A systematic review of 'equity-focused' game-based learning in the teaching of health staff

Background

An unequal distribution of the social determinants of health drives health inequalities. Existing training fails to communicate the impossible circumstances that disadvantaged groups face. Game-based learning is increasingly used as an innovative method with the potential to enhance health staff's ability to address health inequalities, but its effectiveness is unknown. Therefore, the aim of this systematic review was to evaluate the effectiveness of 'equity-focused' game-based learning in training health staff.

Study design

Systematic Review.

Methods

Three databases (Ovid Medline, Embase, Web of Science) and a citation search were systematically searched for articles from January 2010 to July 2023, reporting on effectiveness of 'equity-focused' game-based learning. Titles and abstracts were screened using eligibility criteria to identify relevant studies. Data was extracted and the ROBINS-I tool was used to assess quality.

Results

The search identified 7615 articles, of which thirteen were included involving 2412 healthcare workers. A variety of game-based learning tools were found to have an overall positive effect on motivation, knowledge, attitudes, and engagement of health staff. However, the significance of the results varied depending on specific game context. All included studies were judged to have serious to critical risk of bias.

Conclusions

Game-based learning has the potential to improve the effectiveness of 'equity-focused' training for health staff. Educators and researchers should further collaborate to expand the tools available and evaluate their effectiveness on long-term clinical practice.

The design and evaluation of gamified online role-play as a telehealth training strategy in dental education: an explanatory sequential mixed-methods study

To evaluate user perceptions and educational impact of gamified online role-play in teledentistry as well as to construct a conceptual framework highlighting how to design this interactive learning strategy, this research employed an explanatory sequential mixed-methods design. Participants were requested to complete self-perceived assessments toward confidence and awareness in teledentistry before and after participating in a gamified online role-play. They were also asked to complete a satisfaction questionnaire and participate in an in-depth interview to investigate their learning experience. The data were analyzed using descriptive statistics, paired sample t-test, one-way analysis of variance, and framework analysis. There were 18 participants who completed self-perceived assessments and satisfaction questionnaire, in which 12 of them participated in a semi-structured interview. There were statistically significant increases in self-perceived confidence and awareness after participating in the gamified online role-play (P < 0.001). In addition, the participants were likely to be satisfied with this learning strategy, where usefulness was perceived as the most positive aspect with a score of 4.44 out of 5, followed by ease of use (4.40) and enjoyment (4.03). The conceptual framework constructed from the qualitative findings has revealed five key elements in designing a gamified online role-play, including learner profile, learning settings, pedagogical components, interactive functions, and educational impact. The gamified online role-play has demonstrated its potential in improving self-perceived confidence and awareness in teledentistry. The conceptual framework developed in this research could be considered to design and implement a gamified online role-play in dental education. This research provides valuable evidence on the educational impact of gamified online role-play in teledentistry and how it could be designed and implemented in dental education. This information would be supportive for dental instructors or educators who are considering to implement teledentistry training in their practice.

Effects of game-based learning integrated with the self-regulated learning strategy on nursing students' entrustable professional activities: A quasi-experimental study

BACKGROUND

In the field of nursing education, the expertise and knowledge required to perform Leopold's Maneuvers are critical, forming an integral part of Entrustable Professional Activities for nursing students. As a result, mastering Leopold's Maneuvers has become a core component of nursing education. Despite this, the prevailing didactic methods in many nursing courses tend to limit interactive and contextual learning experiences, which can hinder students' ability to engage deeply with the subject matter. This lack of engagement may subsequently affect both the effectiveness of students' learning and students' clinical judgment capacity, essential elements in the competencies of Entrustable Professional Activities.

METHODS

A quasi-experimental design was employed in this study, involving a total of 55 nursing university students, with 28 participants in the experimental group and 27 in the control group. The research incorporated game-based learning integrated with the self-regulated learning strategy, and employed a pretest, posttest, and questionnaires to assess students' learning performance, self-efficacy, and learning motivation. The experimental group participated in game-based learning with the self-regulated learning strategy, whereas the control group experienced game-based learning without the integration of self-regulated learning. Learning performance was analyzed using an independent samples t-test, while Analysis of Covariance was employed to compare the self-efficacy and learning motivation of the two groups.

RESULTS

The findings showed that the integration of game-based learning with the self-regulated learning strategy can significantly improve students' learning performance, self-efficacy, and learning motivation.

CONCLUSION

As an integral part of Entrustable Professional Activities, Leopold's Maneuvers were integrated into an interactive game-based learning environment, coupled with the self-regulated learning strategy in nursing education. This approach aimed at cultivating core competencies among nursing students. This study has demonstrated its efficacy in engaging students effectively, serving as a dynamic resource for immersive learning in Leopold's Maneuvers, aligning well with the design considerations for promoting Entrustable Professional Activities in nursing education.

"Pharmacotrophy": a playful tournament for game- and team-based learning in pharmacology education - assessing its impact on students' performance

BACKGROUND

At the Faculty of Pharmacy of Paris, we conducted a pharmacology tournament in 2021 and 2022, named "Pharmacotrophy", to offer a game-, team- and competitive-based learning innovation based on fun and challenge. This article aims to (1) provide a detailed overview of the organisation of "Pharmacotrophy," (2) present and compare feedback from both students and teachers, and (3) assess the impact of student participation on their exam marks.

METHODS

"Pharmacotrophy" took place in 2021 and 2022 over a two-week period at the beginning of the exam revision phase. It involved a combination of remote matches using the online quiz creation tool Kahoot!® and in-person matches. Teams, consisting of three students from the 4th or 5th year, participated in several selection rounds leading up to the final match. The questions covered various topics from the pharmacology curriculum. Using an anonymous online survey, we collected the feedback from students and teacher regarding the organisation of the tournament and the interest and difficulty of the different type of questions. We retrospectively compared the exam marks of 4th year students who took part in "Pharmacotrophy" (n2021 = 19 and n2022 = 20) with those of the rest of the 4th year (n2021 = 315-320 and n2022 = 279-281), both in the year before "Pharmacotrophy" and just after the tournament.

RESULTS

Students highlighted the educational benefits of team-based and game-based learning. This novel approach positively and constructively motivated students to review pharmacology. Additionally, students appreciated the establishment of a trust-based relationship with their teachers. All students had a similar pharmacology level based on their exam results in the year before "Pharmacotrophy." After the tournament, participants had marks 20.1% higher in pharmacology questions compared to non-participants (p = 0.02), while they had comparable overall levels, as evidenced by their final grade averages and marks in non-pharmacology questions. Moreover, participants who advanced further in the competition achieved higher marks in pharmacology questions compared to those who were eliminated early in the tournament.

CONCLUSION

The implementation of "Pharmacotrophy" provided students with an enjoyable way to review pharmacology coursework and revived the interest in pharmacology for some. Specifically, participating in "Pharmacotrophy" led to an increase in pharmacology marks for students who were not among the top performers in the class or did not excel in pharmacology in the previous year. This study quantified the pedagogical value of this innovative curriculum in terms of knowledge acquisition.

An Escape Room to Teach First- and Second-Year Medical Students Nephrology

An escape room is a team-based activity that requires players to solve a series of puzzles to complete a story and "break out" of a room. It has recently gained traction in medical education for its ability to interactively and effectively present learning objectives. This was a prospective educational study that describes the successful application of a nephrology themed escape room for first- and second-year medical students. Compared to pre-escape room participation, the 52 students demonstrated a statistically significant improvement in self-reported knowledge for renal physiology (p < 0.01), pharmacology (p < 0.01), pathology (p < 0.01), and relevant clinical practice guidelines (p < 0.01). A majority of the students also claimed that the escape room was "more effective" than traditional lectures (80.8%) and textbooks (73.1%) and "equally effective" as third-party board preparation resources (69.2%) and their institution's problem-based learning curriculum (51.9%). The escape room also facilitated a high-level peer-to-peer collaboration with 82.7% and 76.9% of students reporting that they worked with someone in their year and outside of their year for at least half of the game, respectively. Ninety-five percent of the first-years and 84.6% of the second-years believed that the escape room was effective at preparing them for their respective exams, and an overwhelming majority (90.4%) described the escape room as "very enjoyable." Overall, this nephrology themed escape room was an engaging and well received educational modality and may be an effective supplemental study resource for medical students. Further studies are needed to assess knowledge acquisition.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01917-6.

