title: Serious games and blended learning; effects on performance and motivation in medical education.
abstract: BACKGROUND
  More efficient, flexible training models are needed in medical education. Information technology offers the tools to design and develop effective and more efficient training. The aims of this thesis were: 1) Compare the effectiveness of blended versus classroom training for the acquisition of knowledge; 2) Investigate the effectiveness and critical design features of serious games for performance improvement and motivation.
  
  
  METHODS
  Five empirical studies were conducted to answer the research questions and a descriptive study on an evaluation framework to assess serious games was performed.
  
  
  RESULTS
  The results of the research studies indicated that: 1) For knowledge acquisition, blended learning is equally effective and attractive for learners as classroom learning; 2) A serious game with realistic, interactive cases improved complex cognitive skills for residents, with limited self-study time. Although the same game was motivating for inexperienced medical students and stimulated them to study longer, it did not improve their cognitive skills, compared with what they learned from an instructional e‑module. This indicates an 'expertise reversal effect', where a rich learning environment is effective for experts, but may be contra-productive for novices (interaction of prior knowledge and complexity of format).
  
  
  CONCLUSIONS
  A blended design is equally effective and attractive as classroom training. Blended learning facilitates adaptation to the learners' knowledge level, flexibility in time and scalability of learning. Games may support skills learning, provided task complexity matches the learner's competency level. More design-based research is needed on the effects of task complexity and other design features on performance improvement, for both novices and experts.
authors.affiliation: Institute of Medical Education Research Rotterdam (iMERR) and the Department of Education, Erasmus University Medical Center, Rotterdam, The Netherlands. m.dankbaar@erasmusmc.nl.
authors.forename: Mary
authors.initials: M
authors.lastname: Dankbaar
keywords: Blended learning; Cognitive skills; Motivation; Performance; Serious games