Co-Reflection Versus Self-Reflection in Graphic Organizer-Facilitated Training in the Metaverse: Evidence From Students’ Knowledge Gains, Perceptions, and Case-Handling Performances

In vocational education and training, developing students’ communication, teamwork, reflection, and problem-solving skills has become increasingly important. Previous studies have integrated practical cases into metaverse-based courses using the Problem-Guiding, Exploration, and Reflection (PER) process supported by graphic organizers; however, students’ critical thinking depth has remained limited. To address this issue, this study proposed a graphic organizer-supported, co-reflection-based PER metaverse (GCR-PERM) learning model. An experimental study was conducted with 81 third-year nursing students enrolled in a Pediatric Epilepsy Management course at a university of science and technology in northern Taiwan. Forty-two students in the experimental group used GCR-PERM, while 39 students in the control group used a graphic organizer-supported self-reflection-based PER model (GSR-PERM). The results showed that GCR-PERM significantly improved students’ learning achievement, problem-solving tendencies, and collaboration tendencies compared with GSR-PERM. In terms of cognitive load, GCR-PERM did not increase mental workload, although it required greater mental effort. Regarding case-handling performance, the experimental group demonstrated significant improvements in judgment, accuracy, and application, but no significant difference was found in analysis. These findings indicate that GCR-PERM is an effective approach for enhancing nursing students’ case-handling and problem-solving abilities in metaverse-based learning environments.