Techniques for Increasing Educational Motivation and the Need to Assess Students' Knowledge: The Effectiveness of Educational Digital Games in Learning English Grammatical Material

Educational digital games can be an effective way to teach English grammatical material because they provide an interactive and engaging learning experience. The purpose of this study is to clarify how playing digital games affects students' motivation and performance in university-level English grammar classes. [The North-Eastern Federal Institute of MK Ammosova in Neryungri] used a quasi-experimental study, testing, respondent survey, and statistical data analysis method for this purpose. 114 Fourth-year students were the participants, and they were split into the experimental and control groups at random. Students in the experimental group were given a learning format that included the use of digital games designed to teach English grammar (Quizlet and Kahoot!). The traditional teaching strategies offered by the university curriculum were used with the students in the control group (written assignments, textbooks, presentations, and tests). The post-test revealed that the control group's results were nearly identical to those of the pre-test. The students in the experimental group performed better. The proportion of students scoring "poor" fell from 30 to 10%, while the proportion scoring "moderate" fell from 42 to 27%. The "good" score increased from 17 to 40%, and the "excellent" score increased from 11 to 23%. These results suggest that digital games are a more productive and effective tool for teaching English grammar than traditional games. Students were also highly motivated, as they found digital games to be both entertaining and effective for language acquisition. Academic performance did not significantly improve. Based on this, future research might create electives or courses that teach English grammar more successfully using gamification techniques. These results can also be used to guide future research in education, language acquisition, and modern technology.

Dynamic assessment of the effectiveness of digital game-based literacy training in beginning readers: a cluster randomised controlled trial

In this article, we report on a study evaluating the effectiveness of a digital game-based learning (DGBL) tool for beginning readers of Dutch, employing active (math game) and passive (no game) control conditions. This classroom-level randomized controlled trial included 247 first graders from 16 classrooms in the Netherlands and the Dutch-speaking part of Belgium. The intervention consisted of 10 to 15 min of daily playing during school time for a period of up to 7 weeks. Our outcome measures included reading fluency, phonological skills, as well as purpose built in-game proficiency levels to measure written lexical decision and letter speech sound association. After an average of 28 playing sessions, the literacy game improved letter knowledge at a scale generalizable for all children in the classroom compared to the two control conditions. In addition to a small classroom wide benefit in terms of reading fluency, we furthermore discovered that children who scored high on phonological awareness prior to training were more fluent readers after extensive exposure to the reading game. This study is among the first to exploit game generated data for the evaluation of DGBL for literacy interventions.

Performance in Kahoot! activities as predictive of exam performance

BACKGROUND

Game-based learning (GBL) is effective for increasing participation, creativity, and student motivation. However, the discriminative value of GBL for knowledge acquisition has not yet been proven. The aim of this study is to assess the value of Kahoot! as a discriminative tool for formative assessment in medical education in two different subjects.

METHODS

A prospective experimental study was conducted on a sample of 173 students enrolled in neuroanatomy (2021-2022). One hundred twenty-five students individually completed the Kahoot! prior to the final exam. In addition, students enrolled in human histology during two academic courses were included in the study. The control group course (2018-2019) received a traditional teaching methodology (N = 211), while Kahoot! was implemented during 2020-2021 (N = 200). All students completed similar final exams for neuroanatomy and human histology based on theory tests and image exams.

RESULTS

The correlation between the Kahoot score and the final grade was analyzed for all students enrolled in neuroanatomy who completed both exercises. The correlation between the Kahoot exercise and the theory test, image exam and final grade was significantly positive in all cases (r = 0.334 p < 0.001, r = 0.278 p = 0.002 and r = 0.355 p < 0.001, respectively). Moreover, students who completed the Kahoot! exercise obtained significantly higher grades in all parts of the exam. Regarding human histology, the theory tests, image exams and final grades were significantly higher when using Kahoot! versus the "traditional" methodology (p < 0.001, p < 0.001 and p = 0.014, respectively).

CONCLUSIONS

Our study demonstrates for the first time that Kahoot! can be used to improve and predict the final grade in medical education subjects.

Evaluation of registered nurses' interprofessional emergency care competence through the gamification of cardiopulmonary resuscitation training: a cross-sectional study

BACKGROUNDS

Cardiopulmonary resuscitation (CPR) training is generally led by instructors in a classroom; thus, conventional teaching materials used in CPR training are often constrained by spatiotemporal factors, limiting learners' interest and sense of achievement in learning and preventing them from effectively applying what they learn in practice. For greater effectiveness and more flexible application, clinical nursing education has increasingly emphasized contextualization, individualization, and interprofessional learning. This study determined the self-assessed emergency care competencies of nurses who received gamified emergency care training and explored the factors associated with those competencies.

METHODS

Quota sampling of nurses working at a certain regional hospital in central Taiwan was conducted, and a structured questionnaire was administered to the recruited nurses. A total of 194 valid responses were collected. The research tool was a scale measuring the participants' emergency care competencies after they received gamified emergency care training. The data were analyzed using descriptive and inferential statistics and multiple regression.

RESULTS

Of the recruited participants, 50.52% were ≤ 30 years old; 48.45% worked in the internal medicine department; 54.64% graduated from 2-year university technical programs; 54.12% were N2 registered nurses; 35.57% and 21.13% had ≥ 10 and 1-3 years of work experience, respectively; and 48.45% worked in general wards. User need (r = 0.52, p = 0.000), perceived usefulness (r = 0.54, p = 0.000), perceived ease of use (r = 0.51, p = 0.000), and usage attitude (r = 0.41, p = 0.000) were positively correlated with emergency care competencies. Furthermore, the multiple regression analysis revealed that perceived usefulness was the primary factor associated with the participants' emergency care competencies.

CONCLUSIONS

The results of this study may serve as a reference for acute care facility authorities in designing advanced nursing competency standards and emergency care training programs for nurses.

Preschoolers' Mathematics Game Preferences and Learning Performance through Designing a Degree of Freedom for a Tablet Game

Children always have a natural inclination to play, so the purpose of game-based learning is to establish a way for children to acquire knowledge while playing. This study is to discover the relationship between children's play preferences and learning performances toward a mathematics mobile game we designed. The tablet game we designed, "Lily's Closet", is a mathematics game that guides children aged 3-8 to learn "classification". To explore the preferences and learning performances of the games we designed for the preschool children, we put "Lili's Closet" on a children's tablet named Kizpad with over 200 games. We classify and analyze players' behavior data by Data Mining in our designed game to explore children's play behaviors and preferences. We sampled 6,924 children from Taiwan, aged 3-8 years old. In the results, we found that there is a significant difference in the number of ages and achievements in the game. The maturity of the child's age is positively correlated with the achievement of the game, but it is negatively correlated with the number of times of willing to play. As a result, we suggest that to assist learning, we should give children different levels of games according to their ages. The research hopes to resonate with readers and jointly explore the relationship between mobile games.

