With the development of society and the transformation of the medical model, the complexity and demands of nursing work have significantly increased. Nursing professionals must possess strong clinical reasoning skills to effectively apply their theoretical knowledge in addressing patient care challenges, so as to make sound nursing decisions and provide higher-quality care (McMichael et al., 2021, Mohammadi-Shahboulaghi et al., 2021). Developing nurses with strong decision-making abilities remains a critical challenge for nursing educators. Traditional teaching methods often rely on one-way instruction by instructors, leaving nursing students passive in the learning process and rarely engaging in active knowledge construction or problem-solving (Zhang, 2014). In addition, many nursing courses are content-heavy. They require high levels of integration and synthesis, placing substantial academic pressure on students. At present, in Chinese universities, it is common for two or four classes to be combined, making it difficult for students to maintain focus over extended periods, leading to frequent distractions such as using mobile phones during class. Although many institutions have adopted innovative teaching methods such as Problem-Based Learning (PBL) or flipped classrooms, some educators lack sufficient understanding of these methodologies' core concepts and implementation strategies. As a result, teaching outcomes may be suboptimal.

Based on this, some scholars have proposed teaching methods tailored to China's national conditions. The Presentation-Assimilation-Discussion (PAD) teaching model is a new pedagogical framework introduced in 2014 by Professor Zhang Xuexin from Fudan University. This model aligns with the current learning culture and psychological characteristics of teachers and students in Chinese universities (Zhao and Zhang, 2018). It is student-centered and grounded in humanism, cognitivism, constructivism and behaviorism, emphasizing students' independent engagement with the curriculum (Yang et al., 2024). Humanism advocates that students can learn independently. Teachers act as facilitators who provide learning resources and support, rather than serving as authoritative figures who merely indoctrinate. The “after-school assimilation” stage in the PAD classroom allows students to learn at their own pace, which aligns with humanism’s principle of autonomy. Cognitivism holds that learning is the reorganization of cognitive structures, emphasizing understanding rather than rote memorization. Advance organizers help learners establish connections between prior and new knowledge. The concise lecture with strategic omission phase in the PAD classroom is when teachers only explain the core framework during instruction, encouraging students to actively construct their own knowledge systems. Constructivism posits that knowledge is constructed through individual and social interaction, emphasizing situated learning and advocates that students should reorganize knowledge based on their existing experiences. In the PAD classroom, middle school students answer each other’s questions through the “help me” feature, thereby engaging in social knowledge construction. Behavioral psychology asserts that learning involves the formation of stimulus-response associations, relying on reinforcement and feedback. Procedural teaching (e.g., simulation training) shapes behavior through repeated practice. Instant feedback in the PAD classroom, including corrective feedback provided by teachers during spot checks, reinforces correct nursing procedures. Combined with after-school assignments, such as “test you,” behavior shaping strategies are employed to consolidate key knowledge points.

In this method, class time is divided into two equal parts: one half for teacher-led instruction and the other for student-driven discussion, fostering interactive learning through dialogue. At the same time, the separation of teaching content from discussion topics encourages students' self-directed learning outside of class, enabling them to prepare discussion materials and engage in personalized knowledge internalization (Liu, 2017). According to the temporal sequence of teaching, a PAD-based class is structured into three phases (Ma et al., 2021). During the Presentation phase, instructors introduce the knowledge framework, basic concepts and key challenging points, focusing on concise explanations of critical content while delegating easily understandable or less essential material to students' autonomous study. In the Assimilation phase, students independently choose appropriate learning methods based on their individual conditions after class to comprehensively understand and memorize the knowledge points. Throughout this process, students identify questions, consult relevant literature and materials and attempt to resolve them, thereby transitioning from passive learning to active research. Students are expected to engage in independent study one week after class or between two classes, to complete the homework or tasks assigned by the teacher in the previous session. The homework adopts the "Bright-Test-Help" model as its entry point, a new form of assignment proposed by Professor Zhang Xuexin, the founder of the split-classroom teaching model. This model divides the outcomes of students' independent learning into three components: "Bright," representing the most profound insights or significant gains from the learning process; "Test You," identifying areas where students believe others may lack understanding; and "Help Me," highlighting knowledge gaps requiring assistance from peers or instructors. In the Discussion phase, based on the homework results, group discussions, achievement reports or presentations and whole-class discussions (with open questioning) are conducted at the beginning of the next class regarding the content covered in the previous session. Finally, the teacher provides timely evaluation and summary. In this phase, teachers assume the roles of organizers and listeners, addressing questions related to students' result reports and responding to inquiries. In the second half of the session, the teacher proceeds to introduce new content. Nursing students return to class with learning experiences and unresolved issues for group discussion and communication, working together to solve problems. At this stage, teachers should serve as guides, steering the direction of the discussion and offering full affirmation for constructive debates or discussions, thereby encouraging active student participation (Lv et al., 2024). Since 2014, the PAD classroom has been extensively piloted in universities, primary and middle schools, covering all grades, disciplines and curricula. It has also received widespread recognition (Xu, 2021).

The PAD class has been used in higher nursing education in China since 2015. According to the search results, the PAD classroom has become one of the most popular teaching methods in nursing education in China. The number of published studies on the application of PAD class in nursing education has grown exponentially every year. However, to date, there remains a lack of evidence-based research on the effectiveness of PAD class in nursing education in China. Therefore, the objective of this study is to conduct a systematic review and meta-analysis to assess the impact of the PAD classroom on the core abilities and learning outcomes of Chinese nursing students compared with traditional teaching methods, with a view to providing a reference for nursing educators.