Objective To investigate the effect of the presentation-assimilation-discussion (PAD) class in combination with case-based learning （CBL） in teaching of circulatory system in Medical Nursing for nursing students on an on-site education program.Me-thods Undergraduate nursing students of Grade 2021 from two on-site learning hospitals were cluster randomized into an experimental group of 26 and a control group of 28, receiving either PAD class combining CBL or traditional CBL in teaching circulatory system in Medical Nursing, respectively.Performance in examination at completion of the chapter, self-directed learning ability, critical thinking dispositions, and students′satisfaction with the teaching were compared between the two groups.Results All above-mentioned parameters in the experimental group were significantly higher than those in the control group （all P＜0.05）.Conclusion Combining PAD class with CBL is beneficial to cultivating nursing students′ self-directed learning ability and critical thinking dispositions, and enhances their theoretical knowledge and teaching satisfaction.