IE

Implant Review Essentials

High-Dollar Claim Review · Nurse Education

Theoretical Foundation

References & Theoretical Foundation

The instructional design of this module rests on Social Cognitive Theory and Universal Design for Learning. The references below are the primary sources behind the teaching approach.

Theory

Social Cognitive Theory foundation

This module is grounded in Bandura's Social Cognitive Theory, which holds that people learn by observing others, that learning is regulated by self-efficacy (belief in one's capability to perform a task), and that behavior, cognition, and environment interact reciprocally (Schunk, 2020). For nurses reviewing high-dollar claims, the skill is procedural as much as conceptual — so the course builds competence the way the theory predicts: through modeled examples, guided practice, and feedback keyed to a mastery standard.

Each lesson presents realistic, de-identified claim scenarios (modeling), asks the nurse to flag implants and apply policy themselves (guided practice), and returns case-based feedback against an 80% mastery goal (self-efficacy through mastery). The five-step review workflow is repeated identically across every case so that the process becomes an automatic, defensible habit rather than a one-time recall.

Why this theory

Social Cognitive Theory fits clinical claim review because the work depends on pattern recognition built through repeated, feedback-rich practice — not on memorizing a rule. The mastery standard (80%) gives nurses a credible signal that they are ready to apply the workflow on the job.

UDL alignment

Universal Design for Learning

Instruction also follows the Universal Design for Learning guidelines (CAST, 2018), which call for multiple means of engagement, representation, and action & expression. In practice this means: the same content is shown as coded line items, plain-language policy summaries, and worked walkthroughs (representation); learners flag lines, answer case-based questions, and walk a structured checklist (action & expression); and scenarios stay relevant to daily claim-review work to sustain engagement.

References

Reference list

  1. Schunk, D. H. (2020). Learning theories: An educational perspective (8th ed.). Pearson

    Primary source for Social Cognitive Theory as applied to adult learning — self-efficacy, observational learning, and the role of mastery feedback in building learner confidence.

  2. CAST (2018). Universal Design for Learning Guidelines (version 2.2). Center for Applied Special Technology (CAST)

    https://udlguidelines.cast.org — opens Universal Design for Learning Guidelines (version 2.2) in a new tab

    Framework for designing instruction that gives learners multiple means of engagement, representation, and action & expression — applied here through case-based scenarios, visual cues, and self-paced knowledge checks.

  3. Varma, B., et al. (2025). Effectiveness of case-based learning in comparison to alternate learning methods on learning competencies and student satisfaction among healthcare professional students: A systematic review. Journal of Education and Health Promotion, 14, 76

    https://doi.org/10.4103/jehp.jehp_510_24 — opens Effectiveness of case-based learning in comparison to alternate learning methods on learning competencies and student satisfaction among healthcare professional students: A systematic review in a new tab

    Systematic review evidence supporting the module's case-based scenario design — case-based learning is shown to improve learning competencies and student satisfaction among healthcare professional students relative to alternative methods.

  4. Yao, J., et al. (2023). Case-based learning interventions for undergraduate nursing students in a theoretical course: A review of design, implementation, and outcomes. Journal of Professional Nursing, 46, 119–133

    https://doi.org/10.1016/j.profnurs.2023.03.007 — opens Case-based learning interventions for undergraduate nursing students in a theoretical course: A review of design, implementation, and outcomes in a new tab

    Informs the design and implementation of case-based learning in nursing theory courses — including how scenarios are structured and the outcomes that can be expected, applied here in the case-based knowledge checks and assessment claims.

Reference notes

The Varma et al. (2025) and Yao et al. (2023) entries support the module's case-based scenario design and are linked to the live DOIs above. Confirm the Schunk edition (8th, 2020) and the CAST guideline version (2.2, 2018) against your reference list.

Course sources

Primary policy & clinical sources

The clinical content draws on these live sources — open the current page each time rather than a saved copy.

  1. 1.FDA — Implants and ProstheticsConfirm approval or clearance pathway and the approved indication.https://www.fda.gov/medical-devices/products-and-medical-procedures/implants-and-prosthetics
  2. 2.Investigational (Experimental) Services — Blue Cross NChttps://www.bcbsnc.com/providers/policies-guidelines-codes/commercial/administrative/updates/investigational-experimental-services
  3. 3.Medical Necessity — Blue Cross NChttps://www.bcbsnc.com/providers/policies-guidelines-codes/commercial/administrative/updates/medical-necessity
  4. 4.Bone Morphogenetic Protein — Blue Cross NChttps://www.bcbsnc.com/providers/policies-guidelines-codes/commercial/surgery/updates/bone-morphogenetic-protein
  5. 5.Orthopedic Applications of Stem Cell Therapy — Blue Cross NChttps://www.bcbsnc.com/providers/policies-guidelines-codes/commercial/other-treatments/updates/orthopedic-applications-of-stem-cell-therapy