Primary School Students' Experiences using Minecraft Education during a National Project-Based Initiative: An Irish Study

Minecraft Education is a digital game-based learning platform that is thought to support the development of twenty-first century competencies and skills. The purpose of this study is to explore primary students' experiences of using Minecraft Education during an innovative national project-based initiative. The initiative had two phases: 1) educational episodes for teachers and students on how to use the platform and 2) a national competition that required students to re-imagine a sustainable version of their community. We used a mixed-methods design with a sample of classes taking part in the initiative. First, third to sixth class students (N = 173) completed a survey that examined: 1) learning opportunities with Minecraft Education, 2) ease of use, 3) usefulness, and 4) enjoyment. Eight focus group interviews were then conducted with a subsample of sixth class students (n = 30). Students indicated that 1) there were good opportunities for learning with Minecraft Education, particularly for creativity and collaboration, 2) the platform was easy to use and useful and, 3) using Minecraft Education was enjoyable. Thematic analysis of the qualitative data identified five themes: 'collaboration', 'opportunities for creativity', 'immersive learning environment', 'student engagement', and 'technology and digital skills'. This research highlights the value of innovative project-based learning activities with Minecraft Education for supporting student learning.

The effectiveness of an Instagram-based educational game in a Bachelor of Nursing course: An experimental study

BACKGROUND

Gamification is a novel educational method that adopts elements of games to motivate students using participatory learning. The objective of this study was to measure the effect of participation in an Instagram-based educational game on learning outcomes.

METHOD

Experimental design with 291 university students in a first-year course of the Bachelor of Nursing during the 2020-21 academic year.

RESULTS

After ruling out pretest sensitization, we identified a positive effect of participation in the educational game. An average improvement of 0.62 points was observed in the final grade of the students belonging to the experimental groups.

CONCLUSION

Nursing undergraduate students participating an Instagram-based educational game had better learning outcomes than their counterparts who did not participate in the game.

Design and evaluation of a remote synchronous gamified mathematics teaching activity that integrates multi-representational scaffolding and a mind tool for gamified learning

Gamified learning is an instructional strategy that motivates students to learn, and the use of multiple representations assists learning by promoting students' thinking and advanced mathematical problem-solving skills. In particular, emergency distance learning caused by the COVID-19 pandemic may result in a lack of motivation and effectiveness in learning. This study designed an online gamified learning activity incorporating multi-representational scaffolding and compared the differences in the learning achievement and motivation for the gamified activity and general synchronous distance learning. In addition, for the group that conducted the gamified learning activity, we measured the participants' flow, anxiety, and emotion during the activity. A total of 36 high school students participated in the experiment. The results indicated that the gamified learning activity was not significantly effective in terms of enhancing learning achievement. In terms of learning motivation, a significant decrease in motivation was found for the group using general synchronous learning, while a significant increase in motivation was found for the group using synchronous gamified learning. This indicates that despite the negative impact of the pandemic on learning, gamified learning still enhances students' learning motivation. The results of flow, anxiety, and emotion showed that the participants had a positive and engaged experience. Participants provided feedback that the multi-representational scaffolding facilitates learning.

The Good Behaviour Game: Maintaining students' physical distancing in physical education classes during the COVID-19 pandemic

Background

Maintaining physical distancing is one of the most important steps to enforce in educational institutions to reduce the risk of transmission of COVID-19. However, close proximity and physical contact between students are often considered 'normal' during physical education (PE) classes, making it challenging for PE teachers to ensure physical distancing.

Objectives

The aim of this study was to assess the effect of the implementation of the Good Behaviour Game (GBG) in maintaining physical distancing in PE settings in times of the COVID-19 pandemic.

Method

In a quasi-experimental design, two groups were separately designated as an experimental group (20 classes involving 220 students) and a control group (20 classes involving 231 students). They were all enrolled in the eighth grade of the Tunisian education system. In the experimental group, the PE teacher managed physical distancing by administering the GBG. Physical distancing was evaluated by direct observation of videos of filmed PE sessions using a code grid. It was measured twice for the two groups using Kinovea software.

Results

Quantitative data analyses showed that the level of maintaining physical distancing increased after the GBG intervention in the experimental group (p < .001). Furthermore, greater percent changes between pre- and post-intervention were identified in the experimental group compared to the control group (120% vs 1%, respectively).

Conclusion

The GBG was effective in ensuring students' physical distancing when implemented in PE settings.

The study on designed gamified mobile learning model to assess students' learning outcome of accounting education

This study constructs an innovative course for accounting teaching based on a student-centered strategy. The curriculum is designed through the effective teaching module (BOPPPS) to assist students to understand accounting knowledge. A game-based mobile learning environment is created by developing an accounting mobile game and combining it with a mobile learning system (TronClass). The private technology university students had been selected by purposive sampling. A total of 81 accounting majored students, among them, 41 students are in the experimental group, and the rest were in the control group. The quasi-experimental design was to be applied in curriculum development. Meanwhile, quantitative data were collected by questionnaires and the qualitative data were collected through interviews. The result shows that game-based mobile learning can be beneficial to teaching effectiveness. And the regression model supports that information quality and service quality have positive predictive power on use intention. In addition, use intention and user satisfaction impacted learning engagement positively. Further, user satisfaction has a mediating effect. Finally, some suggestions are put forward to provide references for accounting educators and researchers.

Gender differences in utilizing a game-based approach within the EFL online classrooms

Implementation of digital tools has become a popular practice by teachers to increase student involvement within the classroom. Various technologies are being utilized by educators to help students engage with lessons and enjoy the overall learning experience. Additionally, findings from recent research have indicated that the adoption of digital tools has influenced the learning gaps between genders, specifically in relation to student preferences and gender differences. Despite significant educational development toward gender equality, there is still ambiguity regarding the learning needs and preferences of male and female students within the EFL classroom. The current study examined gender differences in engagement and motivation while using Kahoot! in EFL English literature courses. The study recruited 276 undergraduate female and male students from two English language classes (i.e., both classes were taught by the same male instructor) and surveyed 154 female and 79 male students from those classrooms. The significance of the study lies in determining whether gender impacts the way learners perceive and experience game-based curricula. In this sense, the research found that gender does not, in fact, impact the learner's level of motivation and engagement within game-based classrooms. A t-test revealed that no significant difference between male and female participants had been observed by the instructor. Future studies could fruitfully examine gender differences and preferences in digitized educational settings. Further work is certainly required for policymakers, institutions, and practitioners to disentangle the complexities regarding the role of gender in shaping the experiences of learners in the digital era. In future research, more research is needed to apply and test external factors like age that might impact learners' perception and performance in a game-based curriculum.

Gamification and Game Based Learning for Vocational Education and Training: A Systematic Literature Review

Games have been used as a learning tool for centuries. Gamification and game-based learning are becoming more prominent in educational settings for several reasons. When it comes to learning, being focused and immersed can massively improve a student's experience. The purpose of this study is to map the emerging trends of gamification and game-based learning (GBL) in the Vocational and Education Training (VET) sector. For this purpose, a Systematic Literature Review was conducted through the three most relevant scientific databases - Web of Science, Scopus, ScienceDirect, and PubMed with Google Scholar as a supporting database. The obtained sample was further selected following the PRISMA guidelines with screening and eligibility processes conducted based on inclusion criteria that were defined with consideration to the research's aim. This review comprised seventeen studies. The findings revealed a growing interest in the Asian continents in research from 2020 onwards. Furthermore, most of the study is centred on vocational schools and colleges in the engineering and healthcare fields. According to the overview, the digital learning platform and simulation technology are the most promising tools used in the research. The findings support the conclusion that gamification and game-based learning can improve academic performance, engagement, and motivation in vocational education learners. As a result, this study suggests that more research is needed to determine the gamification strategies that are most suited for vocational education and learning.

