Effectiveness of game-based learning for learning Anesthetic drug in Anesthesiology resident

Effectiveness of game-based learning for learning Anesthetic drug in Anesthesiology resident | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of game-based learning for learning Anesthetic drug in Anesthesiology resident Santi Anchalee, Chanya Deekiatphaiboon, Sumidtra Prathep, Wilasinee Jitpakdee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5873475/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Active learning, particularly game-based learning, is an effective method for increasing participant engagement, fostering learners’ motivation, and promoting dynamic knowledge acquisition. The "Basic Pharmacology for Anesthesia" card game was created and evaluated for its effectiveness in teaching first- to third-year anesthesiology residents. Additionally, the study aimed to assess the trainees' satisfaction levels regarding learning through card games. Methods Nineteen anesthesiology residents participated in this cross-sectional observational study conducted at the Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University. The measured variables included pretest scores, posttest scores, and feedback and satisfaction ratings. Game-based learning was introduced prior to the posttest. The objective of the game was for players to collect a complete set of five cards for a specific anesthetic drug. The deck consisted of 55 cards representing 11 anesthetic drugs, each card detailed the drug’s name, dosage, onset and duration, contraindications, side effects, and metabolism or pharmacology. The test had a total score of 20 points, and satisfaction was assessed using a five-point Likert scale. Results A comparison of the pretest and posttest scores revealed improvements across all categories: 5.25 vs. 7.50 (p < 0.001) for induction drugs, 2.75 vs. 4.00 (p < 0.001) for volatile anesthetics, and 6.50 vs. 7.50 for neuromuscular agents. Additionally, the total score significantly increased from 13.75 on the pretest to 19 on the posttest. The overall satisfaction level was 4.84 (SD = 0.37). Conclusions Game-based learning can enhance anesthesiology residents' understanding of anesthetic drugs and has shown high levels of satisfaction. However, to achieve a more comprehensive evaluation, additional assessment methods, such as measuring learner engagement and comparing the outcomes of game-based learning with traditional teaching methods, should be implemented. Game-based learning card game anesthetic drug anesthesiology resident medical education Figures Figure 1 Figure 2 Background In the past, medical education predominantly relied on classical lectures and instructional materials, which lacked flexibility to accommodate diverse student learning styles. This traditional approach often left students feeling bored, disengaged, and struggling to retain information due to limited interaction with instructors. As concerns grew over the effectiveness of the teacher-centered model, alternative teaching strategies gained prominence. Active learning methods, for instance, have been shown to enhance both academic performance and student motivation while reducing learning challenges and failures [ 1 ]. Recent trends in educational research emphasize the importance of the learning process, innovative teaching methods, and curriculum development, aiming to foster sustained educational success. The anesthesiologist training program equips trainees with the complex competencies necessary for their profession. Trainees must develop expertise in both technical and non-technical skills to excel in this specialized field. A phenomenographic study provided qualitative insights into the process of learning anesthesia, categorizing the findings into three themes: 'Learning Competencies in Anesthesia,' 'Learning the Work of an Anesthesiologist,' and 'Learning to Be an Anesthetic Professional.' These themes are further linked to six dimensions, one of which is 'Learning Resources,' also referred to as fundamental theoretical knowledge. Within this framework, trainees employ diverse methods to acquire these competencies, such as self-directed learning through guidelines and textbooks, discussions with peers, and consultations with nurses they collaborate with [ 2 ]. For this reason, a variety of educational materials is essential in medical schools to support trainees through different learning methods and approaches. At the Anesthesiology Department of Prince of Songkla University, our training curriculum follows a competency-based design. Emphasizing practical application, most trainee activities involve immersion in real-life scenarios and everyday practices, fostering the development of diverse competencies. However, certain topics, such as clinical pharmacology, basic anatomy and physiology, and fundamental principles of general anesthesia, are taught through traditional lectures. These subjects are covered in the first year of training to establish a solid foundation in basic sciences. Despite this approach, we have observed that some trainees struggle to translate their theoretical knowledge into clinical practice. This realization has highlighted the limitations of a lecture-based teaching model, which may not effectively address the learning needs of all trainees. Active learning methods may be the key success of improving the situation. “Serious Games” is the effective method to increase participant engagement, to foster learners’ motivation, to promote knowledge acquisition in the dynamic way. The meaning of serious game was likely defined in 1970 by Clark Abt. as “the games in the sense that have an explicit and carefully thought-out educational purpose”[ 3 ]. The important is they are not intended to be played primarily for amusement [ 3 , 4 ]. The recent medical education literatures of serious games are pay attention to computer-based game or digital game [ 5 ]. Some journals define serious games as the only digital platforms, which renders the concept of them seemingly narrower in scope than it truly is [ 4 ]. Card game and board game in the purpose of promote medical education certainly be classified in the serious game, eg; “Happy Familly”[ 6 ], and “GridlockED”[ 7 ]. Both tabletop games, such as card games and board games, are helpful for memorization, useful for understanding complicated topics, and promote cognitive processes in low-stakes situations. Other strengths include their simplicity of preparation, requiring minimal time investment, and enable to replay for learners[ 6 , 7 , 8 ]. Hence, we created a game in theme ‘Basic Pharmacological for Anesthesia’ to be a material for promote trainee learning process. The 'Basic Pharmacological for Anesthesia ' card game was created and evaluated for its effectiveness in instructing first to third-year anesthesiology residents. Additionally, its aim was to gauge trainees' satisfaction levels regarding learning through card games. Methods The study employed a cross-sectional observational design and was conducted in the Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University. The study was approved by the Office of the Human Research Ethics Committee, Faculty of Medicine, Prince of Songkla University, Thailand (REC.66-429-8-1). The intervention, which involved game-based learning, took place on February 7, 2024. Participants were anesthesiology resident trainees. Prior to their participation, informed consent was obtained. A clinical trial registry was not applicable to our study. The variables measured in the study included pre-test scores, post-test scores, and