Cross-sectional study maps perception gaps among Iranian nursing interns and instructors

Nursing interns at Shahrekord Azad University in Iran rated their clinical internship program more favorably than instructors did across all four domains assessed with the Context, Input, Process and Product, or CIPP, framework. In a cross-sectional census study, 143 nursing interns and eight instructors completed a 55-item CIPP-based questionnaire. Student mean scores were 85.82 for Context, 41.86 for Input, 61.08 for Process and 61.63 for Product, while instructors’ corresponding means were 33.25, 18.51, 27.63 and 32.63.

The results reveal a stakeholder perception gap between the two groups across every domain examined. The researchers tested score normality with the Kolmogorov–Smirnov test, assessed variances with Levene’s test and used independent t-tests and Pearson correlations for the main analyses. Because only eight instructors participated, they also conducted Mann–Whitney U tests as a sensitivity analysis.

A Bonferroni correction set the significance threshold at p < 0.0009 for 55 comparisons. The reported student–instructor differences had p values of 0.019 for Context, 0.021 for Input, 0.009 for Process and 0.034 for Product. These values were identified as significant in the study’s abstract, but all exceeded the stated Bonferroni threshold of p < 0.0009, so the evidence does not establish that the four domain differences remained statistically significant after that correction.

Among students, ratings in the four CIPP domains were positively correlated, with coefficients ranging from r = 0.74 to r = 0.84 at p < 0.01. This pattern means that interns who gave more favorable assessments in one domain generally tended to do so in the others as well. The correlations do not show that an assessment in one domain caused an assessment in another.

Communication between students and instructors was identified as a key program strength. The questionnaire findings instead highlighted insufficient equipment and weak supervision as major weaknesses, while the authors’ broader conclusion characterized planning and communication as areas of strength and resources and supervision as targets needing improvement. The study provides a domain-by-domain account of how students and instructors perceived the same internship program rather than treating the two stakeholder groups as a single audience.

In the questionnaire assessment, the comparatively higher student ratings covered program context, inputs, process and product. The simultaneous evaluation also placed communication, equipment and supervision alongside the numerical perception gap, linking the survey findings to specific operational issues. However, the cross-sectional design captures stakeholder assessments at one point in time and does not demonstrate that the program produced changes in clinical competence or that any program feature caused the reported differences.

Generalization is further constrained by the small instructor sample, which limited the precision of comparisons between the two groups and motivated the nonparametric sensitivity analysis. The research was also confined to one Iranian private university and to questionnaire-based perceptions, so it does not establish how the program performs at other institutions. The authors propose that future work use longitudinal, multi-institutional designs and objective competency measures.

Subject of Research: CIPP evaluation of nursing internship perceptions among students and instructors

Article Title: Evaluation of stakeholder perceptions of a nursing internship program using the CIPP framework: identifying strengths, weaknesses, and perception gaps between students and instructors

Article References: Karimiankakolaki, Z., & Mohammadi, P. (2026). Evaluation of stakeholder perceptions of a nursing internship program using the CIPP framework: identifying strengths, weaknesses, and perception gaps between students and instructors. BMC Medical Education. https://doi.org/10.1186/s12909-026-10411-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10411-7

Keywords: nursing education, clinical internships, CIPP framework, student perceptions, instructor perceptions, clinical supervision, program evaluation, Shahrekord Azad University, Iran, Evaluation, stakeholder, perceptions