Perceptions and factors affecting the adoption of digital games for engineering education: a mixed-method research

Digital games are considered relevant in higher education due to their ability to foster authentic, active and experiential learning opportunities that are of importance in engineering education. However, as a relatively new pedagogical tool, there is the need to understand the perceptions of engineering students as well as to identify factors that influence their adoption of games for learning. So far, only a few studies have investigated the perceptions of higher education students towards learning games and even fewer for engineering students. To bridge this research gap, the current study utilises a mixed-method research design to identify factors that influence the adoption of digital learning games by engineering students as well as their overall perceptions of the use of games for engineering education. Results from the analysed quantitative and qualitative data suggest that engineering students value fun and engagement as well as relevance to the curriculum as factors that would influence their intentions to use digital games for engineering education. Students also showed openness to the use of digital games for learning, but resistance to their use for assessment. These findings have implications for the design of games and classroom deployment of games, as these provide insights to game designers and educators on the factors to consider in the design and classroom deployment of games, respectively.

Promoting respectful maternal and newborn care using the Dignity game: A quasi-experimental study

AIM

This study assessed a) the impact of playing the Dignity board game on participants' understanding of respectful maternal and newborn care and b) participants' perceptions of how the game influenced their subsequent practice in Malawi and Zambia.

BACKGROUND

Nurse-midwives' poor understanding of respectful maternal and newborn care can lead to substandard practice; thus, effective education is pivotal. Used in several disciplines, game-based learning can facilitate skills acquisition and retention of knowledge.

DESIGN

a quasi-experimental study, using mixed-methods of data collection.

METHODS

Data were collected between January and November 2020. Nurse-midwives (N = 122) and students (N = 115) were recruited from public hospitals and nursing schools. Completion of paper-based questionnaires, before and after game-playing, assessed knowledge of respectful care principles and perceptions around behaviours and practice. Face-to-face interviews (n = 18) explored perceived impact of engaging with the game in clinical practice. Paired and unpaired t-test were used to compare scores. Qualitative data were analysed and reported thematically.

RESULTS

The study was completed by 215 (90.7 %) participants. Post-test scores improved significantly for both groups combined; from 25.91 (SD 3.73) pre-test to 28.07 (SD 3.46) post-test (paired t = 8.67, 95 % confidence interval 1.67-2.65), indicating an increased knowledge of respectful care principles. Nurse-midwives performed better than students, both before and after. In Malawi, the COVID pandemic prevented a third of nurse-midwives' from completing post-game questionnaires. Qualitative findings indicate the game functioned as a refresher course and helped nurse-midwives to translate principles of respectful care into practice. It was also useful for self-reflection.

CONCLUSIONS

The Dignity board game has the potential to enhance understanding and practice of respectful maternal and newborn care principles in low-resource settings. Integration into nursing and midwifery curricula and in-service training for students and healthcare workers should be considered.

Escaping the Laboratory: An Escape Room to Reinforce Biomedical Engineering Skills

Commercial escape rooms have grown in popularity as an enjoyable experience that also doubles as an exercise in communication and collaboration. Educators can take advantage of these natural qualities to engage and support students in a low-stress learning environment. The primary goal of this study is to share the development and application of an educational escape room as a tool to provide biomedical engineering (BME) students with an immersive and practical experience. A BME laboratory course-specific escape room was developed and beta-tested on an initial group of BME students. The first set of feedback enabled improvements to the design and difficulty of the escape room, which was followed by the final release of the activity for the intended undergraduate BME course. Across an academic year, 74 participants agreed to provide survey feedback for this study. Despite a moderate escape rate (29%), students reported high satisfaction and enthusiasm for the activity. Student survey responses indicated that participants were engaged and empowered to successfully escape even without external motivators. Responses supported the effectiveness of the escape room as a BME learning environment, allowing students to practice and retain course-related knowledge in a challenging but low-risk activity. The foundational structure of escape rooms offers a beneficial environment for experiential knowledge application. We conclude that educational escape rooms show promise as a pedagogical tool in promoting enhanced knowledge retention through immersive, game-based learning.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43683-022-00089-w.

Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster

BACKGROUND

Clinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed.

METHODS

A multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods.

RESULTS

Two hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15-0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5-55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02-1.21).

CONCLUSIONS

The game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02210442 . Registered 6 August 2014.

Gamification on Instagram: Nursing students' degree of satisfaction with and perception of learning in an educational game

BACKGROUND

Gamification has been shown to lead to greater motivation and participation among students. Currently, many teachers use social networks to share supplementary course materials and student work, but they have not incorporated gamified educational activities into social networking sites.

OBJECTIVE

To determine nursing students' satisfaction with an Instagram-based educational game and their perceptions of its effects on their learning.

DESIGN

We conducted a cross-sectional, descriptive, observational study.

PARTICIPANTS

First-year nursing students in the subject "Dietetics and Nutrition".

RESULTS

Of the total sample, 71.7 % agreed that gamification had helped them assimilate the content. Between 66 % and 70 % agreed that the experience had motivated them to keep up with the subject and learn more about the topic, that it had helped them to better understand certain concepts of the subject, that they would recommend the experience to other students, and that they enjoyed the experience of playing a game while learning. 71.7 % of them were in favour of increased use of gamification in other subjects.

CONCLUSIONS

The use of an Instagram-based educational game as a complement to in-class teaching was useful, enjoyable, and motivating for the acquisition of new knowledge.

Developing a digital game for excel skills learning in higher education - a comparative study analyzing differences in learning between digital games and textbook learning

In higher education, many universities in Taiwan let college students learn excel in a self-directed way. The current axle of the Excel curriculum mainly relies on self-directed learning. In the study, we designed the digital game "Legendary Wizard Excel" and took a certified Excel textbook as the research tool. The game we designed integrated the role-play with cognitive scaffolding to help learners learn Excel skills, whereas the textbook we used was "Excel Expert" in the Microsoft Office Specialist. We compared the Learning Effectiveness, Flow Status, and Technology Acceptance Model with 187 college students between two tools, and found that: (1) The game reached a high Technology Acceptance Model; (2) Both groups of learners had significant improvements in learning effectiveness and were engaged in the activity; (3) On learning effectiveness, learners in game-based learning groups achieved higher than learners in textbook groups; (4) Learners in game-based learning groups engaged better in the activity than learners in textbook groups. Therefore, in the future, we looked forward to bringing our results to higher education levels and workplace training to enhance the Excel skills.

The use and impact of game-based learning on the learning experience and knowledge retention of nursing undergraduate students: A systematic literature review

BACKGROUND

Active engagement of nursing students has deteriorated overtime, especially during the global pandemic. Therefore, there has been a widespread search for learning methods that incorporate digital technologies and active student participation in recent years. Game-based learning may be an option, as it uses game-design elements to enhance academic performance and learning. Its use in nursing education is, however, limited.

OBJECTIVES

The literature review aimed to explore student experience and learning when using game-based learning and to understand its uses in the nursing curriculum.

DESIGN

Systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis.

DATA SOURCES

ESBCO Discovery Service was used to search healthcare, science and education-related databases.

REVIEW METHODS

A comprehensive search of English language primary research published between 2017 and 2022 on the use of game-based learning in nursing undergraduate education was conducted. Data was analysed using thematic analysis.

RESULTS

Seventeen papers from 4 different countries were included. The studies explored interventions and subjects of increased teaching complexity that required increased levels of knowledge retention and critical thinking, such as nursing theory and complex clinical skills. Three themes emerged from the literature, including: approaches to game-based learning; student experience and engagement; impact of game-based learning on student learning and knowledge retention. Studies used a wide range of learning methods, such as quizzes, escape rooms and serious games. These methods were in general well-accepted by students, who endorsed its widespread use in the nursing curriculum. Most studies reported an increase in student experience and learning when using game-based learning, although time-limited games can often increase anxiety on students.

CONCLUSIONS

Game-based learning is an important alternative to traditional teaching methods. However, the recurrent use of game elements and its limited long-term effects may pose a limitation to its widespread use in nursing undergraduate education.

