Nursing Students Rate Content Over Interaction in Hospital Teaching, Survey Finds

A new survey of final-year nursing interns in China has revealed a striking gap between how well clinical teaching is rated for its content and how poorly it scores on interaction, alongside a sharp divide between learning that is scheduled for students and learning they must organize themselves. The study, published in Nursing Open, surveyed 318 final-year associate degree nursing students at two tertiary teaching hospitals in Chongqing that serve as accredited clinical teaching bases, institutions where bedside training and classroom instruction run in parallel during the decisive final internship semester. The findings suggest that the organization of teaching, rather than student motivation, may be the most tractable target for improving the education of the next generation of nurses.

Clinical teaching bases occupy a pivotal position in Chinese nursing education. Partner hospitals take formal responsibility for students’ clinical education, and during the final-year internship, students rotate through multiple specialty departments while simultaneously taking theoretical courses such as nursing management and professional development, delivered on site by hospital-based educators. This dual structure makes the base the environment where theoretical knowledge must be converted into clinical skill, and where the competence of the incoming nursing workforce is effectively shaped. Yet at the two hospitals studied, teaching quality had previously been judged mainly through supervisory inspection and instructor assessment, with no routine collection of structured student feedback.

The research team, led by Hao Zhang of Dianjiang People’s Hospital of Chongqing, designed a cross-sectional questionnaire to answer three questions: how much students actually participate in learning activities, how they perceive the effectiveness of teaching methods and content, and what improvements they would prioritize. The instrument combined three dichotomous participation items with five teaching-perception items, the last of which carried an open-ended field for improvement suggestions, plus a separate five-point overall satisfaction rating. Internal consistency was acceptable in the analytic sample, with a KR-20 of 0.71 for the participation items and Cronbach’s alpha of 0.75 for the teaching-perception ratings. A census approach was used, inviting every eligible student at both bases during the final month of the internship semester in May 2024.

Participation proved to be stratified less by the academic nature of an activity than by whether it was timetabled. Active participation in class discussions and activities, which is scheduled into the working day, reached 64.2 percent of students. By contrast, membership in self-organized study groups stood at just 28.0 percent, and participation in extracurricular academic activities such as lectures and competitions at 31.1 percent, roughly half the level of the timetabled option. Notably, study-group membership and extracurricular participation were moderately correlated at r = 0.56, a pattern consistent with both behaviours being constrained by a shared factor, most plausibly the demanding rotation schedules of interns, who work staggered shifts, are dispersed across departments, and move to a new department every few weeks.

Perceptions of teaching were less uniform than participation figures. Roughly two-thirds of students rated course content as comprehensive and aligned with the nursing discipline, at 68.6 percent, and expressed satisfaction with instructors’ teaching quality and attitude, at 64.5 percent. But only about half considered the teaching methods diverse, at 52.8 percent, and exactly half, 50.0 percent, felt that instructors actively encouraged student participation and expression of opinions. The remainder gave neutral or negative ratings on these interactive dimensions. Overall satisfaction with teaching at the base averaged 3.43 on the five-point scale, a middling score that reflects the split between strong content ratings and weaker delivery ratings.

The feedback process itself emerged as perhaps the most sobering finding. Although 61.0 percent of students said they were willing to comment on teaching, 39.0 percent declined outright, and among those willing, nearly half reported having no specific suggestion. Only 98 students, 30.8 percent of the full sample, provided at least one written improvement suggestion. Conventional content analysis of these responses identified five themes: interdisciplinary case teaching, cited by 28.6 percent of respondents; emergency care training, at 26.5 percent; diversified assessment methods, at 22.4 percent; technology integration, at 18.4 percent; and current-affairs topics, at 15.3 percent. The top two themes align with existing evidence that interdisciplinary case teaching supports integration of knowledge into comprehensive care plans, and that simulation-based emergency training improves nursing students’ knowledge and practical skills.

Why do so many students withhold feedback? The authors point to several features of the internship setting that could contribute, while cautioning that a cross-sectional design cannot distinguish among them. Students may doubt the anonymity of their responses, particularly since clinical instructors often also assess interns’ performance, creating an inherent conflict of interest. There may be no visible follow-up on earlier comments, leaving students unsure whether their input leads anywhere. Some may simply be unfamiliar with how to evaluate teaching. The finding extends prior work noting that nursing curriculum evaluation often lacks meaningful feedback, and that willingness and comfort with evaluation vary considerably among students.

An exploratory comparison between the two centres, located approximately 150 kilometres apart, found no significant differences on any categorical item, with all effect sizes negligible, and overall satisfaction differing only slightly, with a Cohen’s d of 0.20 whose confidence interval included zero. The similarity may reflect shared institutional features such as a common national curriculum framework, comparable accreditation standards and similar student populations. The uniformly small effect sizes are compatible with standardized practice supporting consistent educational quality across sites, although the study was not designed as an equivalence test, and identifying the specific mechanisms responsible would require purpose-built research.

The study carries clear practical implications for clinical teaching bases. First, collaborative learning could be timetabled directly into the internship, for example through a fixed weekly discussion slot, so that peer learning no longer depends on students coordinating around their own rotation schedules. This matters because collaborative learning develops the communication and teamwork skills that are core competencies for clinical nursing practice. Second, the feedback mechanism could be redesigned to lower the barrier to commenting, by separating, as far as practical, the staff who collect feedback from those who assess interns’ performance, and by issuing a written response after each round so students can see where their input leads. Third, because the interactive dimension of teaching was rated below content delivery, preceptor training could target participatory skills specifically, including structured questioning, case-based discussion and techniques for eliciting student contributions, addressing a known weakness in how clinical preceptors are prepared for the teaching component of their role.

The authors acknowledge limitations: all participants were female associate degree students from two centres in one region during a single academic year, self-selection and response bias cannot be excluded, the scheduling explanation for lower participation remains untested, and the questionnaire was developed on small preparatory samples. Even so, the overarching pattern is compelling and hypothesis-generating: students’ learning behaviour tracked the institutional scaffolding available to them, with participation substantially higher wherever the school or hospital organized the activity than where it was left to students themselves. Future research could follow participation longitudinally across an internship, examine its association with licensure performance and workforce retention, and pair questionnaires with interviews to establish why students withhold feedback. For nursing programmes worldwide, the message is that building routine, responsive collection of student feedback into curriculum design may do more to raise engagement than exhorting individual students to participate, and could better prepare students for the complexity of clinical work.

Subject of Research: Nursing students' participation and perceptions of teaching effectiveness at clinical teaching bases in China

Article Title: Nursing Students' Participation and Perceptions of Teaching Effectiveness at Clinical Teaching Bases: A Cross‐Sectional Survey

Article References: Zhang, H., Mei, Y., Zhang, C.-L., Liu, J., & Ma, X.-J. (2026). Nursing Students' Participation and Perceptions of Teaching Effectiveness at Clinical Teaching Bases: A Cross‐Sectional Survey. Nursing Open, 13(10), Article e70824. https://doi.org/10.1002/nop2.70824

Image Credits: AI Generated

DOI: 10.1002/nop2.70824

Keywords: nursing education, clinical teaching bases, student engagement, student feedback, teaching effectiveness, clinical internship, cross-sectional survey, China, preceptor training, collaborative learning, nursing students, teaching quality