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      Comparative effectiveness of a serious game and an e-module to support patient safety knowledge and awareness

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          Serious games have the potential to teach complex cognitive skills in an engaging way, at relatively low costs. Their flexibility in use and scalability makes them an attractive learning tool, but more research is needed on the effectiveness of serious games compared to more traditional formats such e-modules. We investigated whether undergraduate medical students developed better knowledge and awareness and were more motivated after learning about patient-safety through a serious game than peers who studied the same topics using an e-module.


          Fourth-year medical students were randomly assigned to either a serious game that included video-lectures, biofeedback exercises and patient missions ( n = 32) or an e-module, that included text-based lectures on the same topics ( n = 34). A third group acted as a historical control-group without extra education ( n = 37). After the intervention, which took place during the clinical introduction course, before the start of the first rotation, all students completed a knowledge test, a self-efficacy test and a motivation questionnaire. During the following 10-week clinical rotation they filled out weekly questionnaires on patient-safety awareness and stress.


          The results showed patient safety knowledge had equally improved in the game group and e-module group compared to controls, who received no extra education. Average learning-time was 3 h for the game and 1 h for the e-module-group. The serious game was evaluated as more engaging; the e-module as more easy to use. During rotations, students in the three groups reported low and similar levels of patient-safety awareness and stress. Students who had treated patients successfully during game missions experienced higher self-efficacy and less stress during their rotation than students who treated patients unsuccessfully.


          Video-lectures (in a game) and text-based lectures (in an e-module) can be equally effective in developing knowledge on specific topics. Although serious games are strongly engaging for students and stimulate them to study longer, they do not necessarily result in better performance in patient safety issues.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12909-016-0836-5) contains supplementary material, which is available to authorized users.

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          Most cited references 21

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          A randomised controlled trial of the effects of mindfulness practice on medical student stress levels.

          This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students. We carried out a multicentre, single-blinded, randomised controlled trial with intention-to-treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block-randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self-report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow-up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS). Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age-matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (- 3.44, 95% confidence interval [CI] - 6.20 to - 0.68; p < 0.05) and the anxiety component of the DASS (- 2.82, 95% CI - 4.99 to - 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (- 3.69, 95% CI - 7.38 to 0.01; p = 0.05). Follow-up at 8 weeks post-trial revealed that the effect was maintained. Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self-administered, evidence-based intervention now exists to manage stress in this at-risk population and should be widely utilised. © Blackwell Publishing Ltd 2011.
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            A visitor's guide to effect sizes: statistical significance versus practical (clinical) importance of research findings.

            Effect Sizes (ES) are an increasingly important index used to quantify the degree of practical significance of study results. This paper gives an introduction to the computation and interpretation of effect sizes from the perspective of the consumer of the research literature. The key points made are: 1. ES is a useful indicator of the practical (clinical) importance of research results that can be operationally defined from being "negligible" to "moderate", to "important". 2. The ES has two advantages over statistical significance testing: (a) it is independent of the size of the sample; (b) it is a scale-free index. Therefore, ES can be uniformly interpreted in different studies regardless of the sample size and the original scales of the variables. 3. Calculations of the ES are illustrated by using examples of comparisons between two means, correlation coefficients, chi-square tests and two proportions, along with appropriate formulas. 4. Operational definitions for the ES s are given, along with numerical examples for the purpose of illustration.
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                Author and article information

                +3110 7038161 ,
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                2 February 2017
                2 February 2017
                : 17
                [1 ]ISNI 000000040459992X, GRID grid.5645.2, , Institute of Medical Education Research, Erasmus University Medical Center, ; PO Box 2040, 3000 CA Rotterdam, The Netherlands
                [2 ]ISNI 0000000120346234, GRID grid.5477.1, Faculty of Business Informatics, , University of Utrecht, ; Utrecht, The Netherlands
                [3 ]ISNI 0000000090126352, GRID grid.7692.a, , Department of Anesthesiology at University Medical Center Utrecht, ; Utrecht, The Netherlands
                [4 ]ISNI 000000040459992X, GRID grid.5645.2, Department of Internal Medicine, , Erasmus University Medical Center, ; Rotterdam, The Netherlands
                [5 ]ISNI 0000000090126352, GRID grid.7692.a, Center for Research and Development of Education, , University Medical Center Utrecht, ; Utrecht, The Netherlands
                [6 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, Department of Health, Medicine and Life Sciences, Educational Development and Research, , Maastricht University, ; Maastricht, The Netherlands
                [7 ]ISNI 000000040459992X, GRID grid.5645.2, Department of Emergency Care and Internal Medicine, , Erasmus University Medical Center, ; Rotterdam, The Netherlands
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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