To compare the effects of traditional and platform-based case-based learning (CBL) on undergraduate nursing students' academic performance, self-efficacy, clinical decision-making and critical thinking abilities. Traditional CBL can improve students' academic performance but faces challenges in the era of "Internet + education." It is unclear whether platform-based CBL is as effective as traditional CBL. Cluster randomized controlled trial. A total of 88 undergraduate nursing students from two classes were recruited using cluster sampling and separated into two groups by class. The control group (n = 45) received traditional CBL, and the experimental group (n = 43) received platform-based CBL. Academic performance, self-efficacy, clinical decision-making, critical thinking disposition and experimental group's learning records from the online platform were evaluated. No difference was found between the two groups in overall academic performance, but formative evaluation and final examination scores in the course differed. Compared with the control group, the experimental group presented significant differences in self-efficacy and clinical decision-making. There was no difference between the total clinical thinking disposition scores; however, truth-seeking, systematicity and self-confidence exhibited significant differences. Concerning student progression, all experimental students advanced from "Grade I" to "Grade V" or "Grade IV". The usability questionnaire's average score regarding the platform was 77.03 (SD 7.43) and the top dimension was teaching utility. Compared with traditional CBL, platform-based CBL may better enhance self-efficacy and clinical decision-making abilities in nursing undergraduate students.
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