Game-based Intervention Research Articles

Do games reduce maths anxiety? A meta-analysis

In this paper, we present the first meta-analysis of the efficacy of game-based interventions on reducing students’ levels of maths anxiety. After searching for randomised studies describing game-based interventions to reduce maths anxiety, 22 effect sizes with 913 participants described in 15 peer-review articles met the selection criteria. A random effects meta-analysis indicated a reduction of maths anxiety with a small effect size (mean effect size ES = −0.24, CI = [ − 0.47, −0.01]), marginally significant at 0.05 level but not robust to a leave-one-out sensitivity analysis. Several factors moderated the results: non-digital games were more effective, while digital games had a negligible mean effect size of ES = −0.10, CI = [ − 0.24, 0.03]. The effect size was also moderated by the total duration of the intervention, to the advantage of longer interventions, and by the type of gameplay: games had a greater effect on maths anxiety reduction when they promoted collaborative and social interactions. Such features were mainly present in non-digital games, while all bar one of the digital interventions used single-player games. The results obtained, which were particularly weak for digital games, indicated the need to develop and test games explicitly designed for maths-anxious students to increase the impact of game-based interventions. This will require investigation into the relationship between game features and maths anxiety through analysis of the behaviour of anxious and non-anxious students at play. Among the features that an anxiety-aware game could employ, we suggest collaborative gameplay, social interactions, adaptability, features promoting intrinsic motivation and embedding real-time measurements of maths anxiety in the game.

Impacts of Game-based psychotherapy intervention to elderly with memory disorder

Pharmacological treatments for memory disorder are known as costly and giving adverse effects. Alternatively, game has been proposed to be incorporated in intervention plan for elderly with memory disorder based on its strengths. Playing games require mental concentration, memory and quick motor reaction in simulating brain to work and gain memory back. In this study, a game-based psychotherapy has been conducted involving a group of elderly who show some symptoms of memory disorder. Prior to the intervention session, a puzzle-based game namely Neuro-therapy has been designed and developed as a proof of concept for game-based psychotherapy intervention. It is developed based on the proposed guideline which comprises of 34 criteria. Findings show the impacts of game-based intervention in terms of cognitive improvement, improved memory recall proven through the improved time in assembling the puzzle, and improved skills and IT literacy among elderly. Eight dimensions of cog-nitive improvement which have been derived from performance metrics of the EEG reader headset are engagement, relaxation, stress, focus, excitement, and interest. The intriguing and encouraging results can be attributed to the combination of digital gaming and psychotherapy for the elderly, particularly those suffering from memory impairment symptoms.

Neurocognitive analyses reveal that video game players exhibit enhanced implicit temporal processing

Winning in action video games requires to predict timed events in order to react fast enough. In these games, repeated waiting for enemies may help to develop implicit (incidental) preparation mechanisms. We compared action video game players and non-video game players in a reaction time task involving both implicit time preparations and explicit (conscious) temporal attention cues. Participants were immersed in virtual reality and instructed to respond to a visual target appearing at variable delays after a warning signal. In half of the trials, an explicit cue indicated when the target would occur after the warning signal. Behavioral, oculomotor and EEG data consistently indicate that, compared with non-video game players, video game players better prepare in time using implicit mechanisms. This sheds light on the neglected role of implicit timing and related electrophysiological mechanisms in gaming research. The results further suggest that game-based interventions may help remediate implicit timing disorders found in psychiatric populations.