The Male Domain-Digital Game-Based Learning for Human Papillomavirus Vaccination Among Young Males

Background: Human papillomavirus (HPV) is the most common sexually transmitted disease, with the highest infection rates among those sexually active under 25. Although vaccination can reduce HPV cancers among men, public health interventions have primarily targeted females. Increased gaming rates among men provide innovative opportunities to motivate behavior change. This study sought to explore which game development and design strategies are most effective in a game for sexual health, specifically focused on HPV. We also sought to capture information relevant to preferred gaming platforms and game mechanics (health messages, avatars, and visual imagery). Materials and Methods: Twenty-two (n = 22) qualitative interviews were conducted with experts. Using grounded theory, interview data was coded, and emergent themes were identified. Results: Game mechanics most mentioned included simulation/role-playing, social interaction, narrative, and rewards. Experts felt it was important to keep the game in the context of the target audience and integrate the game into an existing game/game scenario or application. Experts also felt the game should link to external resources and enlist partnerships or collaborations with external health agencies. Moreover, while there are benefits to each gaming platform, games on mobile phones and tablets are most appropriate. Conclusion: Digital games are a nonconfrontational approach to discussing HPV and can increase knowledge/awareness and positively influence behavior change toward vaccine uptake. Digital games present a safe environment for role-playing through simulated activities without real-world consequences.

The application of the spot the difference teaching method in clinical skills training for residents

BACKGROUND

Clinical skill training (CST) is indispensable for first-year surgical residents. It can usually be carried out through video-based flipped learning (FL) within a web-based learning environment. However, we found that residents lack the process of reflection, blindly imitating results in losing interest and passion for learning in the traditional teaching pattern. The teaching method of "spot the difference" (SDTM), which is based on the fundamentals of the popular game of "spot the difference," is designed to improve students' participation and reflective learning during skill training. This study aimed to evaluate this novel educational model's short-term and long-term effectiveness for surgical residents in China.

METHODS

First-year residents who required a three-month rotation in the head and neck surgery department were recruited to participate in a series of CSTs. They were randomized into SDTM and traditional FL (control) groups. Clinical skill performance was assessed with validated clinical skill scoring criteria. Evaluations were conducted by comparing the scores that contain departmental rotation skill examinations and the first China medical licensing examination (CMLE) performance on practical skills. In addition, two-way subjective evaluations were also implemented as a reference for the training results. Training effects were assessed using t tests, Mann-Whitney-Wilcoxon tests, chi-square tests, and Cohen' s effect size (d). The Cohen' s d value was considered to be small (<0.2), medium (0.2-0.8), or large (>0.8).

RESULTS

The SDTM group was significantly superior to the control group in terms of after-department skill examination (t=2.179, p<0.05, d=0.5), taking medical history (t=2.665, p<0.05, d=0.59), and CMLE performance on practical skill (t=2.103, p<0.05, d=0.47). The SDTM members rated the curriculum more highly than the control on the items relating to interestingness and participation (p < 0.05) with large effect sizes (d >0.8). There were no significant differences between the two groups on clinical competence (t=0.819, p=0.415, d=0.18), the first-time pass rate for CMLE (χ2 =1.663, p=0.197, d=0.29), and short-term operational skills improvement (t=1.747, p=0.084, d=0.39).

CONCLUSIONS

SDTM may be an effective method for enhancing residents' clinical skills, and the effect is significant both short- and long-term. The improvement effect seemed to be more significant in the peer-involved SDTM than training alone. However, despite positive objective results, SDTM still risks student learning burnout.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN10598469 , 02/04/2022，retrospectively registered.

Game-based learning in undergraduate nursing education: A systematic review of mixed-method studies

AIM

To investigate game-based learning in nursing education and summarize findings of its impact on nursing students' learning outcomes.

BACKGROUND

Nurses are the first point of contact for care and make up the largest proportion of the global health workforce. To respond effectively to the care needs of the population, nurses need to be adequately trained during their professional education. Game-based learning is increasingly becoming a strategy to complement simulation strategies in nursing education.

DESIGN

A systematic review of mixed-methods studies.

METHODS

A search was conducted in the electronic databases Medline, PubMed, Science Direct, Scopus and Web of Science. Quantitative, qualitative and mixed methods studies on nurse education published in English between 2000 and 2020 were considered. The Mixed Methods Assessment Tool was used for quality assessment. Data abstraction and synthesis was performed using a data extraction form.

RESULTS

A total of 46 studies from the 15 countries were included. The included studies were eight quantitative randomized controlled trials, 12 quantitative non-randomized controlled trials, 15 quantitative descriptive, five qualitative and six mixed methods studies. The results showed that game-based learning was used for many different courses or content in nursing education. Simulation games were the most used game type. Game-based learning facilitated the achievement of learning outcomes primarily in the cognitive domain. Some gamification elements and design-related aspects of game-based environments were evaluated as positive and negative. Game-based learning is a useful approach to assessing learning outcomes in only three studies.

CONCLUSION

Game-based learning is a useful method to achieve learning outcomes mainly in the cognitive domain, with some positive and negative aspects. Further research should investigate the effects of games on affective and behavioral learning outcomes, as well as the use of games to assess learning outcomes. Potential limitations of this review are that some studies could not be identified because of access issues and that some studies included participants other than nursing students.

Game-based learning approach on students' motivation and understanding of chemistry concepts: A systematic review of literature

The past decade has seen a significant shift from teacher-centered pedagogy to a learner-centered approach in chemistry education research. Game-based learning has emerged as one of the most beneficial instructional approaches because it emphasizes “hands-on” and “minds-on” activities in chemistry classrooms. However, there has been a scarcity of review studies in chemistry education research that have attempted to document different educational games implemented and how such games have contributed to enhancing students' motivation and understanding of chemistry concepts. A total of 57 articles were reviewed to identify educational games implemented in chemistry classrooms from 2010 to 2021 to address this gap. All the reviewed articles were downloaded from the Google Scholar search engine and have all been indexed by Scopus. A systematic analysis was adopted to identify the purposes, educational game designs and implementation, and the chemistry content areas of focus for all the reviewed studies. Results show that educational games enhance students’ conceptual understanding of chemistry and increase their motivation to learn and have fun while making sense of the learned content.

Exploring students' behavioral patterns when playing educational games with learning supports at different timings

The current study investigated students' gameplay behavioral patterns as a function of in-game learning supports delivery timing when played a computer-based physics game. Our sample included 134 secondary students (M = 14.40, SD = .90) from all over the United States, who were randomly assigned into three conditions: receiving instructional videos before a game level (n = 40), receiving instructional videos after a game level (n = 41), and without instructional videos (n = 53) while playing the game for about 150 min. We collected students' gameplay behavior data using game log files and employed sequential analysis to compare their problem-solving and help-seeking behaviors upon receiving instructional videos at different timings. Results suggested that the instructional videos, delivered either before or after a game level, helped students identify the correct game solution at the beginning of medium-difficulty game levels. Moreover, receiving the instructional videos delayed students' help-seeking behaviors-encouraging them to figure out game problems on their own before asking for help. However, receiving the instructional videos may possibly restrict students from creating diverse gaming solutions. Suggestions on design and implementation of in-game learning supports based on the findings are also presented.

The impact of using an "anatomy escape room" on nursing students: A comparative study

BACKGROUND

Anatomy is an important part of health science education. In teaching anatomy, new teaching strategies have been studied in comparison with traditional-based approaches. In this manner, strategies such as the escape room-based approach have been used as an innovative learning approach in nursing education, but little is known about its application in an Anatomy module.

OBJECTIVE

To evaluate the effectiveness of the escape room for anatomy-related knowledge retention in nursing and the perceived value of the game.

DESIGN

In the first semesters of the academic years 2017-2018 and 2018-2019, a comparative cross-sectional study was conducted.

SETTINGS

This study took place at the University of Almeria with students enrolled in the Anatomy module.

PARTICIPANTS

A total of 248 first-year nursing students took part in the study.

