Background To determine the impact of combining clinical simulation scenario training and Information Technology Integrated Instruction (ITII) on the teaching of nursing skills. Methods 120 4th-year students in a nursing program who were enrolled in medical and surgical nursing courses. 61 received innovative instruction (experimental group) and 59 received conventional instruction (control group). The ADDIE model, systematic method of course development that includes analysis, design, development, implementation, and evaluation,was used to build simulation teaching and clinical scenarios and to create and modify objective structure clinical examination (OSCE) scenario checklists for acute myocardial infarction (AMI) care, basic life support and operation of automated external defibrillator (BLS), and subdural hemorrhage (SDH) care. The modified OSCE checklists were assessed for reliability, consistency, and validity. The innovative training included flipped classrooms, clinical simulation scenarios, ITII and blended learning formats. Results The reliability and validity of the OSCE checklists developed in this study were acceptable and comparable or higher than checklists in past studies and could be utilized as an OSCE performance tool. Students in innovative instruction obtained significantly better OSCE performance, lab scores and improvements from the previous year’s grades. Significant differences were found in situational awareness (SA). No strong correlations were found between OSCE scores and clinical internship scores, and no significant differences were found between the groups in overall clinical internship performance. Conclusions Innovative instruction showed better performance than conventional methods in summative evaluation of knowledge components, OSCE formative evaluation and clinical nursing internship scores, as well as improved situational awareness in nursing students.

Breast cancer is one of the most common cancers among women worldwide (World Health Organization, 2019). Approximately, 2.1 million new cases of breast cancer were diagnosed in 2018, and nearly 627,000 deaths were attributed to the disease (WHO, 2019).Approximately, 75% of breast cancers are oestrogen receptorpositive (ER+) (Moon et al., 2017). Most ER + people with breast cancer are prescribed adjuvant hormonal therapy (AHT), which blocks the effects of oestrogen to inhibit breast cancer cell growth (Moon et al., 2017). AHT choices of tamoxifen or aromatase inhibitors (AIs) depend on the menopausal status of the patient (Pourcelot et al., 2018). AHT for a period of 5-10 years is a standard therapy for obtaining the maximum benefits in breast cancer treatment

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