# Construction and application of a BOPPPS-based clinical teaching model in the operating room: effects on surgical-team performance and patient safety

## TL;DR

A new teaching model called BOPPPS improves surgical nursing skills and reduces errors in operating rooms, but more research is needed to confirm its broader effectiveness.

## Contribution

The study introduces and evaluates a BOPPPS-based clinical teaching model for OR nursing education, showing improved performance and safety outcomes.

## Key findings

- BOPPPS group had significantly higher OSCE scores and lower error rates compared to traditional teaching.
- Surgeon satisfaction and process familiarity improved in the BOPPPS group.
- Exploratory analyses suggest potential benefits on surgical metrics, though more research is needed.

## Abstract

Traditional teaching methods in operating room (OR) nursing education often fail to adequately prepare nurses for the complex demands of surgical environments. The Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary (BOPPPS) model offers a structured approach to enhance learning outcomes in clinical settings.

To evaluate the effectiveness of a BOPPPS-based clinical teaching model on surgical team performance and patient safety outcomes in the operating room.

Following TREND reporting guidelines, a quasi-experimental study was conducted with 120 nursing students assigned to either the BOPPPS intervention group (n = 60) or traditional teaching control group (n = 60) based on clinical rotation schedules. Sample size was calculated to detect an effect size of 0.65 with 80% power. The intervention consisted of structured modules incorporating surgical videos, skill assessments, simulation scenarios, and feedback sessions. Primary outcomes included operational competency scores assessed by blinded evaluators (inter-rater reliability κ > 0.80) and error rates. Secondary outcomes included surgeon satisfaction ratings. Exploratory analyses examined potential impacts on surgical metrics. Multiple comparisons were adjusted using Bonferroni correction.

The BOPPPS group demonstrated significantly higher post-test OSCE scores (85.3 ± 7.2 vs. 74.6 ± 8.9, p < 0.001, Cohen’s d = 1.32, 95% CI: 7.8–13.6), reduced operational error rates (8.5% vs. 18.3%, RR = 0.46, 95% CI: 0.29–0.74, p < 0.01), and improved surgeon satisfaction ratings (4.2 ± 0.6 vs. 3.4 ± 0.8, p < 0.001, 95% CI: 0.5–1.1) compared to controls. Process familiarity scores were also significantly higher in the intervention group. Exploratory analyses suggested potential associations with surgical metrics, though these require further investigation with appropriate controls.

Implementation of the BOPPPS teaching model significantly enhances clinical competencies and reduces errors in OR nursing education within our single-center context. While these findings are promising, multi-site randomized trials are needed to establish generalizability. This structured approach offers a potential framework for improving surgical nursing education, though resource requirements may limit widespread adoption.