METHODS

The study included two groups: an experimental group (EG) that participated in an escape room in the final session of their Anatomy module, and a control group (CG) that received a traditional-based teaching approach in their final lesson.

RESULTS

Students enrolled in the Anatomy module were randomly assigned to either the experimental (EG, n = 128) or control groups (CG, n = 120). The escape room was conducted in groups of four and lasted no more than 15 min. In terms of satisfaction with the escape room, EG scored above the mean. The item "I enjoyed playing" received the highest score (4.88 ± 0.35). Taking the final scores of each group into account, the EG had a final average score of 8.94 ± 0.96, while the CG had a final average score of 7.70 ± 1.25 (p = 0.001).

CONCLUSIONS

According to the findings, the "Anatomy Escape Room" is a game-based approach that motivates students and constitutes a down-to-earth resource for anatomy learning in healthcare students.

Exploring the Effect of Augmented Reality on Cognitive Load, Attitude, Spatial Ability, and Stereochemical Perception

Augmented reality (AR) has the capacity to afford a virtual experience that obviates the reliance on using two-dimensional representations of 3D molecules for teaching stereochemistry to undergraduate students. Using a combination of quantitative instruments and qualitative surveys/interviews, this study explored the relationships between students' attitudes, perceived cognitive load, spatial ability, and academic performance when engaging in an asynchronous online stereochemistry activity. Our activity was designed using elements of game-based learning, and integrated AR technologies. The control group was provided with a copy of our activity that used two-dimensional drawings, whereas the AR group completed an activity using the AR technologies. For this cohort of students, results indicated significant improvement in academic performance in both the control and AR groups. The introduction of AR technologies did not result in the AR group outperforming the control group. Participants from both groups displayed significant improvements in spatial ability throughout the research period. Further, a moderate correlation (r _s = 0.416) between students' spatial ability and academic performance was found. No significant intergroup differences in the perceived cognitive loads of students were observed. A significant difference was observed on one item of the Intellectual Accessibility subscale of the ASCI (V2), Complicated-Simple. We found no correlation for student attitude or cognitive load with academic performance. The findings of this study provide insights for future AR-related studies to explore the role of spatial ability, student attitude, and cognitive load in learning performance.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10956-022-09957-0.

Exploring Kid Space in the wild: a preliminary study of multimodal and immersive collaborative play-based learning experiences

Parents recognize the potential benefits of technology for their young children but are wary of too much screen time and its potential deficits in terms of social engagement and physical activity. To address these concerns, related literature suggests technology usages with a blend of digital and physical learning experiences. Towards this end, we developed Kid Space, incorporating immersive computing experiences designed to engage children more actively in physical movement and social collaboration during play-based learning. The technology features an animated peer learner, Oscar, who aims to understand and respond to children's actions and utterances using extensive multimodal sensing and sensemaking technologies. To investigate student engagement during Kid Space learning experiences, an exploratory case study was designed using a formative research method with eight first-grade students. Multimodal data (audio and video) along with observational, interview, and questionnaire data were collected and analyzed. The results show that the students demonstrated high levels of engagement, less attention focused on the screen (projected wall), and more physical activity. In addition to these promising results, the study also enabled us to understand actionable insights to improve Kid Space for future deployments (e.g., the need for real-time personalization). We plan to incorporate the lessons learned from this preliminary study and deploy Kid Space with real-time personalization features for longer periods with more students.

Do technological knowledge and game-based learning promote students achievement: lesson from Indonesia

Continuous managing the quality of education in the Covid-19 pandemic has been a unique challenge, and the government has acknowledged to shift from conventional to screen adopting technology. This research attempts to examine the relationship between technological understanding, game-based learning, and students' achievements. This work engaged a quantitative approach with SEM-PLS to gain a deeper understanding of the connectivity among variables. The participants were senior high school students from several places in East Java of Indonesia. The findings indicate that technological knowledge, educational competence, computer skills play an essential role in supporting technology-based learning. However, this study notes that game-based learning in distance learning cannot act as a mediator in enhancing the students’ achievement. This study offers policy-makers the use of game-based learning in the learning process during synchronous learning using technology.

Learning experiences of game-based educational intervention in nursing students: A systematic mixed-studies review

BACKGROUND

To meet the evolving needs of today's nursing students and the demand for 21st century skills in modern healthcare, game-based learning has received increasing attention. It can improve learning outcomes, while enhancing learning experiences by promoting engagement and motivation.

OBJECTIVE

To explore the learning experiences of using game-based education in nursing students.

DATA SOURCES

Electronic databases of PubMed, EMBASE, Cochrane Library, CINAHL (EBSCOhost), and Scopus were searched from inception till January 2021.

REVIEW METHODS

Quantitative, qualitative, and mixed-methods studies were included, involving the use of games for education among nursing students. Both published and unpublished studies in English language without restrictions to the year of publication. Methodological quality of included studies was assessed using the mixed methods appraisal tool. Data synthesis used a convergent synthesis approach. Narrative synthesis was used for quantitative findings and thematic synthesis for qualitative findings. A result-based convergent synthesis was adopted to integrate both results.

RESULTS

A total of 53 studies were included among 4612 nursing students across 16 countries. These included 32 quantitative studies, 7 qualitative studies, and 14 mixed-methods studies, with methodological quality ranging from low to high. The findings from this review demonstrate that game-based education interventions can enhance nursing students' learning experiences. Three themes emerged from both quantitative and qualitative syntheses: 1) motivators of learning, 2) facilitators of engagement, and 3) affective response.

CONCLUSIONS

Game-based education is promising in promoting positive learning experiences among nursing students. This can better inform educators and healthcare leaders when considering gaming as an alternative education approach in motivating and engaging students in learning. Future research should provide greater focus on examining the use of specific games under similar contexts.

Escape-cardio: Gamification in cardiovascular physiotherapy. An observational study

INTRODUCTION

In recent years, innovative educational strategies of learning have appeared, to generate greater motivation in the students. Gamification has become popular in the educational area, including Escape Rooms. The primary aim of the study was to evaluate if this gamification activity led to better knowledge acquisition by the students, improving performance in their final exam. As a secondary objective, we surveyed the satisfaction of the students participating in the Educational Escape Room.

MATERIAL AND METHODS

An observational study of cases and controls was carried out. We designed an escape room based on the cardiovascular area of physiotherapy, titled Escape-Cardio. We provided scaffolded learning activities through the activity. Primary outcomes corresponded to the students' qualifications and the number of correct answers in the final exam. Qualitative questionnaire results of students of both courses were collected using a self-created survey, which was completed after the activity.

RESULTS

58 students participated in the Escape-Cardio. We observed better performance in the intervention group, improving their average mark and number of correct answers in the exam, with a statistically significant difference compared to the control group (p-value<0.05). In the qualitative assessment, students answered the survey, and all of them scored unanimously each item with the maximum score, aiming for 100% satisfaction.

CONCLUSION

Escape-Cardio students improved their professional knowledge application in the cardiovascular physiotherapy area in a statistically significant way. An excellent qualitative evaluation was achieved by them.

Blending team-based learning and game-based learning in pharmacy education

BACKGROUND AND PURPOSE

Team-based learning (TBL) and game-based learning (GBL) are evidence-based active learning pedagogies. This study reports a learning experience that harnesses TBL and GBL benefits by blending both pedagogies (referred herein as TGL) in the facilitation of an immunology module for pharmacy students. The manuscript presents the rationale for using TGL, a description of the TGL process, student outcomes and satisfaction with the learning experience, and TGL applicability in different topics/disciplines.

EDUCATIONAL ACTIVITY AND SETTING

Sixty-five students were divided into 12 teams. Pre-class foundational readiness material was posted one week before class. Student readiness was assessed via individual and team readiness assurance tests (iRAT/tRAT) mapped to learning objectives, with immediate instructor-mediated debrief. Then student teams worked toward solving clinical applications using evidence-based clinical information databases, e.g., UpToDate, Lexicomp. Finally, students were engaged in a competitive online game designed to review topic's key concepts and evaluate student knowledge individually post-learning experience.

