Document Type : Original Article


1 Nursing Care Research Center, School of Nursing an Midwifery, Iran University of Medical Sciences, Tehran, Iran

2 Sharekord University of Medical Sciences, Shahrekord, Iran


INTRODUCTION: Problem‑solving skills and learner‑centered approaches provide students with the
ability to solve health challenges by placing them in simulated situations. The aim of this study was to
determine the effect of inter‑professional learning based on problem‑solving on critical thinking (CT)
and satisfaction with learning experience in nursing and midwifery students.
METHODS: This quazi‑experimental study of a single group used pretest–posttest design. 20
undergraduate nursing and 28 midwifery students at the final academic year participated in the study.
The research intervention was interprofessional learning based on problem‑solving conducted in five
2‑h training sessions. California’s CT Scale and 10‑point visual analog scale were used to measure
CT skills and satisfaction with learning before and after the intervention. Finally, data were analyzed
by SPSS software version 23 using descriptive statistics and paired t‑test.
RESULTS: The findings of this study indicated that the mean score of students’ CT before the
intervention was poor, while it statistically significant increased after the intervention (P < 0.05). It
was also found that students’ satisfaction with learning, in the scale of 0–10, was reported from 5 to
9 indicating students had a high level of satisfaction with their learning experience.
DISCUSSION: Based on the findings, it can be concluded that the interprofessional education based
on problem‑solving has been able to significantly enhance the overall critical skills of students,
especially in the dimensions of analysis, inference, and deductive reasoning, and also, students’
satisfaction with learning experience was also increased.


