title: Game-based e-learning is more effective than a conventional instructional method: a randomized controlled trial with third-year medical students.
abstract: BACKGROUND
  When compared with more traditional instructional methods, Game-based e-learning (GbEl) promises a higher motivation of learners by presenting contents in an interactive, rule-based and competitive way. Most recent systematic reviews and meta-analysis of studies on Game-based learning and GbEl in the medical professions have shown limited effects of these instructional methods.
  
  
  OBJECTIVE
  To compare the effectiveness on the learning outcome of a Game-based e-learning (GbEl) instruction with a conventional script-based instruction in the teaching of phase contrast microscopy urinalysis under routine training conditions of undergraduate medical students.
  
  
  METHODS
  A randomized controlled trial was conducted with 145 medical students in their third year of training in the Department of Urology at the University Medical Center Freiburg, Germany. 82 subjects where allocated for training with an educational adventure-game (GbEl group) and 69 subjects for conventional training with a written script-based approach (script group). Learning outcome was measured with a 34 item single choice test. Students' attitudes were collected by a questionnaire regarding fun with the training, motivation to continue the training and self-assessment of acquired knowledge.
  
  
  RESULTS
  The students in the GbEl group achieved significantly better results in the cognitive knowledge test than the students in the script group: the mean score was 28.6 for the GbEl group and 26.0 for the script group of a total of 34.0 points with a Cohen's d effect size of 0.71 (ITT analysis). Attitudes towards the recent learning experience were significantly more positive with GbEl. Students reported to have more fun while learning with the game when compared to the script-based approach.
  
  
  CONCLUSIONS
  Game-based e-learning is more effective than a script-based approach for the training of urinalysis in regard to cognitive learning outcome and has a high positive motivational impact on learning. Game-based e-learning can be used as an effective teaching method for self-instruction.
authors.affiliation: Department of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg i. Br., Baden-Württemberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Boeker
authors.affiliation: Center de Sandà, Sta, Maria, Grisons, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Andel
authors.affiliation: Department of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg i. Br., Baden-Württemberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.affiliation: Department of Urology, University Medical Center Freiburg, Freiburg i. Br., Baden-Württemberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Frankenschmidt
mesh_terms: D003071:Cognition; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007858:Learning; D013337:Students, Medical; D011795:Surveys and Questionnaires; D018910:Video Games