feedback and satisfaction ratings. The pre-test and post-test consisted of identical short-essay questions designed to assess knowledge. The test had a total score of 20 marks, distributed as follows: 8 marks for induction drugs, 4 marks for volatile anesthetics, and 8 marks for neuromuscular drugs. Details of the short-essay questions are provided in Supplement 1. Feedback and satisfaction were assessed across six domains using a five-point Likert scale, ranging from 1 (Very dissatisfied) to 5 (Very satisfied). The card game was designed as an interactive learning tool, focusing on anesthetic drugs and their pharmacologic properties. The objective of the game is for players to collect a complete set of five cards for a specific anesthetic drug. The deck comprises 55 cards representing 11 anesthetic drugs ( Propofol, Thiopental, Ketamine, Midazolam, Etomidate, Cisatracurium, Rocuronium, Succinylcholine, Sevoflurane, Desflurane , and Nitrous Oxide ), with each drug having cards detailing its name, dosage, onset and duration, contraindications and side effects, and metabolism or pharmacology (Fig. 1). The game accommodates 3–8 players. At the start, the deck is shuffled, and each player is dealt five cards, with the remaining cards forming the "draw pile" in the center. Players take turns discarding an unwanted card, passing it to the next player in a clockwise direction, and drawing one card from the draw pile. Each subsequent player decides whether to take the discarded card or draw a new one, discarding a card from their hand afterward. Play continues until a player collects a complete set of cards for one drug, becoming the winner and sharing their set with others to enhance learning about that drug. The game continues to determine additional winners, following the same process, until only two players remain, at which point one final winner is declared while the other is unable to complete a set. Sample size The effectiveness of game-based learning was assessed by evaluating knowledge gain through pre-test and post-test results. The sample size calculation was based on the formula for testing one population mean. A previous study investigated the use of a serious game for teaching medical students about cleft lip and palate treatment. That study reported a pre-test mean (SD) score of 12.23 (2.21) and a post-test mean (SD) score of 14.43 (1.66) out of a total of 17 points. The sample size calculation for testing one population mean was conducted using the n4Studies Plus application [ 9 , 10 , 11 ]. The output for a two-tailed test included the following parameters: Z(0.975) = 1.96, Z(0.8) = 0.84, Reference value (µ0) = 12.23, Mean (µ) = 14.43, Standard deviation (σ) = 1.66 Based on these inputs, the calculated sample size was n = 4.46n = 4.46. Rounding up, the final required sample size was determined to be 5. Statistical methods Continuous data were expressed as means (standard deviation (SD)), while categorical data were presented as frequencies (percentages). Continuous variables were analyzed using a Wilcoxon rank-sum test. Data management and analysis were performed using R software, version 4.3.3. Results The residents involved in the research consisted of 42.1% first-year residents, 21.1% second-year residents, and 36.8% third-year residents. Among the participants, 42.1% were male (Table 1 ). Comparison of the pretest and posttest scores revealed improvements in all categories: 5.25 vs. 7.50 (p < 0.001) for induction drugs, 4.00 2.75 vs. 4.00 (p < 0.001) for volatile anesthetics, and 6.50 vs. 7.50 for neuromuscular agents. Additionally, the total score significantly increased from 13.75 on the pretest to 19 on the posttest (Table 2 ). Subgroup analysis by year of residency revealed that second-year residents showed no significant difference between pretest and posttest scores (Table 3 ), while first-year and third-year residents demonstrated significant improvements (Fig. 2 ). The satisfaction survey used a 5-point scale, where 5 = Very Satisfied, 4 = Satisfied, 3 = Neutral, 2 = Dissatisfied, and 1 = Very Dissatisfied. The level of knowledge gained through game-based learning was rated 4.84 (0.37), and the application of this knowledge was rated 4.95 (0.23). The appropriateness of the game format was rated 4.84 (0.37), while the feasibility of playing the game received a rating of 4.68 (0.48). The optimal number of cards for the game was rated 4.42 (0.69), and the overall satisfaction level was 4.84 (0.37) (Table 4 ). Several suggestions were made by residents to enhance game-based learning. First, it was recommended to limit the number of players per round to optimize gameplay. Second, displaying the details of the cards to all players was suggested to facilitate learning. Third, ensuring that the images on the cards correspond with the data would improve recall. Additionally, some feedback highlighted issues such as the small font size, the thinness of the cards, and their oversized dimensions, which made them difficult to handle. Despite these criticisms, many respondents praised the game for being enjoyable and effective in helping them acquire knowledge. Discussion Our research offered anesthesiology residents an opportunity to deepen their understanding of commonly used anesthetic drugs in clinical practice. The program covered various drug groups, with a focus on their indications, contraindications, pharmacokinetics, and pharmacodynamics. Given that safety is a top priority in anesthetic practice, a thorough understanding of these drug properties is essential. Game-based learning, implemented as a card game, proved to be an effective method for teaching anesthetic drug concepts, as evidenced by statistically significant improvements in pre-test and post-test scores. Additionally, overall satisfaction was rated between 'satisfied' and 'very satisfied'. The game-based learning approach in our research utilized a serious game, in which players actively engaged with the game to acquire knowledge. This contrasts with gamification, where gaming elements are incorporated as only one part of the learning process [ 12 ]. Serious games offer numerous benefits, including promoting active participation, enhancing problem-solving abilities, improving clinical reasoning and decision-making skills, and encouraging teamwork [ 13 , 14 , 15 ]. The game design in our research was implemented as a card game due to its simplicity and the shorter development time compared to digital games. However, serious games can be designed in various formats, including card games, board games, or digital games, depending on the intended objectives and resources available [ 4 ]. The outcomes for evaluating game-based learning in our research were knowledge gain and satisfaction. However, the evaluation of learning management using game-based learning can encompass various aspects, including assessing the game's effectiveness in enhancing learners' knowledge [ 16 , 17 , 18 , 19 ], evaluating satisfaction with game-based learning activities [ 17 , 20 ], measuring learner engagement [ 21 , 22 ], and comparing the outcomes of game-based learning with those of traditional teaching methods [ 23 ]. To achieve a more comprehensive evaluation, additional assessment methods can be applied. Limitations There were several limitations in our study. First, the sample size was limited to our anesthesiology resident trainees, which may reduce the generalizability of the findings. To address this limitation, future studies could include participants from other institutions or adopt a multi-center approach. Secondly, the study faced time constraints. The