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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Med Educ . 2026 Mar 4;26:589. doi: 10.1186/s12909-026-08832-5 Search in PMC Search in PubMed View in NLM Catalog Add to search Gender differences in critical thinking, self-directed learning and humanistic caring abilities among undergraduate nursing students in South China: a cross-sectional study Zitong Zhang Zitong Zhang 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Zitong Zhang 1 , Peijuan Jiao Peijuan Jiao 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Peijuan Jiao 1 , Xiaorou Zeng Xiaorou Zeng 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Xiaorou Zeng 1 , Wanting Zhang Wanting Zhang 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Wanting Zhang 1 , Cai Deng Cai Deng 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Cai Deng 1 , Junxiang Chen Junxiang Chen 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Junxiang Chen 1 , Jia Chen Jia Chen 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Jia Chen 1 , Li Liu Li Liu 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Li Liu 1 , Ya Shi Ya Shi 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Ya Shi 1 , Honghong Wang Honghong Wang 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Honghong Wang 1 , Can Gu Can Gu 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China Find articles by Can Gu 1, ✉ Author information Article notes Copyright and License information 1 Xiang-Ya School of Nursing, Central South University, 172 Tongzipo Street, Changsha, 410013 China ✉ Corresponding author. Received 2025 Sep 16; Accepted 2026 Feb 12; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13067426 PMID: 41782126 Abstract Background There is an urgent need for the highly qualified nursing staff and gender-diverse nursing team to promote the national health, which makes the personalized nursing education based on gender equality particularly important for the preparation of nursing workforce. Methods This study was a cross-sectional study. The participants were asked to complete the Chinese version of the Critical Thinking Scale, Self-directed Learning Scale and humanistic caring scale. Data were examined using Chi-square test, Pearson correlation and hierarchical multiple linear regression. Results We observed a small but significant gender difference ( t = -2.004, P = 0.046, Cohen's d = -0.240) in critical thinking ability among female (Mean score = 100.04 ± 12.40) and male nursing students (Mean score = 103.1 ± 14.18). However, there were no gender differences between male and female nursing students in the overall scores of self-directed learning and humanistic caring abilities. Self-directed learning and humanistic caring abilities were identified as two key variables associated with variations in critical thinking ability among nursing students. Moreover, gender differences were observed in the strength of the associations among self-directed learning (female: β = 0.576, Δ R 2 = 0.207; male: β = 0.412, Δ R 2 = 0.112), humanistic caring (female: β = 0.635, Δ R 2 = 0.389; male: β = 0.614, Δ R 2 = 0.357) and critical thinking ability in undergraduate nursing student. Conclusions This study explored the gender differences in critical thinking, self-directed learning and humanistic caring abilities of nursing students, and also found the different strength of associations among these three key abilities. In the teaching process, nursing educators need to realize the importance of gender issues on nursing education and create gender equality awareness. Gender-mixed reflection activities and case studies that avoid gender-stereotyped roles are recommended. Keywords: Nurse education, Gender difference, Critical thinking, Self-directed learning, Humanistic caring Introduction According to the State of the World's Nursing 2020 [ 27 ], the shortage of nursing staffs has become one of the major global health problems, it is estimated that by 2030, the number of nurses worldwide will reach 36 million, a shortfall of 5.7 million over the projected needs. Achieving the national health and addressing the shortage of nursing resources depend on the investment in nursing quality education, through which to develop high qualified nurses as the crucial promoters and leaders of health career [ 27 ]. For nursing students, focus on the cultivation and development of various capabilities in the undergraduate education could help them cope with the changing technologies and increasingly progressive models of integrated health and social care in the future. Nursing has long been considered a feminine profession, the ratio of male to female nurses from multiple countries shows that women are overwhelmingly represented in the nursing profession [ 29 , 31 ]. Compared with Western countries, the low portion of the male nursing workforce is more prominent in Asian countries [ 8 ]. However, in recent years, the number of male nurses has kept increasing. In China, the proportion of male nurses had increased from 1.8% to 3% in the past decade [ 30 ]. Although male nurses