Effects of Concept Mapping and AI Dialogue on Flow and Learning Outcomes in Simulation-Based Learning

Exploring the Impact of Flipped Classroom Combined With Concept Mapping and AI Dialogue on Students' Flow Experience and Learning Outcomes in Simulation Scenarios: From Personal Traits to Learning Practices

This mixed-methods educational study evaluates the integration of concept mapping and artificial intelligence (AI)-supported dialogue into simulation-based learning for nursing students. The learning activities include structured pre-class preparation, concept mapping, AI-supported dialogue using ChatGPT, and participation in simulated clinical scenarios. The study examines students' flow experience, defined as a state of focused engagement, and their learning outcomes.

Quantitative assessments are used to examine critical thinking, self-efficacy, communication skills, and other learning outcomes specified in the study protocol. Interviews and observations are used to explore students' learning processes and experiences. The study also examines whether individual characteristics, including openness and self-efficacy, are associated with learning practices, flow experience, and learning outcomes.

Study Overview

• Status: Active, not recruiting
• Conditions: Nursing Education; Simulation-Based Learning
• Intervention / Treatment: Other: ChatGPT-Assisted Preparation for Pediatric Nursing Simulation; Other: Standard Preparation for Pediatric Nursing Simulation

Detailed Description

Baseline Big Five personality traits will be assessed using the Chinese 15-item Big Five Inventory (BFI-15), including extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience. The five personality traits will be modeled as exogenous predictors of flow experience and learning-related outcomes in the structural equation model. Flow experience will also be examined as a potential mediator between personality traits and learning-related outcomes.

• Study Type: Interventional
• Enrollment (Actual): 168
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Guishan
    • Taoyuan, Guishan, Taiwan, 333324
      • Chang Gung University of Science and Technology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Nursing students enrolled in the participating pediatric nursing course and in one of the classes selected for the study.
• Aged 18 years or older.
• Able to read and communicate in Chinese.
• Willing to provide written informed consent and participate in the study activities and assessments.

Exclusion Criteria:

• Previous participation in the pilot testing or development phase of the same instructional program.
• Students who are on leave of absence or are not expected to attend the scheduled learning activities during the study period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ChatGPT-Assisted Preparation Group; Classes randomized to this arm will complete preclass preparation for pediatric nursing simulation. Students will watch instructional videos, prepare concept maps, engage in structured dialogue with ChatGPT, and upload their work before class. The preclass activities are intended to improve learning readiness and support efficient participation in the in-class course. During class, students will participate in the same high-fidelity scenario-based simulation, virtual reality learning, and instructor-guided discussion as the comparator group.	Other: ChatGPT-Assisted Preparation for Pediatric Nursing Simulation; Students watch instructional videos, prepare concept maps, and engage in structured dialogue with ChatGPT before class. They then participate in high-fidelity pediatric nursing simulation, virtual reality learning, and instructor-guided discussion. The preparation activities are intended to improve learning readiness and support efficient participation in class.
Active Comparator: Standard Preparation Group; Classes randomized to this arm will complete standard preclass preparation for pediatric nursing simulation. Students will watch the same instructional videos, prepare concept maps, and upload their work before class, but will not engage in structured dialogue with ChatGPT. The preclass activities are intended to improve learning readiness and support efficient participation in the in-class course. During class, students will participate in the same high-fidelity scenario-based simulation, virtual reality learning, and instructor-guided discussion as the experimental group.	Other: Standard Preparation for Pediatric Nursing Simulation; Students watch the same instructional videos and prepare concept maps before class but do not engage in structured dialogue with ChatGPT. They then participate in the same high-fidelity pediatric nursing simulation, virtual reality learning, and instructor-guided discussion as the experimental group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Pediatric Nursing Knowledge Test Score	Pediatric nursing knowledge will be assessed using a test covering fever management for an infant with febrile seizures, chest physiotherapy for a child with pneumonia, and nursing care for a child with epilepsy. Scores range from 0 to 100, with higher scores indicating greater pediatric nursing knowledge. The change score will be calculated as the post-intervention score minus the baseline score.	From baseline before the intervention to immediately after completion of all three simulation scenarios

