Fig. 8 shows the experimental procedure. In the pre-class stage, the NP learners in the experimental group learned with the ASQ- based flipped learning approach; that is, they were guided to learn on the system following the ASQ procedure. On the other hand, those in the control group learned with the conventional flipped learning approach; that is, they were asked to watch the instructional videos and complete a learning sheet on the system by answering several questions prepared by the teacher.In the class, both groups participated in general discussion, case discussion and skills practice. For the experimental group, the questions raised by the learners were discussed and answered by the teacher if necessary. For the control group, the teacher first provided explanations of the learning sheet questions that most learners had failed to correctly answer, and then checked if they had any further questions. Then, two nursing cases, “assessment of the heart and blood vessels” and “assessment of the abdomen,” were presented to both groups for discussion. The learners were divided into groups, practiced history taking, interviewed the simulated patients, and discussed possible differential diagnosis based on the collected physical assessment. During the process of drill and discussion, there were three coaches assisting and guiding. Next, the teachers randomly chose learners and simulated patients to conduct nursing skills practice while other learners evaluated them using the nursing skills checklist. Lastly, learners discussed and provided just-in-time feedback according to the learners' and teachers' checklist. The course lasted for 3 h. Fig. 9 illustrates the learning situation of teaching on site.After the activities, the learners were administered the nursing skills test, as shown in Fig. 10. The examination lasted for 15 min, during which individual learners' skills proficiency level was evaluated. The learners were also asked to take the knowledge test and to complete the questionnaires of self-efficacy, cognitive load, and critical thinking tendency.