The effectiveness of AI-based conversational agents in nursing education: A systematic review.

AIM: Comprehensive evaluation of randomized and non-randomized controlled trials (RCTs and NRCTs, respectively) on the effectiveness of AI-driven conversational agents in nursing education. BACKGROUND: AI-based conversational agents are innovative educational tools enhancing nursing students' learning outcomes. However, evaluation of their educational effectiveness remains limited. DESIGN: Systematic review. METHODS: Three Korean database (RISS, KCI, DBpia) and three international database (PubMed, CINAHL, Web of Science) were searched from March 13, 2025 to April 25, 2025, to identify studies investigating the impact through either RCTs or NRCTs. Quality was appraised using Risk of Bias 2 for RCTs and Risk of Bias in Non-randomized Studies-I for NRCTs. Educational outcomes were analyzed based on Kirkpatrick's evaluation model and Bloom's taxonomy. RESULTS: A total of seven studies were reviewed. Four assessed Level 1 (reaction) and all seven assessed Level 2 (learning) as per Kirkpatrick's model. Affective outcomes were confidence, self-directed learning, motivation and self-efficacy and cognitive outcomes were knowledge, clinical reasoning, critical thinking, problem-solving and learning achievement. Five studies demonstrated significant improvements in both cognitive and affective educational outcomes. CONCLUSION: Conversational agents effectively enhanced cognitive and affective competencies in nursing students. Learner-initiated interactions were applied primarily in practice-oriented education, whereas system-initiated ones, in theoretical learning. Therefore, aligning interaction modes and feedback levels with educational purposes and content is essential to maximize learning outcomes. However, evaluation of long-term effects of conversational agent-based education and its impact at the organizational level is limited. Future research should adopt longitudinal and rigorously designed RCTs to provide robust evidence of educational effectiveness.