constitute a numerical minority, relevant research has indicated that in highly female dominated professional environments, male nursing students often have learning experiences that differ from those of female students [ 5 ], gender is a crucial factor that may influence learning experiences, the development of core competencies and the interactions among these competencies [ 23 ]. Ignoring potential gender differences in nursing education may result in majority-centered training models being assumed to be universally applicable, thereby obscuring the unique needs of minority groups in the process of competency development. McMullan et al. [ 28 ] stated the positive attribute of nursing care that increasing nursing staffs of different genders within the nursing workforce. Therefore, in nursing education, paying attention to gender issues and its importance on students’ various competencies is a crucial step in cultivating a high-quality nursing team. Critical thinking has been defined as the mental process of actively and skillfully conceptualizing, applying, synthesizing, and evaluating information to reach an answer or conclusion [ 22 ]. Critical thinking in nursing profession is about the process of judgment, reflection and reasoning on the purposeful and meaningful self-regulation of nursing decision-making, it can directly affect the decision-making ability and problem-solving skills of nurses, and become the guarantee of safe patient care in the clinical settings [ 14 , 35 ]. A vision of Education of Health Professionals for the 21 st Century Commission proposed that all health professionals should be competent to critical reasoning [ 12 , 13 ],critical thinking is valued in nursing education programme by a growing number of educators and has been included in the regular evaluation of the high-quality nursing education [ 1 ]. A study conducted among Chinese nursing students showed that the students had positive critical thinking ability in general, but with weak scores for systematicity and truth-seeking dispositions [ 37 ], this finding was proved by several other studies from Ireland and Korea [ 19 , 30 ], informing that nursing students lacked the objectivity in truth-seeking, their abilities of systematically re-reorganize knowledge was poor, along with the passive acceptance of knowledge. Therefore, how to strengthen students’ ability in these aspects has become the common concerns for nursing educators in different countries. Self-directed learning is a significant skill in higher nursing education which requires students to play an active role in constructing themselves in relation to their own developmental needs, and to gradually fulfill themselves through reflection [ 15 , 20 ]. A systematic review revealed that self-directed learning ability had benefit in the acquisition of professional knowledge and the lifelong learning tendencies of students [ 41 ]. Relevant research had proved that there were gender differences in critical thinking and self-directed learning skills between male and female college students [ 36 , 45 ], but there is no evidence about the gender differences in critical thinking and self-directed learning skills among undergraduate nursing students. Nursing clinical work is different from other professions, often involving intricate and dynamic conditions of the illness, which makes it more essential for nursing students to develop strong critical thinking skills than other college students, enabling them to make sound judgments in complex situations. Additionally, with the half-life of medical knowledge being only 4–6 years [ 49 ], nursing students must possess self-directed learning skill to better adapt to the demands of future clinical practice. Therefore, understanding the differences between male and female nursing students in these two competencies and helping them cultivate these abilities are crucial for their professional careers. Humanistic caring is the core and essence of nursing [ 40 ]. humanistic caring is the ability to communicate with patients to feel their emotions and meet their needs and then ultimately created a harmonious therapeutic relationship (Waston, 1988). Some researchers had explored the entire developmental trajectory of humanistic caring ability among nursing students, the results emphasized the importance of the stage of transferring the theoretical into practice [ 21 ]. However, cumulative studies showed that nursing students had excellent caring knowledge but poor humanistic caring ability [ 18 , 39 ]. humanistic caring ability plays an important role in the nursing work. Nurses with humanistic caring possessed better team spirit and professional dedication [ 50 ]. Nursing students are in the pre-professional stage with strong plasticity, the commitment to improve their humanistic caring ability has significant meaning to their lives and careers. Although researchers draw the conclusion that gender made a significant influence on nurses' humanistic caring ability in the clinical workplaces [ 47 ], whether gender differences exist in humanistic caring ability