This study was approved by the Ethics Committee of Anhui University of Chinese Medicine (No. AHUCM-HSS-2024014). All participants provided written informed consent. Consent forms detailed study objectives, voluntary participation, and data anonymity, following Ethics Committee guidelines. Participants included two cohorts of nursing master’s students: the 2023 cohort (n = 46) as the control group (traditional teaching) and the 2024 cohort (n = 57) as the experimental group (Kolb-based intervention). Both groups were taught by the same faculty, used identical materials, and followed matched schedules to ensure baseline comparability between groups.

The evaluation framework explicitly aligned assessment components with Kolb’s experiential learning stages.

The quantitative data were expressed as mean ± standard deviation ( χ ¯ ± s). The comparison between the two groups was conducted using an independent samples t-test. All statistical analyses were performed using SPSS 13.0 software, and a p value less than 0.05 was considered statistically significant.

Baseline demographic characteristics, including age (24.26 ± 2.53 vs. 24.82 ± 2.58, p = 0.135), gender distribution (7 vs. 4 males, p = 0.208), and entrance examination scores (74.48 ± 3.10 vs. 75.59 ± 4.34, p = 0.150), showed no significant differences between the 2023 (control) and 2024 (experimental) cohorts, confirming group comparable at baseline (Table 1).

The experimental group, which received the Kolb-based pedagogical intervention, achieved significantly higher final assessment scores (96.54 ± 1.43) compared to the control group (93.07 ± 1.62) (t = 8.731, p < 0.001). This improvement underscores the efficacy of experiential learning in advancing clinical competency among nursing students.

The experimental group demonstrated significant improvements in self-directed learning (SDL) across all stages of Kolb’s experiential learning cycle, as detailed in Table 2.

The experimental group exhibited significant improvements in critical thinking across all stages of Kolb’s experiential learning cycle, as demonstrated in Table 3.

The experimental group reported significantly higher satisfaction across all dimensions of the Kolb-based pedagogical intervention, as detailed in Table 4. Below, we contextualize these findings within each stage of the experiential learning cycle:

The experimental group’s superior academic performance aligns with Kolb’s ELT, where competency development emerges through iterative engagement with four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation (21). Our intervention uniquely operationalized this cycle by integrating case analyses, reflective journals, and mind mapping into a synergistic pedagogical ecosystem. Immersive case analyses (e.g., COPD exacerbation, acute MI management) provided authentic diagnostic challenges, fostering problem-solving skills consistent with contextualized learning principles (4). However, unlike prior studies using isolated tools, we explicitly structured transitions between Kolb’s stages—students progressed from case immersion to reflection and conceptualization, highlighting the insufficiency of case analysis alone without cyclical scaffolding (22). Reflective journals, guided by standardized prompts enabled iterative refinement of clinical reasoning, contrasting with the limited efficacy of unstructured journaling in nursing education (10). Mind mapping further transformed fragmented knowledge into hierarchical frameworks (e.g., COPD, pathophysiology to interventions), aligning with visual tools’ role in conceptual integration (8), while innovating through peer feedback-driven revisions. Finally, peer-led simulations and debates created low-risk hypothesis-testing environments, mirroring OSCE benefits (23) but emphasizing collaborative social learning. Crucially, the cyclical interplay of these tools—where reflection informed conceptualization (e.g., journals refining mind maps) and experimentation generated new experiences (e.g., peer feedback shaping subsequent cases)—formed a self-reinforcing loop absent in traditional instruction, explaining the experimental group’s marked academic gains.

The experimental group demonstrated significant improvements across all SDL dimensions, robustly supporting Kolb’s proposition that cyclical engagement in experiential learning fosters autonomous learning capabilities. Notably, learning motivation was enhanced through the synergistic interplay of case-based immersion (concrete experience) and peer feedback (active experimentation), contextualizing theoretical knowledge in clinical practice—a finding aligned with SDL principles emphasizing learner agency (24, 25). This aligns with the immersive case analyses and peer feedback activities, which contextualized theoretical knowledge within authentic clinical scenarios. The substantial improvement in planning and implementation emerged from mind mapping’s role in abstract conceptualization, enabling students to transform knowledge into actionable workflows through iterative revisions based on peer input—an adaptation absents in earlier visual scaffolding research (26). Similarly, reflective journaling facilitated self-monitoring by guiding students to evaluate clinical reasoning gaps, addressing critiques of unstructured journaling’s limited efficacy (27). These findings collectively validate Knowles’ adult learning principles (28), demonstrating that SDL flourishes when educational approaches emphasize active experiential engagement rather than passive knowledge transmission. Particularly noteworthy is the exceptional progress in interpersonal communication skills, underscoring how collaborative active experimentation fosters essential teamwork competencies alongside cognitive development (29).