posttest was conducted immediately after the game-based learning session, primarily assessing short-term memory. The study did not evaluate or provide insights into long-term memory retention, which could be explored in future research. Thirdly, the measurement tools used, such as the short-answer questions, may not have fully captured the knowledge gained from the game-based learning method. Future studies could employ a more comprehensive assessment framework to better evaluate knowledge acquisition. Finally, the scope of the study was confined to commonly available anesthetic drugs within our institution. This limited scope excluded certain drug categories, such as other induction agents, neuromuscular blocking drugs, and volatile anesthetics, which could be included in future studies to enhance the breadth of the findings. Conclusion Game-based learning can enhance anesthesiology residents' understanding of anesthetic drugs and has shown high levels of satisfaction. However, to achieve a more comprehensive evaluation, additional assessment methods, such as measuring learner engagement and comparing the outcomes of game-based learning with traditional teaching methods, should be implemented. Declarations We have no potential conflict of interest . Ethics approval and consent to participate This study was approved by the Office of the Human Research Ethics Committee, Faculty of Medicine, Prince of Songkla University, Thailand (REC.66-429-8-1). The participants provided informed consent to participate in the study. Clinical trial number Not applicable Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. We provide details of the game card in the supplementary section. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Faculty of Medicine, Prince of Songkla University. Authors' contributions Santi Anchalee: Conceptualization, methodology, data collection, analysis and writing -original draft. Chanya Deekiatphaiboon: Conceptualization, methodology, data collection, analysis and writing – review & editing. Sumidtra Prathep: Conceptualization, methodology, data collection, analysis and writing – review & editing. Wilasinee Jitpakdee: Conceptualization, methodology, and writing – review & editing. Acknowledgements We would like to acknowledge Ms. Jirawan Jayuphan, a statistician at the Faculty of Medicine, Prince of Songkla University, for her assistance with data cleaning and statistical analysis. References Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, Wenderoth MP. Active learning increases student performance in science, engineering, and mathematics. Proceedings of the National Academy of Sciences. 2014;111(23):8410-5. Chin H, Ingerman Å, Hergès HO. Anesthesiologists’ conceptions of learning anesthesia in the context of their specialty training program: a phenomenographic study. BMC Med Educ. 2023;23(1):594. Abt CC. Serious Games. New York: Viking Compass; 1970. Cosimini MJ, Watsjold B, Chan TM. Serious Games Without Screens. Comment on Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review. JMIR Serious Games. 2022;10(1):e34656. Wang R, DeMaria SJ, Goldberg A, Katz D. A Systematic Review of Serious Games in Training Health Care Professionals. Simul Healthc. 2016;11(1):41–51. Hage R, Fourré A, Ramonfosse L, Leteneur S, Jones M, Dierick F. Description and rules of a new card game to learn clinical reasoning in musculoskeletal physiotherapy. J Man Manip Ther. 2023;31(4):287–96. Brar G, Lambert S, Huang S, Dang R, Chan TM. Using Observation to Determine Teachable Moments Within a Serious Game: A GridlockED as Medical Education (GAME) Study. AEM Educ Train. 2021;5(2):e10456. Muthiyan G, Kasat P, Vij V, Solanki RS, C K, Sontakke B. Effectiveness of an Innovative Card Game as a Supplement for Teaching Factual Content to Medical Students: A Mixed Method Study. Cureus. 2023;15(10):e47768. Ngamjarus C, Pattanittum P. n4Studies Plus: application for sample size calculation in health science research. Version 1.4. App store; 2024. Chow S-C, Shao J, Wang H. Sample size calculations in clinical research. 2nd ed. Boca Raton, FLA: Chapman and Hall/CRC; 2003. p. p51. Ngamjarus C. Sample size calculation for health science research. 1st ed. Khon Kaen, Thailand: Khon Kaen University Printing House; 2021. Xu M, Luo Y, Zhang Y, Xia R, Qian H, Zou X. Game-based learning in medical education. Front Public Health. 2023;11:1113682. Akl EA, Kairouz VF, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel C, Schünemann H. Educational games for health professionals. Cochrane Database Syst Rev. 2013;2013(3). Tsoy D, Sneath P, Rempel J, Huang S, Bodnariuc N, Mercuri M, Pardhan A, Chan TM. Creating GridlockED: A Serious Game for Teaching About Multipatient Environments. Acad Med. 2019;94(1):66–70. Min A, Min H, Kim S. Effectiveness of serious games in nurse education: A systematic review. Nurse Educ Today. 2022;108:105178. Palee P, Wongta N, Khwanngern K, Jitmun W, Choosri N. Serious Game for Teaching Undergraduate Medical Students in Cleft lip and Palate Treatment Protocol. Int J Med Inf. 2020;141:104166. Jaunay LB, Zerr P, Peguin L, Renouard L, Ivanoff AS, Picard H, Griffith J, Chassany O, Duracinsky M. Development and Evaluation of a New Serious Game for Continuing Medical Education of General Practitioners (Hygie): Double-Blinded Randomized Controlled Trial. J Med Internet Res. 2019;21(11). Diehl LA, Gordan PA, Esteves RZ, Coelho IC. Effectiveness of a serious game for medical education on insulin therapy: a pilot study. Arch Endocrinol Metab. 2015;59(5):470–3. Hu H, Xiao Y, Li H. The Effectiveness of a Serious Game Versus Online Lectures for Improving Medical Students' Coronavirus Disease 2019 Knowledge. Games Health J. 2021;10(2):139–44. Chon SH, Timmermann F, Dratsch T, Schuelper N, Plum P, Berlth F, Datta RR, Schramm C, Haneder S, Späth MR, Dübbers M, Kleinert J, Raupach T, Bruns C, Kleinert R. Serious Games in Surgical Medical Education: A Virtual Emergency Department as a Tool for Teaching Clinical Reasoning to Medical Students. JMIR Serious Games. 2019;7(1). Walker J, Heudebert JP, Patel M, Cleveland JD, Westfall AO, Dempsey DM, Guzman A, Zinski A, Agarwal M, Long D, Willig J, Lee R. Leveraging Technology and Gamification to Engage Learners in a Microbiology Curriculum in Undergraduate Medical Education. Med Sci Educ. 2022;32(3):649–55. López-Jiménez JJ, Fernández-Alemán JL, González LL, Sequeros OG, Valle BM, García-Berná JA, Idri A, Toval A. Taking the pulse of a classroom with a gamified audience response system. Comput Methods Programs Biomed. 2022;213:106459. Tubelo RA, Portella FF, Gelain MA, de Oliveira MMC, de Oliveira AEF, Dahmer A, Pinto MEB. Serious game is an effective learning method for primary health care education of medical students: A randomized controlled trial. Int J Med Inf. 2019;130:103944. Supplement 1 Pre-test and post-test. Tables Table 1 Baseline characteristics of participants Variable N = 19 Sex Female 11 (57.9%) Male 8 (42.1%) class First year resident 8 (42.1%) Second year resident 4 (21.1%) Third year resident 7 (36.8%) Table 2 The results of knowledge comparison between pre-test and post-test. Variables pretest posttest p-value Induction drug (8) 5.25 (4.50,5.75) 7.50(7.125,8.00) 0.0002115 Anesthetic volatile (4) 2.75(2.25,3.00) 4.00(4.00,4.00) 0.0002796 Neuromuscular agent (8) 6.50(6.125,7.00) 7.50(7.125,8.00) 0.000895 Total score (20) 13.75(13.00,15.25) 19.00(18.25,19.75) 0.0001412 Table 3 The results of knowledge comparison between pre-test and post-test classified by each year of resident Variables pretest posttest p-value First year resident Induction drug (8) 4.625(3.938,5.50) 7.00(6.938,7.438) 0.02225 Anesthetic volatile (4) 2.750(2.00,3.00) 4(4,4) 0.0213 Neuromuscular agent (8) 7.00(6.875,7.625) 7.750(6.875,8.00) 0.1675 Total score (20) 13.88(13.31,14.88) 18.62(17.94,19.25) 0.01415 Second year resident Induction drug (8) 5.125(4.125,5.812) 7.625(7.250,8.00) 0.125 Anesthetic volatile (4) 2.75(2.50,3.00) 4.00(3.75,4.00) 0.1736 Neuromuscular agent (8) 6.250(5.750,6.625) 7.625(7.500,7.812) 0.125 Total score (20) 13.25(12.88,14.06) 19.38(18.94,19.50) 0.125 Third year resident Induction drug (8) 5.500(5.125,5.750) 8.00(7.75,8.00) 0.02225 Anesthetic volatile (4) 2.75(2.250,3.00) 4.00(4.00,4.00) 0.0209 Neuromuscular agent (8) 6.500(6.125,6.750) 7.50(7.125,8.00) 0.01563 Total score (20) 14.75(13.25,15.25) 19.25(19.00,20.00) 0.01563 Table 4 Results of Feedback and Satisfaction Scores (Level of satisfaction; 5 = Very satisfied, 4 = Satisfied, 3 = Neutral, 2 = Dissatisfied, 1 = Very dissatisfied) Variable Mean (SD) min max 1.How much knowledge have you gained from playing game-based learning? 