Using mathematics game-based intervention on children with special educational needs: Preliminary findings

Many video games incorporate positive learning principles, stimulating students' cognitive functioning and promoting problem-solving and spatial abilities. The high levels of engagement and involvement that some students can achieve with video games are notable. Hence, video games for children with a long history of school failure, such as children with special educational needs (SEN). Moreover, it may give educators immediate and ongoing assessment of students' progress. When complemented with human tutoring, video games as a game-based intervention may improve mathematics performance since instruction is more effective when adapted to students' learning needs and pace.
 As part of the research project "GBl4deaf – Game-based Learning for Deaf Students (PTDC/COM-CSS/32022/2017), the video game "Space adventure: Defend the planet!" was designed to stimulate arithmetic competencies in deaf and hearing children. The player must use elementary arithmetical and spatial concepts to rebuild an abandoned space station. Each challenge has three difficulty levels. In the game challenge used in this study, the player must add or remove particles to collect resources. The current research focuses on two questions: The study follows two research questions: Q1: Did the students make any progress in mathematics achievement after playing the video game?; Q2: Is the gameplay of Space adventure: Defend the planet! an engaging experience for players? A pre-and post-game mathematical test was applied to measure mathematics achievement and an observational grid to gather information about arithmetical procedures. Ten fourth- to ninth-graders participated in the study - four girls and six boys, aged between 9 and 16, three deaf and seven hearing students with different special needs (dyscalculia, cognitive deficits, autism spectrum disorder, deafness and Asperger syndrome). Due to the COVID-19 pandemic lockdown, children played the video game using Zoom video conference software in 8-12 sessions (50 minutes, two a three times/week). The results show 4% to 19% of mathematics progression after children played the video game and indicate that they maintain the use of counting-based procedures throughout the game sessions. For instance, they kept counting both addends starting from 1 or counting by 1, 2, 5 or 10 using a number line. The current data suggest that the videogame "Space adventure: Defend the planet!" allows educators to gather immediate information about students' difficulties and progression.

The Contribution of Game-based learning: Children with Autism Spectrum Disorder and Dyscalculia

This paper explores the potential of games to mathematics learning and promotion of globalpsychomotricity, relational/social skills in children with Autism Spectrum Disorder (ASD) and/or Dyscalculia students of Basic Education in Portugal. Inspired by Space Adventure: Defend the Planet! (SADP), an educational research-based game to children's primary mathematics’ learning [PTDC/COM-CSS/32022/2017], a game-based intervention was created to psychomotricity sessions at school facilities. The study was conducted by the researcher, Superior Technician of SEN and Rehabilitation. A mixed method approach is used to research: what impact does the intervention have on participants' motivation, engagement, learning of mathematics and development of participants? Five schools in Portugal participated in the study, between December 2021 and March 2022, with 12 sessions, one session/week, 45 minutes. The sample: 19 participants: 12 boys, 9 with ASD and 3 with Dyscalculia; 7 girls, 2 with ASD and 5 with Dyscalculia. The average age is M=8.6 with SD=1.8. Prior to the intervention, the following instruments were applied: pre-tests of math skills, communication and social interaction, receptive and expressive language; Childhood Autism RatingScale; a Battery Movement Assessment Battery for Children; questionnaire Technologies/Video Games and Questionnaire of Support Measures for Learning and Inclusion. During the intervention, an observation grid and alternative communication materials were used per session. A PC, the SADP, gymnasium/relaxation room with a chair, table and gym supplies. From the results, computers, tablets, and mobile phones are the most frequently used by children. GRID/ABC Autism, Bini ABC/Human Body, and Minecraft/Troll are video games often played by participants. One girl aged 12 explained to the researcher how to create worlds on Minecraft, which is an indicator that “good” video games could be beneficial for ASD. “I feel free to explore my imagination!”- she said. Most children expressed rich verbalizations about SADP: “I love it”, “This game is interesting”. As preliminary results children were motivated, participative, engaged with learning math, and able to co-create motor activities inspired by SADP challenges. The data analysis of the present study is in progress and will be presented.

Computer-Based Intervention Closes Learning Gap in Maths Accumulated in Remote Learning.