1. Fero LJ, O’Donnell JM, Zullo TG, Dabbs AD, Kitutu J, Samosky JT,
et al. Critical thinking skills in nursing students: comparison
of simulation‑based performance with metrics. J Adv Nurs
2. Carter AG, Creedy DK, Sidebotham M. Critical thinking skills
in midwifery practice: Development of a self‑assessment tool for
students. Midwifery 2017;50:184‑92.
3. Shin H, Ma H, Park J, Ji ES, Kim DH. The effect of simulation
courseware on critical thinking in undergraduate nursing
students: Multi‑site pre‑post study. Nurse Educ Today
4. Pucer P, Trobec I, Žvanut B. An information communication
technology based approach for the acquisition of critical thinking
skills. Nurse Educ Today 2014;34:964‑70.
5. Azizi‑Fini I, Hajibagheri A, Adib‑Hajbaghery M. Critical thinking
skills in nursing students: A comparison between freshmen and
senior students. Nurs Midwifery Stud 2015;4:e25721.
6. Mounaghi KH, Jafari H. Is undergraduate midwifery curriculum
promoting critical thinking skills in students? Iran J Obstet
Gynecol Infertil 2013;16:1‑0.
7. Karimi Mounaghi H, Jafari H. Is undergraduate midwifery
curriculum promoting critical thinking skills in students? Iran J
Obstet Gynecol Infertil 2013;16:1‑10.
8. Carter AG, Creedy DK, Sidebotham M. Evaluation of tools used to
measure critical thinking development in nursing and midwifery
undergraduate students: A systematic review. Nurse Educ Today
9. Raymond‑Seniuk C, Profetto‑McGrath J. Can one learn to think
critically? – A philosophical exploration. Open Nurs J 2011;5:45‑51.
10. Olenick M, Allen LR, Smego RA Jr. Interprofessional education:
A concept analysis. Adv Med Educ Pract 2010;1:75‑84.
11. Curran VR, Sharpe D, Flynn K, Button P. A longitudinal study of
the effect of an interprofessional education curriculum on student
satisfaction and attitudes towards interprofessional teamwork
and education. J Interprof Care 2010;24:41‑52.
12. LinYC, Chan TF, Lai CS, Chin CC, Chou FH, Lin HJ. The impact of
an interprofessional problem‑based learning curriculum of clinical
ethics on medical and nursing students’ attitudes and ability of
interprofessional collaboration: A pilot study. Kaohsiung J Med
Sci 2013;29:505‑11.
13. Hadjistavropoulos HD, Juckes K, Dirkse D, Cuddington C,
WalkerK, BrunoP, et al. Student evaluations of an interprofessional
education experience in pain management. J Interprof Care
14. Bennett PN, Gum L, Lindeman I, Lawn S, McAllister S, Richards J,
et al. Faculty perceptions of interprofessional education. Nurse
Educ Today 2011;31:571‑6.
15. Elisabeth C, Ewa P, Christine WH. The team builder: The role of
nurses facilitating interprofessional student teams at a Swedish
clinical training ward. Nurse Educ Pract 2011;11:309‑13.
16. Cusack T, O’Donoghue G. The introduction of an interprofessional
education module: Students’ perceptions. Qual Prim Care
17. Lapkin S, Levett‑Jones T, Gilligan C. A systematic review of the
effectiveness of interprofessional education in health professional
programs. Nurse Educ Today 2013;33:90‑102.
18. Guraya SY, Barr H. The effectiveness of interprofessional
education in healthcare: A systematic review and meta‑analysis.
Kaohsiung J Med Sci 2018;34:160‑5.
19. Vuurberg G, Vos J, Christoph L, de Vos R. The effectiveness of
interprofessional classroom‑based education in medical curricula:
A systematic review. J Interprof Educ Pract 2019;15:157‑67.
20. Sommerfeldt SC, Barton SS, Stayko P, Patterson SK, Pimlott J.
Creating interprofessional clinical learning units: Developing an
acute‑care model. Nurse Educ Pract 2011;11:273‑7.
21. Lewis R. Learning the ‘smart’ way. Results from a pilot study
evaluating an interprofessional acute care study day. Nurse Educ
Today 2011;31:88‑93.
22. Khalili H, Zadeh MH. Investigation of reliability, validity and normality Persian version of the California Critical Thinking Skills
Test; Form B (CCTST). J Med Educ 2003;3:29‑32.
23. Hajrezayi B, Shahalizade M, Zeynali M, Badali M. Effectiveness
of blended learning on critical thinking skills of nursing students.
J Nurs Educ 2015;4:49‑59.
24. Hemmati Maslak Pak M, Orujlu S, Khalkhali H. The effect of
problem‑based learning training on nursing students’ critical
thinking skills. J Med Educ Dev 2014;9:24‑33.
25. Kohan SH, Mohammad Ali Beigi N, Beigi M, Taebi M. Midwives’
experiences of applying critical thinking in high risk situations at
labor unit: A qualitative study. Iran J Med Educ 2013;13:341‑52.
26. Choi E, Lindquist R, Song Y. Effects of problem‑based learning vs.
traditional lecture on Korean nursing students’ critical thinking,
problem‑solving, and self‑directed learning. Nurse Educ Today
27. Kermansaravi F, Navidian A, Kaykhaei A. Critical thinking
dispositions among junior, senior and graduate nursing students
in Iran. Procedia Soc Behav Sci 2013;83:574‑9.
28. Kong LN, Qin B, Zhou YQ, Mou SY, Gao HM. The effectiveness
of problem‑based learning on development of nursing students’
critical thinking: A systematic review and meta‑analysis. Int J
Nurs Stud 2014;51:458‑69.
29. Murphy S, Hartigan I, Walshe N, Flynn AV, O’Brien S. Merging
problem‑based learning and simulation as an innovative
pedagogy in nurse education. Clin Simul Nurs 2011;7:141‑8.
30. Al‑Kloub MI, Salameh TN, Froelicher ES. Nursing students
evaluation of problem based learning and the impact of culture
on the learning process and outcomes: A pilot project. Nurse Educ
Prac 2014;14:142‑7.
31. Yuan HB, Williams BA, Yin L, Liu M, Fang JB, Pang D. Nursing
students’ views on the effectiveness of problem‑based learning.
Nurse Educ Today 2011;31:577‑81.
32. Chan ZC. Students’ and experts’ perspectives on three learning
and teaching activities. Nurse Educ Pract 2014;14:449‑54.
33. Niemer L, Pfendt K, Gers M. Problem‑based learning in nursing
education: A process for scenario development. Nurse Educ
34. Walshe N, O’Brien S, Murphy S, Hartigan I. Integrative learning
through simulation and problem‑based learning. Clin Simul Nurs
35. Frambach JM, Driessen EW, Chan LC, van der Vleuten CP.
Rethinking the globalisation of problem-based learning:
How culture challenges self-directed learning. Med Educ
36. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M.
Interprofessional education: Effects on professional practice
and healthcare outcomes (update). Cochrane Database Syst Rev