4.84(0.37) 4 5 2.How much can the knowledge you gained be applied? 4.95(0.23) 4 5 3.Is the format of the game appropriate or not? 4.84(0.37) 4 5 4. The level of difficulty or ease of playing the game is suitable for the player. 4.68(0.48) 4 5 5.The optimal number of cards to play the game. 4.42(0.69) 3 5 6.The level of overall satisfaction. 4.84(0.37) 4 5 Total scores 28.58(1.98) 23 30 Additional Declarations No competing interests reported. Supplementary Files Supplement1Pre.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 31 Jan, 2025 Editor assigned by journal 29 Jan, 2025 Submission checks completed at journal 29 Jan, 2025 First submitted to journal 21 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5873475","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":408639044,"identity":"8272165e-4329-4292-8fa0-fa3cfa193996","order_by":0,"name":"Santi Anchalee","email":"","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":false,"prefix":"","firstName":"Santi","middleName":"","lastName":"Anchalee","suffix":""},{"id":408639045,"identity":"677e4cf5-1f2e-412d-903c-32a8054926fe","order_by":1,"name":"Chanya Deekiatphaiboon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYDACCQjF2I8uQljLzAaoAA/RWjYcIFYL/+zmZ495ahhkN99ufybBUGPHYC/dgF+LxJ1j5sY8xxiMt905YybBcCyZgUfmAH4tBhIJZtI8bAyJ227ksEkwsB0AOiyBkJb0b9I8/xgSN89IBzrsH1FacsykedsYEjcArZNgbCNCi8SNnDLJuX0SxjPunDG2SOxL5uG5QUAL/4z0bRJvvtnI9s9uf3jjwzc7OfYZBLSAABMPKHZA0QFUzENYPRAw/gA7kSi1o2AUjIJRMBIBAE70OzwyTfvbAAAAAElFTkSuQmCC","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":true,"prefix":"","firstName":"Chanya","middleName":"","lastName":"Deekiatphaiboon","suffix":""},{"id":408639046,"identity":"926521de-7b10-45ab-89f9-7cf4ceacb75b","order_by":2,"name":"Sumidtra Prathep","email":"","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":false,"prefix":"","firstName":"Sumidtra","middleName":"","lastName":"Prathep","suffix":""},{"id":408639047,"identity":"9cfcca12-f15a-4fa7-bb17-92bf6a59262b","order_by":3,"name":"Wilasinee Jitpakdee","email":"","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":false,"prefix":"","firstName":"Wilasinee","middleName":"","lastName":"Jitpakdee","suffix":""}],"badges":[],"createdAt":"2025-01-21 12:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5873475/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5873475/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75189283,"identity":"8c96e9a1-4cbf-4834-a1d9-299c61344392","added_by":"auto","created_at":"2025-01-31 18:03:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":416135,"visible":true,"origin":"","legend":"\u003cp\u003eThe card game: Anesthetic drug\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5873475/v1/ad6bee69a620230e0d7ba7e5.png"},{"id":75190785,"identity":"d93e7022-dc6a-4ef6-b9c6-dd8abdfefb29","added_by":"auto","created_at":"2025-01-31 18:11:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18227,"visible":true,"origin":"","legend":"\u003cp\u003eThe box plot comparing pre-test and post-test results, classified by each year of residency\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5873475/v1/cc212f2a97856dde584cb038.png"},{"id":75191204,"identity":"38060759-a206-454d-bf1c-70ee5b6e8770","added_by":"auto","created_at":"2025-01-31 18:19:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":991495,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5873475/v1/d57b4fe2-9b51-441f-b570-6b828cb454f5.pdf"},{"id":75189292,"identity":"bdb17c6d-973d-4d6e-ba8a-cd5c1e5b3a50","added_by":"auto","created_at":"2025-01-31 18:03:30","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15415,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1Pre.docx","url":"https://assets-eu.researchsquare.com/files/rs-5873475/v1/eb9337d071f3bb52f915dd21.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of game-based learning for learning Anesthetic drug in Anesthesiology resident","fulltext":[{"header":"Background","content":"\u003cp\u003eIn the past, medical education predominantly relied on classical lectures and instructional materials, which lacked flexibility to accommodate diverse student learning styles. This traditional approach often left students feeling bored, disengaged, and struggling to retain information due to limited interaction with instructors. As concerns grew over the effectiveness of the teacher-centered model, alternative teaching strategies gained prominence. Active learning methods, for instance, have been shown to enhance both academic performance and student motivation while reducing learning challenges and failures [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Recent trends in educational research emphasize the importance of the learning process, innovative teaching methods, and curriculum development, aiming to foster sustained educational success.\u003c/p\u003e \u003cp\u003eThe anesthesiologist training program equips trainees with the complex competencies necessary for their profession. Trainees must develop expertise in both technical and non-technical skills to excel in this specialized field. A phenomenographic study provided qualitative insights into the process of learning anesthesia, categorizing the findings into three themes: 'Learning Competencies in Anesthesia,' 'Learning the Work of an Anesthesiologist,' and 'Learning to Be an Anesthetic Professional.' These themes are further linked to six dimensions, one of which is \u003cem\u003e'Learning Resources,'\u003c/em\u003e also referred to as fundamental theoretical knowledge. Within this framework, trainees employ diverse methods to acquire these competencies, such as self-directed learning through guidelines and textbooks, discussions with peers, and consultations with nurses they collaborate with [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. For this reason, a variety of educational materials is essential in medical schools to support trainees through different learning methods and approaches.\u003c/p\u003e \u003cp\u003eAt the Anesthesiology Department of Prince of Songkla University, our training curriculum follows a competency-based design. Emphasizing practical application, most trainee activities involve immersion in real-life scenarios and everyday practices, fostering the development of diverse competencies. However, certain topics, such as clinical pharmacology, basic anatomy and physiology, and fundamental principles of general anesthesia, are taught through traditional lectures. These subjects are covered in the first year of training to establish a solid foundation in basic sciences. Despite this approach, we have observed that some trainees struggle to translate their theoretical knowledge into clinical practice. This realization has highlighted the limitations of a lecture-based teaching model, which may not effectively address the learning needs of all trainees.