Remote learning has reduced the mathematical performance of students. Mathematical reasoning is the critical skill that enables students to make use of all other mathematical skills. The aim of the present study was (1) to develop the mathematical reasoning skills of underachieving students and (2) to explore the application options, benefits and limitations of an online game-based intervention programme among third- and fourth-grade pupils (aged 9–11, N = 810). The content of the programme was designed to strengthen their basic maths skills in line with the curriculum. Beyond assigning the tasks, the digital intervention programme also performed the motivational, differentiation- and feedback-related tasks of the teacher. The reliability indices for pre-, post and follow-up test results proved to be high (Cronbach’s alpha = .90, .91 and .92, respectively). The effect size of the programme proved to be significant in both grades (d = .22 and .38, respectively). The results confirm the potential of the intervention programme to close, or at least significantly reduce the Covid learning gap in basic maths skills, without the need for additional teacher work—which is an important aspect of successful implementation—in areas which are the most challenging for 9-to-11-year-old pupils in the domain of mathematics.

Verification of Game-Based Psychotherapy Intervention Model for Elderly with Memory Disorder Using Expert Review Approach

Game interventions have been demonstrated to have significant effects in terms of increasing treatment adherence and accessibility in the health profession. The use of game has a great therapeutic influence on the experience when doing recovery workouts. Due to its strengths, a game-based intervention model for elderly with memory disorder is proposed. The proposed model consists of both exogenous and instantaneous factors as its main components. Nine exogenous factors are attitude, emotion, skill, belief; support, attractive, fun, reminiscence, complexity. Six instantaneous factors are perceived focus, enjoyment, motivation, comfortability, perceived control, and boredom. To ensure its correctness, verification procedure has been carried out by using an expert review approach involving five experts from three different domains. Qualitative and quantitative feedbacks from the experts are used in refining the proposed model. Our works can be extended by incorporating other related theories to strengthen the model such as reminiscence and flow theories. The improved model is significant in providing a guideline of game-based intervention to other related domains. Our works are believed as effective in improving cognition among elderly, the interesting and positive findings can be attributed to the integration of digital game and psychotherapy for elderly, particularly those with memory disorder symptoms.

Games for COVID-19

The COVID-19 pandemic resulted in various unpleasant affective responses and dysfunctional behaviours, which created an urgent demand for effective interventions to support people’s coping and resilience. In addition to common forms of intervention, alternative approaches have also been explored, including the use of COVID-19-themed games to educate people about the pandemic. The present article explores the diversity of games and gamified interventions developed for the context of the COVID-19 pandemic through the lens of fundamental human needs. By providing an example of how human needs can inform design decisions, the article aims to inform and inspire readers who are interested in developing new impactful game-based interventions for similar large-scale crises.

A Proposal of Cognitive Intervention in Patients with Alzheimer's Disease through an Assembling Game: A Pilot Study.

(1) Background: Alzheimer’s disease is an irreversible brain disease, and current treatments are aimed at fighting cognitive decline. We have explored the feasibility of a game-based intervention for people with moderate Alzheimer’s disease; (2) Methods: Six participants, five women and one man, were recruited from a day center to participate in a five-week study, which included a re- and post-evaluation with the Montreal Cognitive Assessment (MoCA) and INECO Frontal Screening (IFS) tests. Three participants were assigned to the control group and three others to the experimental one. Both groups performed a play activity consisting of assembling a pie toy. Participants in the experimental group were asked to make a pie matching a sample after a time interval. Control group participants were asked to freely assemble a pie without the matching component; (3) Results: Patients were shown to be motivated during such an activity during the nine sessions. The experimental group showed a significant increase in IFS scores when comparing the post- and pre-intervention assessments. No significant differences were observed in MoCA scores; (4) The intervention created a social and emotional climate suitable to maintaining participants’ satisfaction and motivation, as well as to developing executive function while promoting positive emotions.

Effectiveness of active video games in overweight and obese adolescents: a systematic review and meta-analysis of randomized controlled trials.