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Critical Thinking Disposition Score	Critical thinking disposition will be assessed using a 6-item questionnaire adapted by Lin et al. from Chai et al. Each item is rated from 1 to 5. Total scores range from 6 to 30, with higher scores indicating a greater tendency to evaluate information, consider different perspectives, and use logical and analytical thinking. The change score will be calculated as the post-intervention score minus the baseline score.	From baseline before the intervention to immediately after completion of all three simulation scenarios
Change From Baseline in Self-reported Communication Competence Score	Self-reported communication competence will be assessed using the 8-item Communication Competence Scale developed by Li (2013) for nursing students. The scale assesses communication with patients and family members, including initiating communication, establishing therapeutic relationships, using verbal and nonverbal communication, identifying key information, active listening, recognizing emotions, providing health guidance, and organizing communication content. Each item is rated from 1 to 5. Total scores range from 8 to 40, with higher scores indicating greater self-reported communication competence. The change score will be calculated as the post-intervention score minus the baseline score.	From baseline before the intervention to immediately after completion of all three simulation scenarios
Change From Baseline in Learning Self-Efficacy Score	Learning self-efficacy will be assessed using the 8-item self-efficacy subscale of the Motivated Strategies for Learning Questionnaire. Each item is rated from 1 to 5. Total scores range from 8 to 40, with higher scores indicating greater confidence in successfully completing the learning tasks. The change score will be calculated as the post-intervention score minus the baseline score.	From baseline before the intervention to immediately after completion of all three simulation scenarios
Change From Baseline in Flow Experience Score	Flow experience will be assessed using an 8-item questionnaire based on the Flow Experience Scale developed by Pearce et al. The questionnaire assesses perceived control, involvement, enjoyment, immersion, interest, altered perception of time, curiosity, and understanding of the learning activity. Each item is rated from 1 to 5. Total scores range from 8 to 40, with higher scores indicating a greater level of flow experience. The change score will be calculated as the post-intervention score minus the baseline score.	From the baseline learning activity before the intervention to immediately after completion of all three simulation scenarios
Post-intervention Perceived Learning Objective Achievement Score	Perceived achievement of the learning objectives will be assessed using a researcher-developed 15-item questionnaire covering fever management (4 items), chest physiotherapy (6 items), and epilepsy care (5 items). Each item is rated from 1 to 5. Total scores range from 15 to 75, with higher scores indicating greater perceived achievement of the learning objectives.	Immediately after each corresponding simulation scenario

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Students in the experimental group will be invited to participate in semi-structured interviews to explore their experiences with the ChatGPT-assisted learning approach.	Students' experiences with the learning approach will be explored through semi-structured interviews. The interviews will examine perceived differences from previous learning methods, advantages, learning gains, areas requiring improvement, willingness to use the approach again, and willingness to recommend the approach to students and instructors. Interview recordings will be transcribed and analyzed using thematic analysis. Findings will be reported as themes and subthemes describing students' learning experiences.	Within 4 weeks after finalization of the course grades

Collaborators and Investigators

• Sponsor: Chang Gung University of Science and Technology

Study record dates

Study Major Dates

• Study Start (Actual): September 23, 2025
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: August 2, 2026
• First Submitted That Met QC Criteria: August 2, 2026
• First Posted (Actual): August 6, 2026

Study Record Updates

• Last Update Posted (Actual): August 6, 2026
• Last Update Submitted That Met QC Criteria: August 2, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Self-Efficacy; Nursing Students; Communication Skills; Concept Mapping; Generative Artificial Intelligence; Learning Outcomes; Simulation-Based Learning; Critical Thinking; Flow Experience
• Additional Relevant MeSH Terms: Investigative Techniques; Weights and Measures; Reference Standards
• Other Study ID Numbers: 202402091B0 (Other Identifier: Chang Gung Medical Foundation Institutional Review Board)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No