\u003c/p\u003e \u003cp\u003eActive learning methods may be the key success of improving the situation. \u0026ldquo;Serious Games\u0026rdquo; is the effective method to increase participant engagement, to foster learners\u0026rsquo; motivation, to promote knowledge acquisition in the dynamic way. The meaning of serious game was likely defined in 1970 by Clark Abt. as \u0026ldquo;the games in the sense that have an explicit and carefully thought-out educational purpose\u0026rdquo;[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The important is they are not intended to be played primarily for amusement [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The recent medical education literatures of serious games are pay attention to computer-based game or digital game [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Some journals define serious games as the only digital platforms, which renders the concept of them seemingly narrower in scope than it truly is [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Card game and board game in the purpose of promote medical education certainly be classified in the serious game, eg; \u0026ldquo;Happy Familly\u0026rdquo;[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and \u0026ldquo;GridlockED\u0026rdquo;[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Both tabletop games, such as card games and board games, are helpful for memorization, useful for understanding complicated topics, and promote cognitive processes in low-stakes situations. Other strengths include their simplicity of preparation, requiring minimal time investment, and enable to replay for learners[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Hence, we created a game in theme \u0026lsquo;Basic Pharmacological for Anesthesia\u0026rsquo; to be a material for promote trainee learning process.\u003c/p\u003e \u003cp\u003eThe 'Basic Pharmacological for Anesthesia ' card game was created and evaluated for its effectiveness in instructing first to third-year anesthesiology residents. Additionally, its aim was to gauge trainees' satisfaction levels regarding learning through card games.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study employed a cross-sectional observational design and was conducted in the Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University. The study was approved by the Office of the Human Research Ethics Committee, Faculty of Medicine, Prince of Songkla University, Thailand (REC.66-429-8-1). The intervention, which involved game-based learning, took place on February 7, 2024. Participants were anesthesiology resident trainees. Prior to their participation, informed consent was obtained. A clinical trial registry was not applicable to our study.\u003c/p\u003e \u003cp\u003eThe variables measured in the study included pre-test scores, post-test scores, and feedback and satisfaction ratings. The pre-test and post-test consisted of identical short-essay questions designed to assess knowledge. The test had a total score of 20 marks, distributed as follows: 8 marks for induction drugs, 4 marks for volatile anesthetics, and 8 marks for neuromuscular drugs. Details of the short-essay questions are provided in Supplement 1. Feedback and satisfaction were assessed across six domains using a five-point Likert scale, ranging from 1 (Very dissatisfied) to 5 (Very satisfied).\u003c/p\u003e \u003cp\u003eThe card game was designed as an interactive learning tool, focusing on anesthetic drugs and their pharmacologic properties. The objective of the game is for players to collect a complete set of five cards for a specific anesthetic drug. The deck comprises 55 cards representing 11 anesthetic drugs (\u003cem\u003ePropofol, Thiopental, Ketamine, Midazolam, Etomidate, Cisatracurium, Rocuronium, Succinylcholine, Sevoflurane, Desflurane\u003c/em\u003e, and \u003cem\u003eNitrous Oxide\u003c/em\u003e), with each drug having cards detailing its name, dosage, onset and duration, contraindications and side effects, and metabolism or pharmacology (Fig.\u0026nbsp;1). The game accommodates 3\u0026ndash;8 players. At the start, the deck is shuffled, and each player is dealt five cards, with the remaining cards forming the \"draw pile\" in the center. Players take turns discarding an unwanted card, passing it to the next player in a clockwise direction, and drawing one card from the draw pile. Each subsequent player decides whether to take the discarded card or draw a new one, discarding a card from their hand afterward. Play continues until a player collects a complete set of cards for one drug, becoming the winner and sharing their set with others to enhance learning about that drug. The game continues to determine additional winners, following the same process, until only two players remain, at which point one final winner is declared while the other is unable to complete a set.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eThe effectiveness of game-based learning was assessed by evaluating knowledge gain through pre-test and post-test results. The sample size calculation was based on the formula for testing one population mean. A previous study investigated the use of a serious game for teaching medical students about cleft lip and palate treatment. That study reported a pre-test mean (SD) score of 12.23 (2.21) and a post-test mean (SD) score of 14.43 (1.66) out of a total of 17 points.\u003c/p\u003e\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1738323562.png\"\u003e\u003cbr\u003e\u003c/p\u003e \u003cp\u003eThe sample size calculation for testing one population mean was conducted using the n4Studies Plus application [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe output for a two-tailed test included the following parameters:\u003c/p\u003e \u003cp\u003eZ(0.975)\u0026thinsp;=\u0026thinsp;1.96, Z(0.8)\u0026thinsp;=\u0026thinsp;0.84,\u003c/p\u003e \u003cp\u003eReference value (\u0026micro;0)\u0026thinsp;=\u0026thinsp;12.23, Mean (\u0026micro;)\u0026thinsp;=\u0026thinsp;14.43, Standard deviation (σ)\u0026thinsp;=\u0026thinsp;1.66\u003c/p\u003e \u003cp\u003eBased on these inputs, the calculated sample size was n\u0026thinsp;=\u0026thinsp;4.46n\u0026thinsp;=\u0026thinsp;4.46. Rounding up, the final required sample size was determined to be 5.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStatistical methods\u003c/h3\u003e\n\u003cp\u003eContinuous data were expressed as means (standard deviation (SD)), while categorical data were presented as frequencies (percentages). Continuous variables were analyzed using a Wilcoxon rank-sum test. Data management and analysis were performed using R software, version 4.3.3.