PurposeThe purpose of this review was to assess the effect of active video games among overweight and obese adolescents.MethodsA systematic review and meta-analysis were conducted using records from the English-language electronic databases MEDLINE, the Web of Science, and PubMed. These databases were searched from January 2010 to December 2020 using the keywords (adolescent*) AND (overweight OR obese *) AND (active video games OR exergaming * OR video game*).ResultsFive articles met the inclusion criteria. Four studies were conducted in the United States of America and 1 study was conducted in Canada. In addition, all included articles had a randomized controlled trial study design. It was determined that the sample size of the studies was 30–46 participants and there were a total of 195 overweight and obese adolescents across the included studies. Active video gaming was negatively associated with changes in body mass index percentile (mean difference [MD], -1.77; 95% confidence interval [CI], -2.55 to -0.99; P<0.001) and total cholesterol (MD, -11.16; 95% CI, -16.64 to -5.68; P<0.001).ConclusionsPlaying active video games can reduce both the body mass index percentile and total cholesterol in overweight and obese adolescents. Active video games can provide a different method for combating childhood obesity. High-quality randomized controlled trials are recommended to assess the impact of game-based interventions.

The Role of Agency and Threat Immediacy in Interactive Digital Narrative Fear Appeals for the Prevention of Excessive Alcohol Use: Randomized Controlled Trial.

BackgroundSerious games for the training of prevention behaviors have been widely recognized as potentially valuable tools for adolescents and young adults across a variety of risk behaviors. However, the role of agency as a distinguishing factor from traditional health interventions has seldom been isolated and grounded in the persuasive health communication theory. Fear appeals have different effects on intentions to perform prevention behaviors depending on the immediacy of the consequences. Looking into how to increase self-efficacy beliefs for health behavior with distant consequences is the first step toward improving game-based interventions for adverse health outcomes.ObjectiveThis study aimed to investigate the effect of agency on self-efficacy and the intention to drink less alcohol in an interactive digital narrative fear appeal. Furthermore, the communicated immediacy of threat outcomes was evaluated as a potential moderator of the effect of agency on self-efficacy.MethodsA web-based experimental study was conducted with university students (N=178). The participants were presented with a fear appeal outlining the consequences of excessive alcohol use in a fully automated web-based interactive narrative. Participants either had perceived control over the outcome of the narrative scenario (high agency) or no control over the outcome (low agency). The threat was either framed as a short-term (high immediacy) or long-term (low immediacy) negative health outcome resulting from the execution of the risk behavior (drinking too much alcohol).ResultsA total of 123 valid cases were analyzed. Self-efficacy and intention to limit alcohol intake were not influenced by the agency manipulation. Self-efficacy was shown to be a significant predictor of behavioral intention. The immediacy of the threat did not moderate the relationship between agency and self-efficacy.ConclusionsAlthough agency manipulation was successful, we could not find evidence of an effect of agency or threat immediacy on self-efficacy. The implications for different operationalizations of different agency concepts, as well as the malleability of self-efficacy beliefs for long-term threats, are discussed. The use of repeated versus single interventions and different threat types (eg, health and social threats) should be tested empirically to establish a way forward for diversifying intervention approaches.Trial RegistrationClinicalTrials.gov NCT05321238; https://www.clinicaltrials.gov/ct2/show/NCT05321238

Game-Based Intervention to Improve Knowledge on the Benefits of Fruits and Vegetables of In-School Adolescents Attending the International School, Ibadan, Nigeria

