デジタルマイクロラーニングと看護学生における患者安全 (DigiM-2026)

実験的：Digital Microlearning Intervention Group

Participants received a seven-day patient-safety-focused digital microlearning program in addition to standard education before surgical clinical practice.

行動：Digital Microlearning Program on Patient Safety

A structured, mobile-optimized digital microlearning program delivered asynchronously over seven consecutive days. Participants completed one scenario-based module per day, lasting approximately 3-5 minutes. Each module included a surgical patient-safety scenario, a pause to identify the risk, a forced-choice retrieval question, corrective feedback, and a cue-action takeaway. Content covered patient identification, medication safety, documentation omissions, deterioration cues, falls and other safety risks, prioritization, escalation, and clinical decision-making under stress.

介入なし：Control Group Standard Education

Participants received the existing undergraduate curriculum without additional digital microlearning. Standard education consisted of two two-hour surgical patient-safety lectures and a written guideline. Participants then completed seven weeks of routine surgical clinical practice, one day per week, with the same usual supervision as the intervention group. The control condition was not attention matched.

Clinical Error Recognition Performance at Clinical Week 7 (T3)

Clinical error recognition was assessed using alternate scenario-based forms drawn from an expert-reviewed bank of 15 retained surgical patient-safety scenarios. Each assessment form contained 10 scored scenarios covering patient identification, medication safety, documentation, deterioration, falls, and escalation. Each response was scored 1 for correct identification of the safety error and 0 for an incorrect or absent identification. The form score was converted to a 0-100 scale as (number correct/10) × 100, yielding scores in 10-point units; higher scores indicate better clinical error recognition. Alternate forms used patients, clinical cues, and action sequences distinct from the intervention scenarios. T3 was the principal endpoint; T0, T1, and T2 measurements described the outcome trajectory.

Clinical Decision-Making Under Stress

Clinical decision-making under stress was assessed using scenario-based evaluations that required participants to recognize, prioritize, and respond to patient-safety problems in stressful surgical clinical situations. Scores were converted to a 0-100 scale, with higher scores indicating better decision-making performance under stress.

Patient Safety Awareness

Patient-safety awareness was assessed using the Patient Safety Awareness Questionnaire, which evaluates understanding of patient-safety principles, recognition of safety risks, and safe practices relevant to surgical care. Scores were converted to a 0-100 scale, with higher scores indicating greater patient-safety awareness.

Clinical Practice Readiness

Perceived readiness for surgical clinical practice was assessed using the 12-item Clinical Placement Readiness Scale. Item responses were transformed to a 0-100 score for analysis, with higher scores indicating greater perceived readiness for clinical practice.

Clinical Self-Confidence

Clinical self-confidence was assessed using a structured self-confidence measure addressing preparedness and the performance of patient-safety actions within supervised surgical clinical practice. Scores were converted to a 0-100 scale, with higher scores indicating greater clinical self-confidence.

Acceptability of the Digital Microlearning Program

Acceptability was assessed in the intervention group using a post-intervention questionnaire covering satisfaction, perceived usefulness, usability, and relevance to surgical clinical practice. The total score ranged from 1 to 5, with higher scores indicating greater acceptability and perceived usefulness.

Blinded Objective Transfer Composite

Objective transfer at T3 was assessed using three independently administered performance tasks: an Objective Structured Clinical Examination safety station, a transfer vignette containing scenarios not used in the intervention, and a standardized escalation task. Each component was z-standardized across the full randomized sample and assigned equal weight. The mean of the three standardized components was transformed as 50 + 10 x mean(z). Higher scores indicate better objective transfer of patient-safety learning. Supervisor ratings were not included in this composite.

EMA Behavioral Transfer Index

Safety-oriented behavioral transfer during surgical clinical practice was assessed using one ecological momentary assessment prompt at the end of each scheduled clinical practice day. The index comprised three binary actions: noticing a patient-safety risk, making an appropriate response, and escalating or discussing the concern with a supervisor. The index was calculated as the mean of the three binary actions multiplied by 100, producing a score from 0 to 100. Higher scores indicate stronger safety-oriented behavioral transfer. EMA confidence, stress, reflective depth, and the contemporaneous note were separate contextual items and were not included in the index. Free-text notes were not used in quantitative group-effect estimates or interview-derived qualitative themes. Potentially identifying patient information was removed during data cleaning and was not retained in the analytical dataset.

Intervention Fidelity

Intervention fidelity was assessed from platform-recorded module completion (0-7 modules), completion percentage (0-100%), total time on task in minutes, retrieval-question accuracy (0-100%), proportion of corrective feedback viewed (0-100%), reminder-opening percentage (0-100%), and platform uptime (0-100%). These measures described exposure and delivery fidelity and were not interpreted as clinical outcomes.

Unintended Effects and Access Burdens

Unintended effects and access burdens were prospectively elicited through weekly study prompts and a T3 assessment. Each report was coded by event category (notification fatigue, temporary pre-placement anxiety, technical access frustration, minor extra stress, or data/connectivity barrier), severity, relatedness, action taken, resolution, and whether it led to discontinuation. The outcome was summarized for each arm as the number of event reports by category and the number and percentage of participants reporting at least one event. This was a count-based outcome, not a scale; no composite score or score range was used, and lower counts indicated fewer reported burdens. Reports included both intervention-related experiences and burdens arising from the study's ecological momentary assessment and reminder procedures. Notification or access reports in the control arm were not attributed to digital microlearning exposure.