among male and female nursing students remains unclear. At present, critical thinking, self-directed learning skill and humanistic caring ability were often used as three important assessment indicators of nursing students’ competence in the undergraduate education program. In several studies investigated the self-directed learning skill of nursing students, researchers found that self-directed learning had positive correlation with critical thinking and could improve the collaborative skills of students [ 17 , 34 ]. Moreover, humanistic caring ability and the perception of caring behaviors could motivated the nursing staffs to develop their critical thinking skill [ 32 ]. However, no prior study has simultaneously examined the gender-specific relationships among critical thinking, self-directed learning and humanistic caring abilities among undergraduate nursing students in China. Modern education models are increasingly focused on individualized ability training programs which based on gender equality. The 4-year bachelor's program of this research university, accredited by China's Ministry of Education, prepare registered nurses with integrated clinical expertise and public heath leadership while advancing population health outcomes. This study was aimed at exploring the gender differences in critical thinking, self-directed learning and humanistic caring abilities and analyzing the relationship between these abilities among undergraduate nursing students in this college, enabling educators to become more aware of gender-related issues in the nursing education programme and its implications for the future nursing profession. Meanwhile, conducting such a survey can provide an insight into the development of personalized nursing education, relevant teaching model can be piloted at this college and then promoted to more nursing institutions in the future, aiming at the preparation of highly qualified nursing workforce. Methods Study design and participants The cross-sectional study design and the cluster sampling method was used in this research. This survey was conducted in a nursing school of the “Double First-Class” university in Changsha, Hunan province, where the nursing major is recognized as the first-class discipline in China and enroll 90 students every year. We recruited the undergraduate nursing students from four grades from October 2023 to March 2024, which included 114 male and 231 female nursing students. The inclusion criteria were (1) over 18 years old and (2) agree to participate in this study. The exclusion criteria were (1) have mental illness and (2) participation in similar studies concurrently or within the past 6 months. Two researchers identified potential participants and assessed their eligibility. Eligible participants were provided an explanation of the purpose of the study and the content of the study assessments and were asked whether they were willing to participate in the study. Those who agreed to participate provided written informed consent and were then given the questionnaires, which they subsequently completed within approximately 20 min in a quiet room. Instruments Demographic information questionnaire The personal information collected from the participants comprised their age, gender, ethnicity, having siblings or not, participation in clubs, reading habits, and part-time job. Critical thinking The Chinese version of the Critical Thinking Scale (CTS) was used to measure the critical thinking ability of nursing students. This scale was validated in Chinese by Yuan [ 48 ] and contains 27 items with seven dimensions, namely “truth seeking”, “analytical ability”, “open-mindedness”, “systematization skills”, “self-confidence”, “intellectual curiosity” and “cognitive maturity”. Each item is assessed on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree); the high scores indicates a higher level of critical thinking ability, and the total score greater than 80 or a mean score greater than 3 indicates positive critical thinking skills. The Cronbach’s α coefficient of the scale was reported to be 0.781. The scale demonstrated good internal consistency in this study, with a Cronbach’ s alpha of 0.940. Self-directed learning The self-directed learning ability was measured using the Self-directed Learning Scale (SDLS) developed by Su-Fen Cheng et al. [ 7 ]. The scale was divided into four dimensions, which were “motivation”, “planning and implementation”, “self-supervision”, and “interpersonal communication”, with a total of 20 items. The scale is scored on a 5-point Likert scale, with “strongly disagree” scoring 1 point and strongly agree” scoring 5 points, with higher total scores indicating stronger independent learning ability. The Cronbach's α coefficient of the scale was 0.916. In this study, the Cronbach’s alpha coefficient was 0.965, indicating good internal consistency of the scale. humanistic caring ability The humanistic caring scale was used to measured the humanistic caring ability. This scale was revised by Wu [ 42 ], which consists of three dimensions, namely “cognition”, “courage”, and “patience”, with a total of 37 items. The Likert 7-point scale was used, with answers ranging from 1 (strongly oppose) to 7 (strongly agree), and the total score ranged from 33 to 231, the higher score indicates stronger humanistic caring ability. The Cronbach's α coefficients for each dimension of the scale ranged from 0.710 to 0.840. The scale demonstrated good internal consistency in this study, with a Cronbach’ s alpha of 0.914. Data analysis Data were analyzed using Statistical Product and Service Solutions (SPSS) 26.0 statistical software (Armonk, NY, USA). Before formal data analysis, assumptions for parametric tests were examined. Normality of the scale scores was assessed using the Shapiro–Wilk test, Q-Q plots and skewness and kurtosis statistics. The results indicated that the scale scores were normally distributed in this study. Descriptive statistics were used to describe the sample and the main study variables (critical thinking, self-directed learning and humanistic caring abilities). The independent samples t -test was used to compare male and female nursing students' scores on critical thinking, self-directed learning and humanistic caring skills. Pearson correlation was used to analyze the correlations between the three abilities in male and female nursing students. Hierarchical multiple linear regression analysis was used to analyse the the effect of self-directed learning and humanistic caring ability on critical thinking. Statistical significance was established by a P -value of less than 0.05. Results Distributions of demographic characteristics in male and female undergraduate nursing students The total of 345 undergraduate nursing students completed the questionnaires, including 231 female students (66.96%) and 114 male students (33.04%), the response rate was 95.8%. The average age of the participants was 20.51 ± 1.38 years. In terms of the experience of part-time job ( χ 2 = 12.123, P < 0.001) and having siblings or not ( χ 2 = 6.143, P < 0.05), there was a statistically significant difference between male and female nursing students ( P < 0.05), however, the reading habits in male and female nursing students had no significant difference. More details were shown in Table 1 . Table 1. Distributions of demographic characteristics in male and female nursing students Variables N (%) χ2 P female male Ethnicity 1.031 0.310 Han 207 (60%) 106 (30.7%) Ethnic minorities 24 (7%) 8 (2.3%) Having siblings or not 6.143 0.013 Yes 103 (29.9%) 67 (19.4%) No 128 (37.1%) 47 (13.6%) participated in any clubs Yes 151 (43.8%) 70 (20.3%) 0.521 0.470 No 80 (23.1%) 44 (12.8%) Experience of part-time job 12.123 < 0.001 Yes 106 (30.7%) 75 (21.7%) No 125 (36.3%) 39 (11.3%) Reading habit 0.004 0.950 Yes 198 (57.4%) 98 (28.4%) No 33 (9.6%) 16 (4.6%) Open in a new tab The scores of the critical thinking, self-directed learning and humanistic caring abilities of nursing students according to gender differences The results of t- test analysis showed that both male and female nursing students had positive critical thinking ability. The total score and three dimensions scores (analytical ability, systematization skills and self-confidence) of the CTS of female students was lower than male students, there were gender differences between female and male nursing students ( t = −2.004, P = 0.046), and the Cohen’s d for the total score of CTS was −0.240, representing a small effect size for the gender difference. But there was no significant difference in the scores of the SDLS ( t = 1.027, P > 0.05) and humanistic caring scale ( t = −1.620, P > 0.05), except for courage dimension ( t = −2.990, P = 0.003), in female and male nursing students. More details were shown in Table 2 . Table 2. The comparison of critical thinking, self-directed learning and humanistic caring abilities in male and female nursing students Variables female ( n = 231) male ( n = 114) t P Cohen's d humanistic caring scale Cognition 72.74 ± 10.13 72.51 ± 10.71 0.200 0.842 0.023 Courage 52.81 ± 13.52 57.87 ± 15.39 −2.990 0.003* −0.357 Patience 41.52 ± 5.53 41.09 ± 5.69 0.676 0.500 0.077 Total score 167.07 ± 20.86 171.46 ± 24.99 −1.620 0.107 −0.197 SDLS Motivation 23.9 ± 3.50 23.69 ± 4.16 0.449 0.654 0.055 Planning and Implementation 23.12 ± 3.85 22.64 ± 4.86 0.923 0.357 0.114 Self-supervision 15.93 ± 2.53 15.46 ± 2.99 1.455 0.147 0.176 Interpersonal communication 15.93 ± 2.43 15.54 ± 3.04 1.211 0.227 0.149 Total score 78.88 ± 11.27 77.32 ± 14.09 1.027 0.306 0.127 CTS Truth seeking 14.52 ± 2.20 14.89 ± 2.69 −1.279 0.203 −0.157 Analytical ability 13.42 ± 2.25 14.27 ± 2.70 −2.893 0.004* −0.352 Open-mindedness 15.42 ± 2.07 15.88 ± 2.24 −1.878 0.061 −0.215 Systematization skills 10.45 ± 1.83 11.01 ± 2.14 −2.544 0.011* −0.291 Self-confidence 14.95 ± 2.29 15.59 ± 2.19 −2.459 0.014* −0.281 Intellectual curiosity 19.17 ± 2.80 19.49 ± 2.93 −0.991 0.322 −0.113 Cognitive maturity 12.11 ± 1.65 12.04 ± 1.82 0.375 0.708 0.043 Total score 100.04 ± 12.40 103.17 ± 14.18 −2.004 0.046* −0.240 Open in a new tab Abbreviations : SDLS self-directed learning scale, CTS critical thinking scale * P < 0.05 Correlation analysis of critical thinking, self-directed learning and humanistic caring abilities in undergraduate nursing students according to gender differences The Pearson's correlation results showed that there was a significant positive correlation ( P < 0.05) between the total scores of critical thinking, self-directed learning and humanistic caring abilities in male and female nursing students. However, for female nursing students, the courage dimension did not significantly correlate with the open-mindedness, intellectual curiosity and cognitive maturity (Fig. 1 ), and for male nursing students, it did not significantly correlate with the cognitive maturity (Fig. 2 ). Fig. 1. Open in a new tab Correlation of critical thinking, self-directed learning and humanistic caring abilities in female nursing students Fig. 2. Open in a new tab Correlation of critical thinking, self-directed learning and humanistic caring abilities in male nursing students. Abbreviations: * P < 0.05; ** P < 0.01 SDLS1: Motivation; SDLS2: Planning and Implementation; SDLS3: Self-supervision; SDLS4: Interpersonal communication; CTS1: Truth seeking; CTS2: Analytical ability; CTS3: Open-mindedness; CTS4: Systematization skills; CTS5: Self-confidence; CTS6: Intellectual curiosity; CTS7: Cognitive maturity Hierarchical linear regression analyses of critical thinking in undergraduate nursing students according to gender differences Critical thinking ability was set as the dependent variable, and according to gender, the demographic variables, humanistic caring ability and self-directed learning were incorporated into the model in turn. After testing the model for collinearity levels, the variance inflation factor (VIF) and tolerance values showed that there was no multi-collinearity in the model. The results indicated that the self-directed learning skill and humanistic caring ability was positively related to critical thinking in both male and female nursing students. humanistic caring ability could respectively explain 35.7% and 38.9% of the variance in critical thinking ability among male and female nursing students ( P < 0.05), meanwhile, self-directed learning accounted for 11.2% of the variance in critical thinking ability among male nursing students and 20.7% of its variance in female nursing students ( P < 0.05). More details were shown in Table 3 . Table 3. Hierarchical linear regression analyses of critical thinking in male and female undergraduate nursing students Variables Female students Male students β Δ R 2 F Tolerance VIF β Δ R 2 F Tolerance VIF Model 1 0.014 0.640 0.032 0.720 Ethnicity −0.070 0.986 1.015 −0.036 0.972 1.029 Having siblings or not −0.057 0.985 1.015 −0.096 0.957 1.045 Participated in any clubs 0.004 0.972 1.029 0.034 0.967 1.034 Part-time job −0.023 0.977 1.023 −0.088 0.926 1.079 Reading habit −0.061 0.981 1.020 −0.110 0.990 1.010 Model 2 0.389 25.241** 0.357 11.351** Ethnicity −0.014 0.978 1.023 −0.011 0.970 1.031 Having siblings or not −0.071 0.985 1.015 −0.031 0.946 1.057 Participated in any clubs −0.009 0.971 1.030 0.088 0.960 1.042 Part-time job 0.074 0.955 1.047 0.005 0.906 1.104 Reading habit −0.071 0.981 1.020 −0.092 0.989 1.011 humanistic caring ability 0.635** 0.967 1.035 0.614** 0.945 1.058 Model 3 0.112 15.173** Ethnicity 0.040 0.207 49.846** 0.965 1.036 −0.013 0.970 1.031 Having siblings or not −0.035 0.979 1.022 −0.023 0.945 1.058 Participated in any clubs 0.006 0.97 1.031 0.077 0.958 1.043 Part-time job 0.050 0.952 1.050 0.038 0.898 1.114 Reading habit 0.003 0.956 1.046 0.026 0.881 1.135 humanistic caring ability 0.297** 0.631 1.585 0.418** 0.712 1.405 Self-directed learning 0.576** 0.623 1.606 0.412** 0.656 1.524 R 2 = 0.610; Adjust R 2 = 0.598 R 2 = 0.501; Adjust R 2 = 0.468 Open in a new tab Abbreviations : Δ R 2 variation of R 2 ; ** P < 0.01 Discussion Main findings To the best of our knowledge, this is the first study to compare the critical thinking, self-directed learning and humanistic caring skills among male and female undergraduate nursing students in China. Our results showed a small but significant gender difference in critical thinking between male and female students, with higher mean score of critical thinking observed among male students. These findings are consistent with the results of previous studies indicated that male role presented greater critical thinking among nursing students [ 23 , 43 ], however, some researchers found no gender difference in critical thinking ability among male and female nursing students [ 33 ]. Wang & Shen [ 38 ] thought it may cause by the heterogeneity of the effect of college education on the value-added of critical thinking skills for male and female students. The relationship with gender and critical thinking ability still needs more further research to explore. Additionally, the college education had been found to have a significant and pervasive effect on critical thinking skills and was recognized as a factor that can be directly adapted and transformed [ 4 ]. Therefore, we recommend nursing educators pay attention to the gender issues in education