Game element appraisals and learning outcomes in a game-based child development course for medical students

Abstract

Educational games are often evaluated as unitary interventions, and little is known about how learners appraise individual game elements or how these appraisals relate to experiential and cognitive outcomes. We examined these associations in a board game–based child-development course. This single-center, nonrandomized, curriculum-based educational study included 103 fifth-year medical students across 13 clerkship blocks. All students participated in the standard clerkship curriculum and received the same game-based learning (GBL) activity, with pre- and post-tests used to evaluate learning outcomes. Seven blocks received early GBL during week 1 or 2 (game-based group [GBG]; n = 56), whereas six blocks followed the conventional teaching curriculum until completion of the week-4 post-test and subsequently received GBL (conventional teaching group [CTG], representing the delayed-GBL group; n = 47). A linear mixed-effects model compared post-test scores between groups while adjusting for pre-test score and accounting for clustering within clerkship blocks. Within the GBG, exploratory models examined associations among game-element appraisals, Flow State Questionnaire (FSQ) scores, and post-test performance. Benjamini–Hochberg procedures controlled the false discovery rate (FDR). Adjusted post-test means were 3.671 (standard error [SE] = 0.145) for the GBG and 2.635 (SE = 0.158) for the CTG. The adjusted between-group difference was 1.036 points (95% confidence interval [CI], 0.560 to 1.513; p < .001). All 10 game elements were highly rated. Nine appraisal–flow associations met the FDR criterion: six for enjoyment, two for sense of control, and one for engagement. Among cognitive models, only teamwork appraisal showed an inverse marginal association with adjusted post-test performance (coefficient = − 0.811; 95% CI, − 1.283 to − 0.339; FDR-adjusted q = 0.0113). No FSQ subscale was significantly associated with post-test performance. The GBG had higher adjusted post-test scores than the CTG under the observed schedules, but differences in assessment timing and intervening clerkship exposure prevent attribution to game-based learning alone. Appraisal associations were detected more frequently for flow than for knowledge performance, and no statistically significant flow-knowledge associations were detected. The findings motivate a hypothesis that experiential and cognitive outcomes may involve partly distinct processes. This hypothesis requires prospective testing.