ObjectivesIn Southwestern Nigeria, studies have shown that only 6–12% of adolescents met the recommended minimum daily intake of fruits and vegetables. Poor knowledge of the nutritional and health benefits of fruits and vegetables is a major contributor to low consumption of fruits and vegetables. Insufficient intake of fruits and vegetables may be an underlying factor in the high prevalence of micronutrient deficiencies among adolescents. This study aimed to improve knowledge on the benefits of fruits and vegetables among in-school adolescents in Ibadan, Nigeria, through a game-based approach.MethodsThis quasi-experimental study was conducted among 40 students of the International School, Ibadan, Nigeria. Data on the knowledge of the benefits of fruits and vegetables of the students was collected pre-and post-intervention, via a semi-structured, self-administered questionnaire. The intervention group (n = 20) was exposed to a gamified nutrition intervention “Nutripoly” while the control group (n = 20) received no intervention. “Nutripoly” is a fruit- and vegetable-themed board game similar to Monopoly, in which players aim to win by becoming the wealthiest based on their knowledge of the benefits of fruits and vegetables to human health. Data were analyzed using descriptive statistics and McNemar's test.ResultsThe mean age of respondents was 14.9 ± 0.6 years. The study showed that most participants preferred fruits to vegetables. In the experimental group, the proportion of the students with adequate knowledge increased significantly from 30% at baseline, to 95% after the intervention (p = 0.000). In the control group, the change in the proportion of students with adequate knowledge (from 35% at baseline to 40% post-intervention) was not significant (p = 0.250). Preference and love of the participants for fruits and vegetables improved remarkably in the intervention group, as compared to the control group in which there was minimal improvement.ConclusionsA game-based nutrition education intervention is capable of improving the knowledge of in-school adolescents on the nutritional benefits of fruits and vegetables. Further investigations should be conducted to determine if the game-based intervention can increase the intake of fruits and vegetables among the adolescents.Funding SourcesThe research was self-funded.

Where Exactly Is the Therapist in Virtual Reality and Game-Based Rehabilitation Applications? A Randomized Controlled Trial in Children with Specific Learning Disability

Objective: Children with specific learning disability (SLD) experience problems in visual perception that influence academical skills and activities of daily living. Virtual reality and game-based rehabilitation applications are becoming increasingly popular in rehabilitation, including visual perception rehabilitation. However, the usage of commercially available and easily accessible games as intervention tools raises the question whether rehabilitation conducted with these games is really rehabilitation, or just casual gameplay. Therefore, we aimed to investigate the effects of a nonactively supervised (game-based intervention program [GIP]) and an actively supervised (therapist guided game-based intervention program [TGGIP]) on the visual perception skills of children with SLD. Materials and Methods: This study was designed as a single-blind randomized, controlled trial of a TGGIP on visual perception skills in children with SLD compared with the self-oriented, nonsupervised program (GIP). A total of 138 children with SLD participated in the study and were randomly divided into two groups (TGGIP and GIP). Children's visual perception skills were assessed with Motor-Free Visual Perception Test-3. Results: Both groups showed significant improvements in visual perception after the intervention programs (P < 0.05). However, the TGGIP (a supervised and structured intervention program) was significantly more effective in improving the visual perception skills compared with the GIP (a standard, nonsupervised, and unstructured intervention program) (P < 0.05). Conclusion: We think that the TGGIP methodology that we designed acts as a facilitator for therapists in using trademarked, commercially available, and easily accessible games for structured and supervised virtual reality and game-based rehabilitation applications.

Using Video Games to Improve the Sexual Health of Young People Aged 15 to 25 Years: Rapid Review.

BackgroundSexually transmitted infections and unintended pregnancies among young people remain public health concerns in many countries. To date, interventions that address these concerns have had limited success. Serious games are increasingly being used as educational tools in health and professional public education. Although acknowledged as having great potential, few studies have evaluated the use of serious games in sexual health education among young people, and to date, there have been no published reviews of these studies.ObjectiveThis study aims to assess the effects of video game–based sexual health interventions for risky sexual behavior in young people aged between 15 and 25 years.MethodsA rapid review of randomized controlled trials and quasi–randomized controlled trials was performed. The search included the following bibliographic databases: Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycINFO, and Scopus. A total of 2 reviewers independently screened 50% (35/70) of the retrieved articles during the full-text screening phase.ResultsFrom a total of 459 identified citations, after removing duplicates, 327 (71.2%) articles were deemed eligible for title and abstract screening. Of the 327 articles, 70 (21.4%) full texts were screened, from which 10 (3.1%) articles (evaluating 11 different games) were included in the review. The findings highlighted the considerable diversity in video game–based interventions and assessed sexual health outcomes. Although there were some promising findings in outcome studies using game-based interventions, the results across studies were mixed.ConclusionsAlthough game interventions for sexual health have been in existence for almost three decades, relatively few studies have evaluated them, and the results of previous outcome studies have been mixed. Moreover, there is little clarity regarding which specific elements of a game facilitate positive outcomes. We provide recommendations for future researchers developing video game–based interventions to improve sexual health in young people.

