Waddell 2015.

Study characteristics
Methods	Study design: RCT Study grouping: parallel group Unit of randomisation: individuals Power (power sample size calculation, level of power achieved): not specified Imputation of missing data: no imputation of missing data; not specified if attrition from intervention or lost to assessments; probably per‐protocol analysis (only participants who took part in allocated intervention) and available‐case analysis (only participants for whom outcomes were obtained)
Participants	Country: Canada Setting: collaborative baccalaureate nursing degree programme at academic sites (2 colleges, 1 university site) Age: range = 18 ‐ 22 years Sample size (randomised): 142 (recruited in 2 cohorts in year 1, n = 120, and beginning of year 3, n = 22) Sex: not specified; most of analysed sample was female Comorbidity (mean (SD) of respective measures in indicated, if available) at baseline: not specified Population description: nursing students in a collaborative baccalaureate degree program Inclusion criteria: not specified Exclusion criteria: not specified Attrition (withdrawals and exclusions): probably attrition of n = 70 participants over study course (not specified which group) Reasons for missing data: CG: probably information about assignment to control group; IG: probably due to time commitment; most students withdrew in year 2,which is considered by students and faculty to be most demanding and difficult
Interventions	Intervention: career planning and development (CPD) programme (n not specified; for 72 participants analysed: n = 33) delivery: face‐to‐face; group sessions (workshop) providers: 3‐hour workshop by principal investigator (PI) who is an experienced career coach; faculty study participants with training and expertise in career coaching guide and structure the discussions; coaches debriefed following each workshop to ensure consistency in approach to workshop facilitation duration of treatment period and timing: 3 years 3‐hour workshop in first term of year 2 of the 4‐year BScN academic programme 3‐hour, year‐specific workshop sessions at beginning of each academic term in programme years 2 ‐ 4, respectively (6 intervention sessions, 18 hours in total) description: INTRODUCTION WORKSHOP: introduction to CPD model 6 x YEAR‐SPECIFIC WORKSHOP SESSIONS: guided career‐visioning exercise at the beginning of each session in which students are asked to imagine the “perfect day” in their “perfect career”; participants encouraged to give themselves the freedom to dream and imagine what is possible With their career vision in mind, participants complete a self‐assessment focused on (a) the values embedded in their vision that they determine to be most significant, (b) the areas of strength they believe they possess in relation to the professional competencies required to “live” their vision, and (c) the areas they need to develop in terms of the professional competencies necessary to progress toward their vision Participants then discuss specific career goals arising from their vision that would guide them to shape their academic work in the coming term to build on their strengths and work on identified areas for development. Finally, participants create a career plan that outlines activities, resources, timelines, and indicators of success for each of their identified career goals Marketing strategies in general and in relation to participants’ career goals and plans are discussed in each intervention session; participants explore who and what within their programme could help them actively participate in, and shape the curriculum to achieve their goals They also investigate which marketing strategies would help them articulate their overall career vision and specific term goals to faculty, preceptors, peers, and mentors CPD model is applied consistently across years of the programme and is responsive to established year‐specific curricular focus and student experiences within the programme year: curriculum foci for years 2 ‐ 4 are: knowledge of self in the context of health; knowledge of others in the context of illness; knowledge of community in the context of primary health care; and integration of professional self into the healthcare system; different year‐specific foci help participants tailor the programme and activities to their evolving needs and the academic context in each term compliance: not specified integrity of delivery: not specified economic information: not specified theoretical basis: based on a standardised, multi‐component CPD model (Waddell 2009) Control: TAU (standard undergraduate curriculum group) (n not specified; for 72 participants analysed: n = 39) delivery: not specified providers: not specified duration of treatment period and timing: not specified description: Participants in CG are offered CPD programme along with individual career coaching after 4 years of their academic programme and after 12‐month follow‐up in IG BUT: Specific and limited elements of the CPD Model (career vision and career plan) were integrated into Year 3 of the programme within a nursing leadership course In year 4, a similar CPD assignment targeting the career vision and plan components of the CPD model was added to a professional issues and trends course. In order not to jeopardise study integrity, faculty teaching in year 3 and year 4 courses should refer students to the student guide Building Your Nursing Career: A Guide for Students (Waddell 2009) as a resource, but would not include the teaching of CPD in the content of classroom discussions; i.e. brief introduction to these elements of the CPD model distinctly different in scope and breadth from the 6‐session interactive CPD programme in IG compliance: not specified integrity of delivery: not specified economic information: not specified theoretical basis: not specified
Outcomes	Outcomes collected and reported: career planning activities, total score ‐ CPAM career planning activities, career visioning ‐ CPAM career planning activities, self‐assessment ‐ CPAM career planning activities, environmental scan ‐ CPAM career planning activities, career plan ‐ CPAM career planning activities, marketing ‐ CPAM career decision‐making, self‐efficacy ‐ CDMSES‐SF total score career planning activity and self‐efficacy ‐ CPAM and CDMSES‐SF Time points measured and reported: 1) pre‐intervention (year 2 of baccalaureate programme, prior to randomisation); 2) during intervention, year 3 of baccalaureate programme; 3) post‐intervention, year 4 of baccalaureate programme; and 4) 12‐month follow‐up (12 months post‐intervention/after baccalaureate programme); 4) presented in 2nd report Adverse events: not specified