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe residents involved in the research consisted of 42.1% first-year residents, 21.1% second-year residents, and 36.8% third-year residents. Among the participants, 42.1% were male (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Comparison of the pretest and posttest scores revealed improvements in all categories: 5.25 vs. 7.50 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for induction drugs, 4.00 2.75 vs. 4.00 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for volatile anesthetics, and 6.50 vs. 7.50 for neuromuscular agents. Additionally, the total score significantly increased from 13.75 on the pretest to 19 on the posttest (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSubgroup analysis by year of residency revealed that second-year residents showed no significant difference between pretest and posttest scores (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), while first-year and third-year residents demonstrated significant improvements (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The satisfaction survey used a 5-point scale, where 5\u0026thinsp;=\u0026thinsp;Very Satisfied, 4\u0026thinsp;=\u0026thinsp;Satisfied, 3\u0026thinsp;=\u0026thinsp;Neutral, 2\u0026thinsp;=\u0026thinsp;Dissatisfied, and 1\u0026thinsp;=\u0026thinsp;Very Dissatisfied. The level of knowledge gained through game-based learning was rated 4.84 (0.37), and the application of this knowledge was rated 4.95 (0.23). The appropriateness of the game format was rated 4.84 (0.37), while the feasibility of playing the game received a rating of 4.68 (0.48). The optimal number of cards for the game was rated 4.42 (0.69), and the overall satisfaction level was 4.84 (0.37) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral suggestions were made by residents to enhance game-based learning. First, it was recommended to limit the number of players per round to optimize gameplay. Second, displaying the details of the cards to all players was suggested to facilitate learning. Third, ensuring that the images on the cards correspond with the data would improve recall. Additionally, some feedback highlighted issues such as the small font size, the thinness of the cards, and their oversized dimensions, which made them difficult to handle. Despite these criticisms, many respondents praised the game for being enjoyable and effective in helping them acquire knowledge.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur research offered anesthesiology residents an opportunity to deepen their understanding of commonly used anesthetic drugs in clinical practice. The program covered various drug groups, with a focus on their indications, contraindications, pharmacokinetics, and pharmacodynamics. Given that safety is a top priority in anesthetic practice, a thorough understanding of these drug properties is essential. Game-based learning, implemented as a card game, proved to be an effective method for teaching anesthetic drug concepts, as evidenced by statistically significant improvements in pre-test and post-test scores. Additionally, overall satisfaction was rated between 'satisfied' and 'very satisfied'.\u003c/p\u003e \u003cp\u003eThe game-based learning approach in our research utilized a serious game, in which players actively engaged with the game to acquire knowledge. This contrasts with gamification, where gaming elements are incorporated as only one part of the learning process [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Serious games offer numerous benefits, including promoting active participation, enhancing problem-solving abilities, improving clinical reasoning and decision-making skills, and encouraging teamwork [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe game design in our research was implemented as a card game due to its simplicity and the shorter development time compared to digital games. However, serious games can be designed in various formats, including card games, board games, or digital games, depending on the intended objectives and resources available [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe outcomes for evaluating game-based learning in our research were knowledge gain and satisfaction. However, the evaluation of learning management using game-based learning can encompass various aspects, including assessing the game's effectiveness in enhancing learners' knowledge [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e19\u003c/span\u003e], evaluating satisfaction with game-based learning activities [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], measuring learner engagement [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and comparing the outcomes of game-based learning with those of traditional teaching methods [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. To achieve a more comprehensive evaluation, additional assessment methods can be applied.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThere were several limitations in our study. First, the sample size was limited to our anesthesiology resident trainees, which may reduce the generalizability of the findings. To address this limitation, future studies could include participants from other institutions or adopt a multi-center approach. Secondly, the study faced time constraints. The posttest was conducted immediately after the game-based learning session, primarily assessing short-term memory. The study did not evaluate or provide insights into long-term memory retention, which could be explored in future research. Thirdly, the measurement tools used, such as the short-answer questions, may not have fully captured the knowledge gained from the game-based learning method. Future studies could employ a more comprehensive assessment framework to better evaluate knowledge acquisition. Finally, the scope of the study was confined to commonly available anesthetic drugs within our institution. This limited scope excluded certain drug categories, such as other induction agents, neuromuscular blocking drugs, and volatile anesthetics, which could be included in future studies to enhance the breadth of the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGame-based learning can enhance anesthesiology residents' understanding of anesthetic drugs and has shown high levels of satisfaction. However, to achieve a more comprehensive evaluation, additional assessment methods, such as measuring learner engagement and comparing the outcomes of game-based learning with traditional teaching methods, should be implemented.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eWe have no potential conflict of interest\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Office of the Human Research Ethics Committee, Faculty of Medicine, Prince of Songkla University, Thailand (REC.66-429-8-1). The participants provided informed consent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eWe provide details of the game card in the supplementary section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Faculty of Medicine, Prince of Songkla University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSanti Anchalee:\u0026nbsp;Conceptualization,\u0026nbsp;methodology, data collection,\u0026nbsp;analysis\u0026nbsp;and writing -original draft.\u003c/p\u003e\n\u003cp\u003eChanya Deekiatphaiboon:\u0026nbsp;Conceptualization,\u0026nbsp;methodology, data collection,\u0026nbsp;analysis\u0026nbsp;and\u0026nbsp;writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eSumidtra Prathep:\u0026nbsp;Conceptualization,\u0026nbsp;methodology, data collection,\u0026nbsp;analysis\u0026nbsp;and\u0026nbsp;writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eWilasinee Jitpakdee:\u0026nbsp;Conceptualization,\u0026nbsp;methodology, and\u0026nbsp;writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge Ms. Jirawan Jayuphan, a statistician at the Faculty of Medicine, Prince of Songkla University, for her assistance with data cleaning and statistical analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFreeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, Wenderoth MP. Active learning increases student performance in science, engineering, and mathematics. Proceedings of the National Academy of Sciences. 