FINDINGS

TGL process fulfilled learning outcomes, indicated by successful student performance in module-related assessments: iRAT = 92.5% ± 1.2; tRAT = 98.3% ± 1.1; educational game = 71.5% ± 3.6; block exam = 82.1% ± 5.3. Student survey indicated that >90% of students are satisfied with readiness material, alignment of activities with learning outcomes, engagement in active learning, gaining new relevant knowledge/skills/mindset, and merging TBL with GBL.

SUMMARY

Combining GBL with TBL allowed assessing student performance individually after the learning experience, an element that is not part of canonical TBL structure, to ensure students are prepared for high-stake/board exams. TGL can be applied in diverse topics/disciplines and is generalizable to small and large cohorts.

Technology-enhanced and game based learning for children with special needs: a systematic mapping study

Technology-based education of children with special needs has become the focus of many research works in recent years. The wide range of different disabilities that are encompassed by the term "special needs", together with the educational requirements of the children affected, represent an enormous multidisciplinary challenge for the research community. In this article, we present a systematic literature review of technology-enhanced and game-based learning systems and methods applied on children with special needs. The article analyzes the state-of-the-art of the research in this field by selecting a group of primary studies and answering a set of research questions. Although there are some previous systematic reviews, it is still not clear what the best tools, games or academic subjects (with technology-enhanced, game-based learning) are, out of those that have obtained good results with children with special needs. The 18 articles selected (carefully filtered out of 614 contributions) have been used to reveal the most frequent disabilities, the different technologies used in the prototypes, the number of learning subjects, and the kind of learning games used. The article also summarizes research opportunities identified in the primary studies.

The strengths and weaknesses of user-generated microgames for assisting learning

Recent developments in educational technology have led to a renewed interest in the utilisation of user-generated microgames for facilitating learning. The advantages and disadvantages of microgames which have been voluntarily created, modified, shared and used by users on open learning platforms to support learning are not yet clearly understood. The present study explores the strengths and weaknesses of user-generated microgames for assisting learning followed with some recommendations for the development and effective use of microgames from elementary teacher perspectives. This study is exploratory research conducted within the GeoGebra application with the participation of elementary school teachers from Indonesia. The study found that, on the one hand, user-generated microgames have multiple advantages to support learning mainly by their simplicity and short duration gameplay. On the other hand, the games have several disadvantages, especially due to the lack of content directly related to learning objectives and less interesting interfaces. It is recommended for users of open learning platforms to create more targeted microgames respecting a particular learning objective and for teachers to creatively connect games to learning for mastering knowledge, skills, or literacies.

A team-based competition for undergraduate medical students to learn radiology within the virtual world Second Life

Background

A multi-user competitive game within the virtual world Second Life for undergraduate radiology learning was adapted for team participation. This study aimed to assess student perception, impact on learning, and eventual correlation of game results with post-exposure tests and course grades.

Methods

The game consisted of six weekly stages, dedicated to thoracic, abdominal, and musculoskeletal radiological anatomy and semiology. Participants had several days a week to review self-guided radiology educational content and then complete individual multiple-choice tests and solve team tasks to progress through the game's ranking. Additionally, they completed a cognitive load test, a questionnaire about the experience and a post-exposure knowledge test.

Results

Fifty-two students organised into 13 teams participated in the game and assessed different aspects of the experience with a mean score ≥ 7.8 on a 10-point scale, highlighting the participation of the teacher (9.3 ± 1.1), the educational contents (8.8 ± 1.4) and the usefulness for their education (8.7 ± 1.4). Participants obtained better post-exposure test results (p < 0.007) and better course grades (p < 0.021) than non-participants did.

Conclusion

A multi-user game adapted to team competition to learn radiology in Second Life was very positively perceived by third-year medical students, who highly valued its content, organisation, and usefulness for their training. Most of the participants agreed that they had collaborated as a team and that playing in competitive environments helps them learn better. The best post-exposure and academic results compared to non-participating students indicate the potential impact of the game on learning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13244-021-01032-3.

Co-design of mini games for learning computational thinking in an online environment

Understanding the principles of computational thinking (CT), e.g., problem abstraction, decomposition, and recursion, is vital for computer science (CS) students. Unfortunately, these concepts can be difficult for novice students to understand. One way students can develop CT skills is to involve them in the design of an application to teach CT. This study focuses on co-designing mini games to support teaching and learning CT principles and concepts in an online environment. Online co-design (OCD) of mini games enhances students' understanding of problem-solving through a rigorous process of designing contextual educational games to aid their own learning. Given the current COVID-19 pandemic, where face-to-face co-designing between researchers and stakeholders could be difficult, OCD is a suitable option. CS students in a Nigerian higher education institution were recruited to co-design mini games with researchers. Mixed research methods comprising qualitative and quantitative strategies were employed in this study. Findings show that the participants gained relevant knowledge, for example, how to (i) create game scenarios and game elements related to CT, (ii) connect contextual storyline to mini games, (iii) collaborate in a group to create contextual low-fidelity mini game prototypes, and (iv) peer review each other's mini game concepts. In addition, students were motivated toward designing educational mini games in their future studies. This study also demonstrates how to conduct OCD with students, presents lesson learned, and provides recommendations based on the authors' experience.

Gamification of health professions education: a systematic review

Gamification refers to using game attributes in a non-gaming context. Health professions educators increasingly turn to gamification to optimize students' learning outcomes. However, little is known about the concept of gamification and its possible working mechanisms. This review focused on empirical evidence for the effectiveness of gamification approaches and theoretical rationales for applying the chosen game attributes. We systematically searched multiple databases, and included all empirical studies evaluating the use of game attributes in health professions education. Of 5044 articles initially identified, 44 met the inclusion criteria. Negative outcomes for using gamification were not reported. Almost all studies included assessment attributes (n = 40), mostly in combination with conflict/challenge attributes (n = 27). Eight studies revealed that this specific combination had increased the use of the learning material, sometimes leading to improved learning outcomes. A relatively small number of studies was performed to explain mechanisms underlying the use of game attributes (n = 7). Our findings suggest that it is possible to improve learning outcomes in health professions education by using gamification, especially when employing game attributes that improve learning behaviours and attitudes towards learning. However, most studies lacked well-defined control groups and did not apply and/or report theory to understand underlying processes. Future research should clarify mechanisms underlying gamified educational interventions and explore theories that could explain the effects of these interventions on learning outcomes, using well-defined control groups, in a longitudinal way. In doing so, we can build on existing theories and gain a practical and comprehensive understanding of how to select the right game elements for the right educational context and the right type of student.

Pharmacy student experience, preference, and perceptions of gaming and game-based learning

INTRODUCTION

The incorporation of serious games in higher education has shown improvement in student engagement and motivation to learn. Research that explores local pharmacy student preferences of gamification aspects of serious games is scarce. Therefore, this study was conducted to investigate local pharmacy student experience, preference, and perceptions of gaming and game-based learning.

METHODS

A cross-sectional study was conducted by distributing self-administered questionnaires among pharmacy students in Malaysia. Descriptive statistics, the Mann-Whitney test, the Kruskal-Wallis test, and the Spearman's correlation test were used for analysis.

RESULTS

A total of 328 pharmacy students enrolled in this study, and 84.1% (n = 276) had video game experience. Students usually played video games using mobile phones (n = 231, 70%). Pharmacy students showed positive perceptions regarding serious games with a mean score of 3.69. However, limited awareness and knowledge of serious games was observed among pharmacy students. The most preferred game genres were role-playing and strategy (n = 174, 53%). Pharmacy students also preferred playing a cooperative game style (n = 113, 34.5%) with scores as a reward system (n = 204, 62.6%). Over three quarters (n = 292, 89.3%) wanted to see the results of the assessment after the game.

