Multimodal AI-Enhanced Training for Novice Operating Room Nurses: a Multi-Center Randomized Controlled Trial Grounded in Cognitive Learning Theory

INTERVENTION: Control Group: Standard 10‐month OR nursing orientation program consisting of didactic lectures (40%, covering fundamental OR principles, patient safety protocols, and evidence‐based surgical nursing practices), hands‐on practice (40%, supervised by senior OR nurses focusing on instrument handling, sterile technique, and anesthetic monitoring), and simulation sessions (20%, using static mannequins and simple case scenarios). Total: 160 hours theoretical instruction and 480 hours supervised clinical practice, averaging 16 hours per week.;Basic AI‐Assisted Training:Standard curriculum (same as Control) plus a text‐based GPT‐2 educational platform fine‐tuned on 8,000 de‐identified OR nursing cases. Platform features included textual case discussions, adaptive quizzes with immediate text‐based feedback, and search/bookmark functions. Participants dedicated approximately 2 hours per week to the AI platform in addition to the standard curriculum.;Advanced AI‐Assisted Training:Standard curriculum (same as Control) plus a multimodal AI system leveraging Visual BERT and CLIP models, fine‐tuned on 15,000 clinical cases and multimedia resources. System features included interactive visual simulations (high‐resolution videos and annotated images), voice‐guided scenarios, adaptive learning paths with real‐time analytics, and immediate corrective feedback. Participants spent approximately 2 hours per week engaging with the system, with additional self‐paced access allowed.; CONDITION: None PRIMARY OUTCOME: Modified Objective Structured Clinical Examination (M‐OSCE) score; SECONDARY OUTCOME: Knowledge test score;Practical skill assessment score; INCLUSION CRITERIA: 1. Registered nurses aged 22 ‐ 55 years old; 2. With less than 12 months of experience in operating room (OR) work; 3. Holding a bachelor's degree in nursing (BSN) or above; 4. Holding a unrestricted nurse practice certificate; 5. Has not used any artificial intelligence‐assisted training tools before (confirmed by the screening questionnaire for enrollment).