2014;111(23):8410-5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChin H, Ingerman \u0026Aring;, Herg\u0026egrave;s HO. Anesthesiologists\u0026rsquo; conceptions of learning anesthesia in the context of their specialty training program: a phenomenographic study. BMC Med Educ. 2023;23(1):594.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbt CC. Serious Games. New York: Viking Compass; 1970.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosimini MJ, Watsjold B, Chan TM. Serious Games Without Screens. Comment on Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review. JMIR Serious Games. 2022;10(1):e34656.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang R, DeMaria SJ, Goldberg A, Katz D. A Systematic Review of Serious Games in Training Health Care Professionals. Simul Healthc. 2016;11(1):41\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHage R, Fourr\u0026eacute; A, Ramonfosse L, Leteneur S, Jones M, Dierick F. Description and rules of a new card game to learn clinical reasoning in musculoskeletal physiotherapy. J Man Manip Ther. 2023;31(4):287\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrar G, Lambert S, Huang S, Dang R, Chan TM. Using Observation to Determine Teachable Moments Within a Serious Game: A GridlockED as Medical Education (GAME) Study. AEM Educ Train. 2021;5(2):e10456.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuthiyan G, Kasat P, Vij V, Solanki RS, C K, Sontakke B. Effectiveness of an Innovative Card Game as a Supplement for Teaching Factual Content to Medical Students: A Mixed Method Study. Cureus. 2023;15(10):e47768.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgamjarus C, Pattanittum P. n4Studies Plus: application for sample size calculation in health science research. Version 1.4. App store; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChow S-C, Shao J, Wang H. Sample size calculations in clinical research. 2nd ed. Boca Raton, FLA: Chapman and Hall/CRC; 2003. p. p51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgamjarus C. Sample size calculation for health science research. 1st ed. Khon Kaen, Thailand: Khon Kaen University Printing House; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu M, Luo Y, Zhang Y, Xia R, Qian H, Zou X. Game-based learning in medical education. Front Public Health. 2023;11:1113682.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkl EA, Kairouz VF, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel C, Sch\u0026uuml;nemann H. Educational games for health professionals. Cochrane Database Syst Rev. 2013;2013(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsoy D, Sneath P, Rempel J, Huang S, Bodnariuc N, Mercuri M, Pardhan A, Chan TM. Creating GridlockED: A Serious Game for Teaching About Multipatient Environments. Acad Med. 2019;94(1):66\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMin A, Min H, Kim S. Effectiveness of serious games in nurse education: A systematic review. Nurse Educ Today. 2022;108:105178.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalee P, Wongta N, Khwanngern K, Jitmun W, Choosri N. Serious Game for Teaching Undergraduate Medical Students in Cleft lip and Palate Treatment Protocol. Int J Med Inf. 2020;141:104166.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaunay LB, Zerr P, Peguin L, Renouard L, Ivanoff AS, Picard H, Griffith J, Chassany O, Duracinsky M. Development and Evaluation of a New Serious Game for Continuing Medical Education of General Practitioners (Hygie): Double-Blinded Randomized Controlled Trial. J Med Internet Res. 2019;21(11).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiehl LA, Gordan PA, Esteves RZ, Coelho IC. Effectiveness of a serious game for medical education on insulin therapy: a pilot study. Arch Endocrinol Metab. 2015;59(5):470\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu H, Xiao Y, Li H. The Effectiveness of a Serious Game Versus Online Lectures for Improving Medical Students' Coronavirus Disease 2019 Knowledge. Games Health J. 2021;10(2):139\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChon SH, Timmermann F, Dratsch T, Schuelper N, Plum P, Berlth F, Datta RR, Schramm C, Haneder S, Sp\u0026auml;th MR, D\u0026uuml;bbers M, Kleinert J, Raupach T, Bruns C, Kleinert R. Serious Games in Surgical Medical Education: A Virtual Emergency Department as a Tool for Teaching Clinical Reasoning to Medical Students. JMIR Serious Games. 2019;7(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalker J, Heudebert JP, Patel M, Cleveland JD, Westfall AO, Dempsey DM, Guzman A, Zinski A, Agarwal M, Long D, Willig J, Lee R. Leveraging Technology and Gamification to Engage Learners in a Microbiology Curriculum in Undergraduate Medical Education. Med Sci Educ. 2022;32(3):649\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026oacute;pez-Jim\u0026eacute;nez JJ, Fern\u0026aacute;ndez-Alem\u0026aacute;n JL, Gonz\u0026aacute;lez LL, Sequeros OG, Valle BM, Garc\u0026iacute;a-Bern\u0026aacute; JA, Idri A, Toval A. Taking the pulse of a classroom with a gamified audience response system. Comput Methods Programs Biomed. 2022;213:106459.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTubelo RA, Portella FF, Gelain MA, de Oliveira MMC, de Oliveira AEF, Dahmer A, Pinto MEB. Serious game is an effective learning method for primary health care education of medical students: A randomized controlled trial. Int J Med Inf. 2019;130:103944. Supplement 1 Pre-test and post-test.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline characteristics of participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (57.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (42.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eclass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst year resident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (42.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecond year resident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird year resident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (36.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe results of knowledge comparison between pre-test and post-test.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003epretest\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eposttest\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInduction drug (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.25 (4.50,5.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.50(7.125,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.0002115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnesthetic volatile (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.75(2.25,3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.0002796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeuromuscular agent (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.50(6.125,7.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.50(7.125,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000895\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal score (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.75(13.00,15.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.00(18.25,19.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.0001412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe results of knowledge comparison between pre-test and post-test classified by each year of resident\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003epretest\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eposttest\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst year resident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInduction drug (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.625(3.938,5.