CONCLUSIONS

This research provided information on serious games preferences of local pharmacy students. Further study should evaluate the acceptance and effectiveness of the implementation of serious games among pharmacy students in Malaysia.

Effectiveness of the game-based learning over traditional teaching-learning strategy to instruct pharmacology for Phase II medical students

BACKGROUND

Game-based education is fast becoming an innovative teaching approach in the field of medical education. Traditional review sessions (tutorials) are mainly focused on instructor-based learning and they help to review concepts previously taught in the lecture class. The primary objective was to evaluate the cognitive learning of students in game based learning (GBL) as compared to the conventional review sessions. The secondary objectives were to assess the perception and feedback of students regarding GBL and conventional review sessions.

MATERIALS AND METHODS

An interventional GBL study was designed for 2^nd year MBBS students. The enrolled students were randomly assigned to either tutorial (Group A) or GBL (Group B), and informed consent was obtained. Group B students were further divided into smaller groups, and for Group A, the traditional tutorial method was followed. For both the groups, a multiple choice question (MCQ) pre-test and post-test was conducted on the selected topics. A total of 15 MCQs with gradually increasing difficulty were used in the GBL. For each group of students, one student would be on hot seat by answering the questions and then continued the game. Lifelines were provided.

RESULTS

From the pretest and posttest scores, students performed better in Group B (39.53%) than Group A (18.43%) with respect to the knowledge score, and the difference was statistically significant. Students' perception and feedback regarding GBL were very enthusiastic and promising than the tutorial group. Largely, students commented that GBL was unique, active participation, fun, and novel learning style.

CONCLUSIONS

GBL is a student-centered learning and showed more effective than the traditional tutorials in understanding the topic and was more enjoyable by students.

Outcomes of the implementation of game-based anatomy teaching approaches: An overview

OBJECTIVE

We aimed to investigate to what extent the literature supports that game-based learning (gamification) could play a significant role in anatomy education.

MATERIALS AND METHODS

PubMed, Education Resources Information Center and Cochrane Databases were searched for papers with purpose to investigate the educational outcomes of game-based anatomy learning. We extracted from each paper the number of participants, type of study (comparative or not), level of evidence according to Kirkpatrick hierarchy, possible evaluation of statistical significance, method which was implemented, academic performance of participants after the educational intervention, perceptions about the effectiveness of game-based approach and its impact on motivation to learn.

RESULTS

Eight papers were included. Six of them were comparative, comprised assessment of students' examinations results and showed that those results were generally improved after exposure to game-based methods, in comparison with non-game-based ones. There is lack of evidence that the intensity of competition is correlated with the educational outcomes and that game-based approaches motivate students to a greater extent in comparison with other teaching methods.

CONCLUSION

Game-based methods could obtain a remarkable supplemental role in the blended learning approach, which is applied by anatomy educators. Further research is needed to shed light on the characteristics of game-based methods which are more useful and should be adopted.

Contextualized game-based intervention for digital literacy for the Pacific Islands

In the digital age, advocating and improving digital literacy is a global challenge. There have been scales developed to measure individuals' digital literacy competencies; however, intervention programs have been only a few. This research paper articulates design details, validity, reliability and effectiveness of a new online modulated digital literacy intervention program (DLIP). For the development of DLIP, digital literacy is stipulated in this research as a universal framework that consists of six different literacies; media, information, technology, computer, visual, and communication literacy. An online module has been designed for each of these six literacies, and the concept of game-based learning has been used to engage the users and secure high user satisfaction. To test the reliability of the intervention, the Kuder- Richardson- 20 (KR-20) test was performed. The developed intervention was deemed to be reliable with the KR-20 value of 0.86. The construct validity was measured using the spearman's correlation test and since the values for all the constructs were above 0.3, the DLIP was valid. The effectiveness of the DLIP was evaluated by calculating the effect size. The Cohen's d test was used and the results show that the intervention was moderately effective. Although DLIP has been developed for the Pacific Islands it has global applicability.

The Effects of Scientific Self-efficacy and Cognitive Anxiety on Science Engagement with the "Question-Observation-Doing-Explanation" Model during School Disruption in COVID-19 Pandemic

Game-based learning supported by mobile intelligence technology has promoted the renewal of teaching and learning models. Herein, a model of Question-Observation-Doing-Explanation (QODE) based on smart phones was constructed and applied to science learning during school disruption in COVID-19 pandemic. In this study, from the theoretical perspective of cognitive-affective theory of learning with media, Bandura's motivation theory and community of inquiry model, self-report measure was used to verify the effect of students' scientific self-efficacy and cognitive anxiety on science engagement. A total of 357 valid questionnaires were used for structural equation model research. The results indicated that two types of scientific self-efficacy, as indicated by scientific learning ability and scientific learning behavior, were negatively associated with cognitive anxiety. In addition, cognitive anxiety was also negatively correlated to four types of science engagement, as indicated by cognitive engagement, emotional engagement, behavioral engagement, and social engagement through smartphone interactions. These findings provide further evidence for game-based learning promoted by smart phones, contributing to a deeper understanding of the associations between scientific self-efficacy, cognitive anxiety, and science engagement. This study points out that the QODE model is suitable for implementing smart mobile devices to students' science learning.

Examining the Technological Pedagogical Content Characteristics of Games for Medical Education

Virtual learning environments (VLEs) such as games can greatly enhance medical education curriculum. In this monograph, we argue for the importance of identifying existing VLEs and analyzing their characteristics in order for medical educators to establish alignment with their curricular goals. We introduce the co-opted technological pedagogical content knowledge framework as an analytical lens for examining the context-attuned design features of games [1]. We apply the lens to study three games designed to advance medical education; namely, CD4 Hunter, Septris, and Microbe Invader. We conclude with implications for enhancing medical education curricula through the incorporation of digital games.

Expertise and Engagement: Re-Designing Citizen Science Games With Players' Minds in Mind

Many studies have already shown that games can be a useful tool to make boring or difficult tasks more engaging. However, with serious game design being a relatively nascent field, such experiences can still be hard to learn and not very motivating. In this paper, we explore the use of learning and motivation frameworks to improve player experience in the well-known citizen science game Foldit. Using Cognitive Load Theory (CLT) and Self Determination Theory (SDT), we developed six interface and mechanical changes to the tutorial levels in Foldit designed to increase engagement and retention. We tested these features with new players of Foldit and collected both behavioral data, using game metrics, and prior experience data, using self-report measures. This study offers three major contributions: (1) we document the process of operationalizing CLT and SDT as new game features, a unique methodology not used in game design previously; (2) the user interface, specifically the level selection screen, significantly impacts how players progress through the game; and (3) a player's expertise, whether from prior domain knowledge or prior gaming experience, increases their engagement. We discuss both implications of these findings as well as how these implementations can generalize to other designs.

Using Kahoot! as a formative assessment tool in medical education: a phenomenological study

BACKGROUND

Gamification is an increasingly common phenomenon in education. It is a technique to facilitate formative assessment and to promote student learning. It has been shown to be more effective than traditional methods. This phenomenological study was conducted to explore the advantages of gamification through the use of the Kahoot! platform for formative assessment in medical education.

METHODS

This study employed a phenomenological design. Five focus groups were conducted with medical students who had participated in several Kahoot! sessions.

RESULTS

Thirty-six categories and nine sub-themes emerged from the focus group discussions. They were grouped into three themes: attractive learning tool, learning guidance and source of motivation.

CONCLUSIONS

The results suggest that Kahoot! sessions motivate students to study, to determine the subject matter that needs to be studied and to be aware of what they have learned. Thus, the platform is a promising tool for formative assessment in medical education.