditions, lasting a total of 14 hours over four consecutive days (first, second, and third days: 4 hours; fourth day: 2 hours), with each class lasting 45 minutes." (PDF p. 10) 4) "With the control group of students, standard course procedures were followed. After the pre-test, students received 4 hours of theory, 2 hours of skill demonstration, and 16 hours of hands-on laboratory training on nutritional needs related to enteral nutrition. The control group also spent 14 hours practicing skills in the laboratory." (PDF p. 10) Detailed Analysis: ERCT criterion B asks whether the intervention and control conditions are balanced in time and resources, unless additional resources are the explicit treatment variable. Here, the intervention is a different pedagogy (collaborative learning / Jigsaw technique) rather than an explicit "more time/more money" resource intervention. The paper describes substantial time commitments for both arms, including extensive lab practice for both groups (14 hours for the experimental lab session and 14 hours of lab practice for the control group), and additional structured teaching components in the control arm. The experimental arm includes additional elements (e.g., small-group preparation and between-group sharing) but the paper does not quantify these as extra instructional hours beyond the described sessions in a way that clearly indicates an unbalanced addition of time/budget. Final: Criterion B is met because the paper does not provide evidence that the intervention group received a clear, non-integral increase in time/budget/resources unmatched by the control condition.

• Level 3 Criteria

  • R

    Reproduced

    • No independent peer-reviewed replication of this specific study was found or cited as of the ERCT check date.
    • Relevant Quotes: 1) (No statement in the paper indicates this study has been independently replicated by another research team.) Detailed Analysis: ERCT criterion R requires an independent replication by a different research team in a different context, published in a peer-reviewed journal. The article presents a single RCT conducted in one university setting and does not describe any replication. An internet search (performed on 2026-02-14) for the DOI/title and for papers explicitly describing a replication did not identify a distinct peer-reviewed replication study by a different author team. Final: Criterion R is not met because no independent replication was identified or evidenced in the paper or in post-publication searches.
  • A

    All-subject Exams

    • Criterion E is not met, so criterion A is not met; additionally, the outcomes are not assessed across all core subjects via standardized exams.
    • Relevant Quotes: 1) "Knowledge Test on Enteral Nutrition: The relevant test was prepared by the researchers by reviewing the literature [2,5,7]." (PDF p. 7) Detailed Analysis: ERCT criterion A requires standardized exam-based assessment across all main subjects, and per the ERCT rules provided for this task, if criterion E is not met then criterion A is not met. This study uses a researcher-prepared enteral nutrition knowledge test rather than standardized exams, and it does not assess broad multi- subject academic outcomes. Final: Criterion A is not met because criterion E is not met and the study does not use standardized all-subject exams.
  • G

    Graduation Tracking

    • The study follow-up ends after a 4-week retention test, and no evidence of tracking participants through graduation (or any graduation-linked endpoint) was found.
    • "To measure the retention of the knowledge level, the same test was applied again 4 weeks after the post-test (28 June 2024)." (PDF p. 10)
    • 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)." (PDF p. 10) 2) "This study was conducted in the spring semester of the 2023-2024 academic year between 15 May and 28 June 2024." (PDF p. 9) Detailed Analysis: ERCT criterion G requires follow-up tracking until participants’ graduation from the relevant educational stage. Per the ERCT rules provided for this task, if criterion Y is not met then criterion G is not met. The paper describes a short-term follow-up only (a 4-week retention test) and provides no statement about longer-term tracking to end-of- program completion or graduation. An internet search (performed on 2026-02-14) did not identify a follow-up publication by the same authors reporting graduation tracking for this cohort. Final: Criterion G is not met because follow-up ends within weeks and no graduation tracking evidence was found.
  • P

    Pre-Registered

    • The study reports a ClinicalTrials.gov registration (NCT06412835), and registry dates show submission before the study start date.
    • "The study was registered in the ClinicalTrials.gov system on the date the students began the study and was assigned the registration number NCT06412835." (PDF p. 2)
    • 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." (PDF p. 2) 2) "The study was registered in the ClinicalTrials.gov system on the date the students began the study and was assigned the registration number NCT06412835. The study's ClinicalTrials registration date is May 2024, and the study's start date is May 8, 2024." (PDF p. 7) 3) "Study Start (Actual) May 8, 2024" (ICHGCP registry page, Study record dates section) 4) "First Submitted May 3, 2024" (ICHGCP registry page, Study record dates section) Detailed Analysis: ERCT criterion P requires that the study protocol be registered before the study begins (i.e., before data collection / first participant enrollment as defined by the registry and the paper’s timeline). The paper provides a ClinicalTrials.gov identifier (NCT06412835). The registry record (as mirrored by ICHGCP) reports "First Submitted May 3, 2024" and "Study Start (Actual) May 8, 2024", indicating registration submission occurred before the study start date. The paper’s own stated study window begins later (15 May 2024), which is also after the submission date. Final: Criterion P is met because registry dates indicate registration submission before the study start date.