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.00(6.938,7.438)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnesthetic volatile (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.750(2.00,3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(4,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0213\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeuromuscular agent (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.00(6.875,7.625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.750(6.875,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1675\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal score (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.88(13.31,14.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.62(17.94,19.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01415\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecond year resident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInduction drug (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.125(4.125,5.812)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.625(7.250,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnesthetic volatile (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.75(2.50,3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.00(3.75,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1736\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeuromuscular agent (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.250(5.750,6.625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.625(7.500,7.812)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal score (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.25(12.88,14.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.38(18.94,19.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird year resident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInduction drug (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.500(5.125,5.750)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.00(7.75,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnesthetic volatile (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.75(2.250,3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0209\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeuromuscular agent (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.500(6.125,6.750)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.50(7.125,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal score (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.75(13.25,15.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.25(19.00,20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of Feedback and Satisfaction Scores (Level of satisfaction; 5\u0026thinsp;=\u0026thinsp;Very satisfied, 4\u0026thinsp;=\u0026thinsp;Satisfied, 3\u0026thinsp;=\u0026thinsp;Neutral, 2\u0026thinsp;=\u0026thinsp;Dissatisfied, 1\u0026thinsp;=\u0026thinsp;Very dissatisfied)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emin\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emax\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.How much knowledge have you gained from playing game-based learning?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.84(0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.How much can the knowledge you gained be applied?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.95(0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.Is the format of the game appropriate or not?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.84(0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4. The level of difficulty or ease of playing the game is suitable for the player.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.68(0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.The optimal number of cards to play the game.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.42(0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.The level of overall satisfaction.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.84(0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.58(1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Game-based learning, card game, anesthetic drug, anesthesiology resident, medical education","lastPublishedDoi":"10.21203/rs.3.rs-5873475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5873475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eActive learning, particularly game-based learning, is an effective method for increasing participant engagement, fostering learners\u0026rsquo; motivation, and promoting dynamic knowledge acquisition. The \"Basic Pharmacology for Anesthesia\" card game was created and evaluated for its effectiveness in teaching first- to third-year anesthesiology residents. Additionally, the study aimed to assess the trainees' satisfaction levels regarding learning through card games.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eNineteen anesthesiology residents participated in this cross-sectional observational study conducted at the Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University. The measured variables included pretest scores, posttest scores, and feedback and satisfaction ratings. Game-based learning was introduced prior to the posttest. The objective of the game was for players to collect a complete set of five cards for a specific anesthetic drug. The deck consisted of 55 cards representing 11 anesthetic drugs, each card detailed the drug\u0026rsquo;s name, dosage, onset and duration, contraindications, side effects, and metabolism or pharmacology. The test had a total score of 20 points, and satisfaction was assessed using a five-point Likert scale.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA comparison of the pretest and posttest scores revealed improvements across all categories: 5.25 vs. 7.50 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for induction drugs, 2.75 vs. 4.00 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for volatile anesthetics, and 6.50 vs. 7.50 for neuromuscular agents. Additionally, the total score significantly increased from 13.75 on the pretest to 19 on the posttest. The overall satisfaction level was 4.84 (SD\u0026thinsp;=\u0026thinsp;0.37).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eGame-based learning can enhance anesthesiology residents' understanding of anesthetic drugs and has shown high levels of satisfaction. However, to achieve a more comprehensive evaluation, additional assessment methods, such as measuring learner engagement and comparing the outcomes of game-based learning with traditional teaching methods, should be implemented.\u003c/p\u003e","manuscriptTitle":"Effectiveness of game-based learning for learning Anesthetic drug in Anesthesiology resident","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-31 18:03:23","doi":"10.21203/rs.3.rs-5873475/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-31T05:53:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-29T12:51:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-29T12:50:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-01-21T12:16:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"079d93dc-355b-4848-80e4-8755cc5476b8","owner":[],"postedDate":"January 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-13T14:38:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-31 18:03:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5873475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5873475","identity":"rs-5873475","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}