program and its relationship with the critical thinking ability of students, for example by implementing gender-mixed reflection sessions following simulation to expose students to diverse thinking styles, or using case studies that deliberately avoid gender-stereotyped roles for patients and nurses to foster unbiased critical analysis. In this study, we also found that, except the courage dimension, there was no gender difference in self-directed learning and humanistic caring skills among male and female undergraduate nursing students, which is contrary to the findings of several studies [ 3 , 25 , 44 ]. For a long time, there exist the prejudice against the differences between male and female students in self-directed learning and humanistic caring skills, that males are perceived to be logical and therefore better at knowledge acquisition, while females have long been assigned the role of caregiver by society and are perceived to have better humanistic caring skills. Our results highlighted that male and female undergraduate nursing students had same level of self-directed learning and humanistic caring skills and broke down the stereotypes about male and female students. It is therefore for nursing educators, both in clinical settings and higher school, to alert to the gender bias in education process and work to eliminate it. The future of education should place greater emphasis on gender equality. The United Nations Educational Scientific and Cultural Organization (UNESCO) has published a checklist for promoting the gender equality in education (UNESCO, 2022), in which measures such as building safe teaching environments that are gender-equitable and revising teaching materials to eliminate gender stereotypes, providing a strong reference for the future development of nursing education. The results revealed that nursing students’ self-directed learning skill and humanistic caring ability were positively associated with critical thinking. Our results further demonstrated that the strength of these associations differed between male and female nursing students. Despite previous studies stated that critical thinking could improve the self-directed learning skill [ 34 ], our study innovatively found self-directed learning skill was statistically related to critical thinking. This finding is supported by Social Cognitive Theory [ 2 ], which highlights the interactions between thinking processes and self-regulated learning. Students who have self-directed learning ability were more active in seeking answers and thinking rather than passively accepting information [ 26 ], which could cultivate their critical thinking in the self-directed learning process. Although our findings indicated that male nursing students had higher critical thinking scores than female students, self-directed learning showed a stronger association with critical thinking among female nursing students, highlighting gender-specific patterns in the relationships between two competencies. It is recommended that nursing educators can make use of the relationship between the two abilities and the observed gender difference to promote the co-development of self-directed learning and critical thinking abilities in educational practice, which may be particularly important for female students. It has been proven that team-based learning (TBL) pedagogy, problem-based learning (PBL) pedagogy, and self-directed inquiry were helpful in developing self-directed learning and critical thinking abilities of students [ 16 , 51 ], which provided important insights for nursing educators to optimize teaching models. We also found that humanistic caring ability accounted for a larger proportion of the variance in critical thinking among female nursing students than male students, indicating that the association between humanistic caring ability and critical thinking was more pronounced among female students. Liu et al. [ 24 ] discussed the interrelationship between humanistic caring skills and critical thinking ability, in which stated that emotional perception and communication skills were essential in this association. Compared with male, females are better at communicating with others and have a greater ability to perceive emotions [ 9 , 11 ], which could be interpreted by the neurobiological differences [ 6 ]. Beyond biological factors, Social Role theory indicates that socially and culturally assigned roles and unique learning opportunities shape role-consistent behaviors of individuals, including creativity, collaboration, emotional expression, and communication [ 10 ]. When women are perceived as possessing stronger communication skills and greater emotional sensitivity, they are more likely to be encouraged to engage in affective communication in nursing education. Conversely, man may be seen as “muscular” and assigned to technical and physically demanding tasks, which reduce opportunities for practicing interpersonal communication [ 46 ]. Such gendered socialization and distribution of learning opportunities may imperceptibly cultivate female students’ humanistic