Notes	Contact with authors: We contacted the authors for the number of participants randomised to each group and whether there were 70 missing, but they had not responded at the time of writing this review Study start/end date: not specified Funding source: funding support by Social Sciences and Humanities Council Declaration of interest: not specified Ethical approval needed/obtained for study: research ethics board approval Comments by authors: not relevant Miscellaneous outcomes by the review authors: Waddell 2015 is the first of 3 reports on this study; besides this 1st report on the undergraduate student outcomes of the programme, 2nd paper will examine graduate nurses’ experiences at 12 months post‐graduation, 3rd paper will explore faculty outcomes for those participating in the programme Correspondence: Janice Waddell; Department of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada; jwaddell@ryerson.ca
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Eligible students who consented to participate were randomly assigned by means of a random numbers chart with allocation concealment, to one of two conditions: (a) a 4‐year CPD group (intervention) or (b) a 4‐year standard undergraduate curriculum group (control)." Quote: "There were no significant group differences in terms of marital status (majority were single), number of children (majority were childless), registration with the Registered Nurses Association of Ontario (majority were not members), or employment status. Finally, there were no significant group differences in terms of previous CPD training/ involvement outside of this study (most respondents reported no previous engagement in CPD activities)." Quote: "Mean career scores, including total scores (p = 0.002) and subscale scores, were higher for all intervention participants except at Time 1 (when baseline scores for the initial 142 participants were gathered prior to randomization where there were no significant between group differences)." Judgement comment: investigators describe a random component in the sequence‐generation process (random‐numbers chart); verified baseline comparability of groups for sociodemographic characteristics and outcome variables on the basis of analysis (mean career scores refers to total score of CPD activities and self‐efficacy as well as subscales in Table 1)
Allocation concealment (selection bias)	Unclear risk	Quote: "Eligible students who consented to participate were randomly assigned by means of a random numbers chart with allocation concealment, to one of two conditions: (a) a 4‐year CPD group (intervention) or (b) a 4‐year standard undergraduate curriculum group (control)." Judgement comment: insufficient information about allocation concealment to permit judgement of 'Low risk' or 'High risk'; unclear if random‐sequence generation was concealed from personnel or participants, or both; exact method not described
Blinding of participants and personnel (performance bias) Subjective outcomes	High risk	Quote: "A large number of those randomized into the control group dropped out of the study after completing the pre‐study measures and being informed of their assignment to the control group." Judgement comment: no blinding of participants and personnel (face‐to‐face intervention; CG participants were informed of being in the control group) and the outcome is likely to be influenced by lack of blinding
Blinding of outcome assessment (detection bias) Subjective outcomes	High risk	Judgement comment: insufficient information about blinding of outcome assessment; but due to performance bias (no blinding of participants), the review authors judge that the participants' responses to questionnaires may be affected by the lack of blinding (i.e. knowledge and beliefs about intervention they received)
Incomplete outcome data (attrition bias) All outcomes	High risk	Quote: "One hundred and twenty students in their first year in the program consented to participate (Cohort # 1). Due to participant attrition in Year 2 of the program, a second recruitment phase was undertaken as the Year 2 cohort was beginning the third year of their program." Quote: "A final sample size, after accounting for attrition, was an additional 22 participants (Cohort # 2) for a total of 142 participants entering the third year of the program." Quote: "The final sample for quantitative data analysis consisted of 50 participants from Cohort #1 (Intervention = 29, Control = 21) and 22 participants from Cohort #2 (Intervention = 4, Control = 18) for a total of 72 participants, 33 of whom were in the intervention group and 39 in the control group." Quote: "large number of those randomized into the control group dropped out of the study after completing the pre‐study measures and being informed of their assignment to the control group." Quote: "The time commitment involved may have been a major factor that contributed to attrition in the intervention group. These participants were required to attend one 3‐hour CPD workshop per term, per program year. The majority of students who withdrew from the study during its first year were in Year 2, which is considered by students and faculty to be the most demanding and difficult, as students’ clinical hours increase to 11 per week in addition to five classroom or online courses per term." Judgement comment: insufficient information about attrition/exclusions (number of participants randomised to each group not stated; number of attrition per group not specified; not specified if attrition from intervention or lost to assessments); probably per‐protocol analysis (only participants who took part in allocated intervention) and available‐case analysis (only participants for whom outcomes were obtained) since only 72 participants were analysed
Selective reporting (reporting bias)	Unclear risk	Judgement comment: no study protocol available; published report seems to include all expected outcomes, including those that were prespecified; unclear if Time 4 refers to 12‐month follow‐up since not further specified in text