Is There Hope for First Graders at the Lowest Percentiles? The Roles of Self-Efficacy, Task Avoidance, and Support in the Development of Reading Fluency

Self-efficacious children are expected to be more task-focused in challenging achievement situations and consequently have better chances of overcoming learning difficulties than children who have lower self-efficacy. The present study investigates this presumption with Finnish-speaking first graders struggling with reading acquisition ( N = 285). The development of the children’s reading fluency, self-efficacy, and task avoidance was followed from the middle of Grade 1 to the end of Grade 2, and a 6-week mobile game-based intervention was administered to those who exhibited the greatest risk for reading disabilities (≤ 5th percentile). Exploratory structural equation modeling was used to test the theoretical model. The results suggest that higher self-efficacy in the middle of Grade 1 predicted lower task avoidance and higher reading fluency at the end of Grade 1, but no support for the mediating role of task avoidance was found. The intervention benefited both self-efficacy and reading fluency.

Video Game Play Does Not Improve Spatial Skills When Controlling for Speed-Accuracy Trade-Off: Evidence From Mental-Rotation and Mental-Folding Tasks.

Researchers have been divided on the efficacy of computerized cognitive training (CCT) for enhancing spatial abilities, transfer of training, and improving malleability of skills. In this study, we assessed the effects of puzzle video game training on subsequent mental rotation (MR) and mental folding (MF) performance among adults with no cognitive impairment. We assessed participants at baseline with the Shepard-Metzler MR test followed by the differential aptitude test: space relations MF test (i.e., far transfer). We ranked participants' skills on these pre-tests and used a matching technique to form two skill groups from which we then randomly assigned members of each skill group either to an experimental group or a wait-list control group. The experimental group played two puzzle video games closely related to two-dimensional and three-dimensional MR tasks during 4-week training sessions (total of 12hour of video games). Post-training, participants completed the MR and MF tests again. Two months later, we re-assessed only the experimental group's spatial skills to explore the sustainability of the trained performance. In addition to response times (RT) and error scores (ES), reported separately, we combined these variables into rate correct scores (RCS) to form an integrated measure of potential speed-accuracy trade-offs (SAT). As a result, we did not find significant improvements in MR performance from CCT engagement, nor did participants show a transfer of skills obtained by practicing MR-related puzzle games to a MF task. Based on the current findings, we urge caution when proposing a game-based intervention as a training tool to enhance spatial abilities. We argue that separately interpreting individual test measures can be misleading, as they only partially represent performance. In contrast, composite scores illuminate underlying cognitive strategies and best determine whether an observed improvement is attributable to enhanced capacities or individual heuristics and learned cognitive shortcuts.

Developing two game-based interventions for dyslexia therapeutic interventions using gamification and serious games approaches entertainment computing journal

Dyslexia (reading disorder) is one of the most common learning disabilities, affecting about 20% of Iranian children. The current treatments are expensive and should be performed with school homework, resulting in children's demotivation. Game-inspired designs (GBIs) like gamification and serious games are widely used to increase users' participation in monotonous tasks. However, there are no appropriate tools based on them for Iranian dyslexic children. This study examines gamification and serious game approaches efficacy in improving dyslexic children’s motivation aged 6–8 to complete cognitive rehabilitation interventions like phonological awareness. After studying existing interventions, we selected one of the common clinic interventions. Based on it, two games with serious games and gamification approaches were developed, and then eight experts evaluated them using a questionnaire designed by Nielsen's heuristics evaluation. The initial tests with experts showed the potential application of the games as therapeutic tools for dyslexic children to improve their learning process, especially difficulties in recognizing letters. Also, they can increase dyslexic children’s motivation, significantly using the least negative feedback and much positive feedback effectively encourages them. After rigorous evaluation with potential users, the GBIs can be used with minimum cost and time accessible to all outside non-clinical settings.

