| Sumario: | The cultivation of history-taking ability is a progressive process. Students typically begin by learning the foundational knowledge of history-taking and common clinical symptoms, and then proceed to study the knowledge of common diseases. Virtual patient (VP) can provide safe and repeatable opportunities for history-taking practice, helping to develop students' history-taking abilities. Based on this progressive process, this study designed a VP-based stepwise training approach, gradually transitioning from single symptom to comprehensive case history-taking, to meet the learning needs of students. To evaluate the intervention effects of VP-based stepwise training on the history-taking abilities of nursing undergraduates at different phases. This study adopted a non-concurrent control design and was conducted at the nursing schools of three universities in Guangdong Province, China, from March 2020 to June 2022. The intervention group of 200 students underwent Virtual Patient-based Stepwise History-Taking Training, beginning with symptom history-taking in the Health Assessment phase and followed by case history-taking in the Internal Medicine Nursing phase. The control group of 175 students received conventional history-taking instruction in both phases. Evaluation indicators included history-taking abilities and self-efficacy levels, which were separately evaluated using VPs via computer or mobile terminal for abilities and the Academic Self-Efficacy Scale (ASES) online for self-efficacy levels. Data were collected at the beginning of the Health Assessment course (T 0), at its end (T 1), and at the end of the Internal Medicine Nursing course (T 2). Statistical analyses were conducted using Generalized Estimating Equations and the Mann-Whitney U test. The intervention group demonstrated significantly higher scores in both symptom (T 1) and case history-taking (T 2) test compared to the control group (Z = 9.604, P < 0.001; Z = 11.784, P < 0.001). At T 1 and T 2 , referring to the baseline T 0 stage, the intervention group showed a statistically significant improvement in ASES scores compared to the control group (Group × T 1 : β = 2.79, P < 0.05; Group × T 2 : β = 5.48, P < 0.001). The VP-based stepwise history-taking training can sustainably and significantly enhance nursing undergraduates' history-taking abilities and self-efficacy levels. This training method offers students a gradual practice pathway and supports the systematic development of their history-taking abilities, meeting the practical needs of students at different stages of their education. • The stepwise training significantly enhanced history-taking abilities and self-efficacy. • The stepwise VP-based training method offers students a gradual practice pathway. • The design of stepwise VP meets the students' practice needs at different learning stages.
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