caring ability and make it more possible to strengthen its association with critical thinking through emotional perception and communication experiences, whereas male students, due to the limited exposure to learning and practice of humanistic caring, may show a weaker association between humanistic caring and critical thinking abilities. Therefore, gendered socialization, hidden curricula, and unequal exposure to learning opportunities warrant more attention in the context of nursing education. In summary, nursing educator should foster gender equality awareness and eliminate gender stereotypes, creating a satisfactory educational environment and achieving balanced development of various important abilities of nursing students, in order to lay the foundation for the construction of a high-quality nursing workforce in the future. Limitations There are several limitations to this study. First, we could not infer any causation, a limitation shared with many other cross-sectional studies. In addition, this study was conducted in only one higher medical school and the status of critical thinking, self-directed learning and humanistic caring abilities as well as gender differences in these ability among nursing students with different academic qualifications have not yet known, which may limit the generalizability of the findings. All data were collected using self-reported questionnaires, which may cause self-report bias. Moreover, the observed gender differences in nursing students’ abilities may have been influenced by unmeasured confounding variables, such as specific teaching methodologies adopted by faculty at this institution or students’ prior educational experiences, which were not fully controlled for in the present study. the observed gender differences in nursing students' abilities may be related to the teaching methods employed by the faculty at this institution. Future studies with larger and more diverse samples, as well as multi-center and longitudinal designs, are needed to further examine gender differences and to explore the associations of educational and contextual factors with these key competencies. Conclusions The results showed that there was a small but significant gender difference in critical thinking ability between male and female nursing students, with male students showing higher scores of critical thinking ability. However, both male and female students possessed similar levels of self-directed learning and humanistic caring abilities. This finding challenge the traditional gender biases in nursing education regarding the various competencies of male and female nursing students. In addition, we found gender differences in the strength of the associations among these three core competencies. After further analysis, issues such as gendered socialization and unequal exposure to learning opportunities may exist in the process of nursing education. Accordingly, we recommend nursing educators valuing the gender issues in educational programs, working to eliminate gender stereotypes and avoiding the use of teaching language and instructional approaches that reinforce gender-stereotyped roles. Acknowledgements We would like to express a sincere thanks to all participant in this study. Authors’ contributions **Z.Z.:** Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing-original draft; **P.J.:** Investigation, Formal analysis, Data curation, Writing-review; **X.Z.:** Investigation, Formal analysis, Data curation, Writing-review. **W.Z.:** Conceptualization, Methodology, Validation, Writing-review; **C.D.:** Methodology, Validation, Writing-review; **J.C.:** Conceptualization, Methodology, Validation; **J.C.:** Conceptualization, Methodology; **L.L.:** Writing-review & editing, Supervision; **Y.S.:** Writing-review & editing, Supervision; **H.W.:** Conceptualization, Methodology, Validation; **G.C.:** Conceptualization, Methodology, Validation, Writing-review, Supervision. All authors reviewed the manuscript. Funding This study was supported by the China Association of Higher Education (Grant No. 24YJ0415) and the Philosophy and Social Science Foundation Project of Hunan Province (Grant No.19YBA348). Data availability Data for reasonable use are available from the corresponding author upon request. Declarations Ethics approval and consent to participate This study was approved by the Nursing and Behavioral Medicine Research Ethics Review Committee of Xiang-ya School of Nursing, Central South University (E202478). This study was conducted in accordance with the Declaration of Helsinki. After obtaining the consent of the participants in our investigation successfully, we submitting the questionnaire. The front page of the assessment stated that the survey was anonymous and assured participants that their privacy would be protected and all participants have the right to withdraw from the survey at any stage. Consent for publication The submission of this manuscript has been approved by all authors. Competing interests The authors declare no competing interests. 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