Exploring the Impact of the "RUEU?" Game on Greek Students' Perceptions of and Attitudes to European Identity.

European identity is a complex, multi-faced and inherently imprecise concept relating to a range of socio-political and psychological factors. Addressing this topic in educational practice, particularly with respect to Higher Education students, constitutes a complex and open problem for research. This paper reports on an experimental study designed to explore the effectiveness of the educational game “RUEU?” in supporting university students in understanding the key socio-political issues regarding European identity. Quantitative data regarding Greek university students’ (N = 92) attitudes to European identity, before and after playing the game, were collected. Students’ performance of the game group (N = 46) was compared with that of a control group (N = 46) who explored the same issues about European identity through a tutor-guided discussion. The findings showed that both instructional interventions were effective but in different ways. The participants in the game-based group appeared more attached to the EU after the intervention and moved toward a more balanced description of their Greek and European identity. On the other hand, the students in the control group rated higher what “European identity” and being EU citizen means to them. The findings indicated the potential of game-based interventions to deliver not only academic content but also to promote students’ reflection and influence them at an attitudinal and emotional level.

Serious Gaming for Behaviour Change: A Systematic Review

Over the years, there has been a significant increase in the adoption of game-based interventions for behaviour change associated with many fields such as health, education, and psychology. This is due to the significance of the players’ intrinsic motivation that is naturally generated to play games and the substantial impact they can have on players. Many review papers measure the effectiveness of the use of gaming on changing behaviours; however, these studies neglect the game features involved in the game design process, which have an impact of stimulating behaviour change. Therefore, this paper aimed to identify game design mechanics and features that are reported to commonly influence behaviour change during and/or after the interventions. This paper identified key theories of behaviour change that inform the game design process, providing insights that can be adopted by game designers for informing considerations on the use of game features for moderating behaviour in their own games.

Gamification for the Win in Internal Medicine Residency: A Longitudinal, Innovative, Team-Based, Gamified Approach to Internal Medicine Board-Review.

Background: Game-based learning is an engaging and effective educational strategy in medical education. The Internal Medicine resident board review at our institution was considered dull and poorly attended by trainees. We hypothesized that a gamified, longitudinal, team-based approach to board review would rejuvenate board review and improve learner perception of quality and attendance.Methods: We sought to improve the resident perception of and participation in board review through an innovative longitudinal, team-based, game-based intervention, the “Cohort Cup”. The “Cohort Cup” was developed and implemented over a 22-week intervention period from November 2017 to May 2018. Teams (cohorts) competed in real-time against one another. Evaluation methods include a pre/post attitudes survey on a 5-point Likert scale (1 - strongly disagree, 5 - strongly agree) and attendance data. Findings: Of 105 residents eligible to participate, 82 completed the pre-intervention survey, and 74 completed the post-intervention survey. We observed statistically significant increases in self-perceptions of engagement, the perceived value of the sessions, and preferences for game-based learning. Self-perceptions of learner engagement improved from 2.74 to 3.8. The value of the educational experience increased from 2.68 to 3.95. Preferences for game-based learning improved from 3.77 to 4.32. Board review attendance doubled. Residents commented the intervention improved class bonding. Board passage rate increased from 86% to 97%.Conclusions: Our game-based intervention successfully rejuvenated our board review. We observed more joy in the learning environment and improvements in resident engagement, and in their attitudes regarding board review. Game-based learning can be a valuable educational tool and can be a positive facet of educational communities.