Critical thinking refers to the ability to analyze, evaluate, and interpret information logically and systematically (30). The experimental group’s superior performance in critical thinking demonstrates the efficacy of Kolb’s experiential framework in cultivating higher-order cognitive skills essential for clinical practice. These gains, observed across all CTDI-CV dimensions, underscore how structured engagement with clinical complexity through Kolb’s cycle fosters robust critical thinking. Enhanced analytical ability and systematic thinking emerged from mind mapping’s role in abstract conceptualization, enabling students to deconstruct cases into logically organized frameworks—a finding aligned with Lin et al.’s emphasis on visual scaffolding but extending it through iterative peer-driven revisions (31). Similarly, reflective journaling promoted open-mindedness and cognitive maturity by challenging assumptions and integrating diverse perspectives, resonating with interdisciplinary studies on structured reflection (32). Active experimentation further elevated confidence and curiosity through peer debates and simulated OSCEs, highlighting how low-risk hypothesis testing nurtures both willingness and capacity for critical analysis (21). Crucially, these outcomes illustrate that critical thinking arises not from isolated tools but from the integrated cyclicality of Kolb’s stages: concrete experiences provided diagnostic challenges, reflection refined reasoning, conceptualization structured knowledge, and experimentation tested hypotheses. The cyclical interplay between reflective observation and abstract conceptualization drove substantial gains in cognitive maturity, demonstrating the non-linear nature of clinical reasoning development. This dynamic interplay created a reinforcing cognitive ecosystem where analytical precision, intellectual flexibility, and evidence-seeking behaviors mutually enhanced clinical decision-making—a transformative outcome unattainable through traditional didactic methods (33).

The experimental group’s consistently high satisfaction ratings across all dimensions demonstrate the profound impact of Kolb’s experiential approach on the learning experience. Students reported particularly strong satisfaction with classroom instruction, where the dynamic integration of case discussions, reflective journaling, mind mapping, and peer simulations created an engaging, clinically relevant environment. Quantitative ratings underscored the explicit connection between theory and practice, mirroring established findings on contextualized learning’s role in nursing education (34). Exceptional satisfaction with teaching ability highlighted a collaborative culture where weekly case refinements based on student input fostered perceptions of partnership. High scores for teaching preparation and overall effectiveness further confirmed that systematically implementing Kolb’s cycle across instructional components addressed diverse learning needs without compromising rigor. These results transcend conventional satisfaction metrics, revealing how faithful operationalization of experiential principles—through sequenced concrete experiences, reflection, conceptualization, and application—created a self-reinforcing educational ecosystem (35). The pedagogy not only elevated perceived teaching quality but also deepened engagement and competency development, validating its transformative potential in advanced nursing education.

While this study demonstrates the efficacy of Kolb’s ELT in clinical education, several limitations must be acknowledged. First, the single-institution setting may limit generalizability, as institution-specific factors (e.g., faculty expertise, curricular structure) could influence outcomes. Second, potential cohort effects—such as unmeasured yearly variations in clinical exposure or student motivation—may confound results despite baseline comparability. Third, the absence of long-term follow-up precludes conclusions about the durability of competency retention post-graduation.

Methodological and theoretical constraints further warrant consideration. Kolb’s linear cyclical structure assumes sequential progression through stages, potentially oversimplifying clinical learning contexts requiring non-linear, adaptive problem-solving (36). Additionally, individual differences in learning styles (e.g., stage-specific preferences) may lead to uneven engagement, challenging ELT’s universal applicability (37). Finally, the resource-intensive nature of Kolb-based interventions—requiring faculty training, structured case development, and sustained reflective activities—poses scalability challenges in resource-constrained settings (38).