title: An experimental study on the effects of a simulation game on students' clinical cognitive skills and motivation.
abstract: Simulation games are becoming increasingly popular in education, but more insight in their critical design features is needed. This study investigated the effects of fidelity of open patient cases in adjunct to an instructional e-module on students' cognitive skills and motivation. We set up a three-group randomized post-test-only design: a control group working on an e-module; a cases group, combining the e-module with low-fidelity text-based patient cases, and a game group, combining the e-module with a high-fidelity simulation game with the same cases. Participants completed questionnaires on cognitive load and motivation. After a 4-week study period, blinded assessors rated students' cognitive emergency care skills in two mannequin-based scenarios. In total 61 students participated and were assessed; 16 control group students, 20 cases students and 25 game students. Learning time was 2 h longer for the cases and game groups than for the control group. Acquired cognitive skills did not differ between groups. The game group experienced higher intrinsic and germane cognitive load than the cases group (p = 0.03 and 0.01) and felt more engaged (p < 0.001). Students did not profit from working on open cases (in adjunct to an e-module), which nonetheless challenged them to study longer. The e-module appeared to be very effective, while the high-fidelity game, although engaging, probably distracted students and impeded learning. Medical educators designing motivating and effective skills training for novices should align case complexity and fidelity with students' proficiency level. The relation between case-fidelity, motivation and skills development is an important field for further study.
authors.affiliation: Institute of Medical Education Research, Erasmus MC, University Medical Center Rotterdam, Room Ae-234, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. m.dankbaar@erasmusmc.nl.
authors.forename: Mary E W
authors.initials: ME
authors.lastname: Dankbaar
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jelmer
authors.initials: J
authors.lastname: Alsma
authors.affiliation: Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Els E H
authors.initials: EE
authors.lastname: Jansen
authors.affiliation: School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jeroen J G
authors.initials: JJ
authors.lastname: van Merrienboer
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jan L C M
authors.initials: JL
authors.lastname: van Saase
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Stephanie C E
authors.initials: SC
authors.lastname: Schuit
mesh_terms: D002983:Clinical Competence; D003071:Cognition; D005260:Female; D005717:Games, Experimental; D006801:Humans; D008297:Male; D009042:Motivation; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult
keywords: Cognitive load; Cognitive skills; Fidelity; Motivation; Simulation game