2024_04_17_5872f04e0e86bda2fa04g

Department of Pharmacology, KAHER J.N. Medical College, Belagavi, Karnataka, India,

Department of Community Medicine USM-KLE International Medical Programme,
印度卡納塔克邦貝拉加維KAHER J.N.醫學院藥理學系，USM-KLE國際醫學計劃社區醫學系

Address for correspondence: Dr. Jyoti M. Benni, Department of Pharmacology, KAHER J.N. Medical College, Belagavi, Karnataka, India. E-mail: benni_jyoti@ yahoo.co.in
通訊地址：印度卡納塔克邦貝拉加維 KAHER J.N.醫學院藥理學系 Dr. Jyoti M. Benni。電子郵件：benni_jyoti@yahoo.co.in

Received: 05-06-2020 Accepted: 02-10-2020
收到日期：2020 年 5 月 6 日接受日期：2020 年 10 月 2 日

Published: 31-03-2021 發表日期：2021 年 3 月 31 日

Effectiveness of the game-based learning over traditional teaching-learning strategy to instruct pharmacology for Phase II medical students
遊戲化學習相較於傳統教學策略對於教授第二階段醫學生藥理學的效果

Anupama M. Gudadappanavar, Jyoti M. Benni, Shivalingappa B. Javali

Abstract 摘要

: BACKGROUND: Game-based education is fast becoming an innovative teaching approach in the field of medical education. Traditional review sessions (tutorials) are mainly focused on instructor-based learning and they help to review concepts previously taught in the lecture class. The primary objective was to evaluate the cognitive learning of students in game based learning (GBL) as compared to the conventional review sessions. The secondary objectives were to assess the perception and feedback of students regarding GBL and conventional review sessions.
背景：基於遊戲的教育正迅速成為醫學教育領域中的創新教學方法。傳統的複習會議（教程）主要著重於基於教師的學習，有助於複習之前在講座課程中教授的概念。主要目標是評估基於遊戲的學習（GBL）與傳統複習會議相比學生的認知學習。次要目標是評估學生對於GBL和傳統複習會議的感知和反饋。

MATERIALS AND METHODS: An interventional GBL study was designed for year MBBS students. The enrolled students were randomly assigned to either tutorial (Group A) or GBL (Group B), and informed consent was obtained. Group B students were further divided into smaller groups, and for Group A, the traditional tutorial method was followed. For both the groups, a multiple choice question (MCQ) pre-test and post-test was conducted on the selected topics. A total of 15 MCQs with gradually increasing difficulty were used in the GBL. For each group of students, one student would be on hot seat by answering the questions and then continued the game. Lifelines were provided. RESULTS: From the pretest and posttest scores, students performed better in Group B (39.53%) than Group A (18.43%) with respect to the knowledge score, and the difference was statistically significant. Students' perception and feedback regarding GBL were very enthusiastic and promising than the tutorial group. Largely, students commented that GBL was unique, active participation, fun, and novel learning style.
材料和方法：為年級醫學生設計了一項干預性GBL研究。受試學生被隨機分配到教程組（A組）或GBL組（B組），並獲得知情同意。B組學生進一步分成小組，而A組則採用傳統教程方法。對兩組學生進行了選定主題的多項選擇題（MCQ）預測測和後測。在GBL中使用了總共15個逐漸增加難度的MCQ。對於每組學生，一名學生將回答問題並繼續遊戲。提供了生命線。結果：從預測測和後測分數來看，學生在知識得分方面B組（39.53%）表現優於A組（18.43%），差異具有統計學意義。學生對GBL的感知和反饋比教程組更熱情和有前景。大多數學生評論認為GBL是獨特的、積極參與的、有趣的和新穎的學習方式。

CONCLUSIONS: GBL is a student-centered learning and showed more effective than the traditional tutorials in understanding the topic and was more enjoyable by students.
結論：GBL 是以學生為中心的學習方式，比傳統的教程更有效，有助於學生理解主題，並且更受學生喜愛。

Keywords: 關鍵詞：

Game-based learning, motivation, pharmacology, review session, student centered
基於遊戲的學習，動機，藥理學，複習會議，以學生為中心

Introduction 介紹

ducational gaming, in recent times, has gained peak attention as a technique to inspire students' learning by providing learner-centered atmospheres that provide experiential experiences, enhance learning, and stimulate interest and motivation for students to learn. An educational game is
近年來，教育遊戲作為一種激發學生學習興趣的技術，已經引起了高度關注。它提供以學習者為中心的環境，提供體驗式經驗，增強學習，激發學生學習興趣和動力。教育遊戲是

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這是一本開放存取的期刊，文章根據創用 CC 姓名標示-非商業性-相同方式分享 4.0 協議的條款進行分發，允許他人以非商業方式重新混合、調整和構建作品，只要給予適當的榮譽，並且新創作以相同條款許可。

For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com defined as an instructional method that requires the learner to participate in a competitive activity with the preset rules. .

Electronic game-based learning GBL has a long tradition in medical education with the release of its first application in the 1960s and has gained much attention in recent years due to rapid technical advances in the computer and gaming industries.

轉載請聯繫：WKHLRPMedknow_reprints@wolterskluwer.com 定義為一種需要學習者參與具有預設規則的競爭活動的教學方法。電子遊戲式學習 GBL 在醫學教育中有著悠久的傳統，自 1960 年代推出第一個應用以來，由於電腦和遊戲行業的技術迅速進步，近年來引起了很多關注。

Traditional review sessions (tutorials) are mainly focused on instructor-based learning, provides a brief review of concepts taught in the lecture class

Review sessions typically involve an overview of course materials followed by a period of questions and answers. Sometimes, the review sessions are less informative and uninteresting, simply a brief lecture on material previously covered, leading to little or no student participation and without any scope for a higher order of learning, i.e., critical thinking or application of the acquired knowledge.

傳統的復習會議（教程）主要集中在基於教師的學習上，對在講座課程中教授的概念進行簡要復習。復習會議通常包括課程材料的概述，然後進行問答。有時，復習會議缺乏信息量且乏味，僅是對先前涵蓋的材料進行簡短講座，導致學生參與少或沒有，也沒有提供更高層次的學習機會，即批判性思維或應用所獲知識。

Medical educators' present challenge is to find new approaches to make learning more stimulating, motivating, and entertaining. The doyens in the field of medical education have formerly recommended teaching modalities that incorporate student-based active-learning strategies, also called learner-centered education.

The integration of games as a teaching tool is an innovative and challenging approach in the educational field

Assimilation of digital educational games into existing medical education, i.e., GBL is a newly designed platform for medical students.

The modern technology of digital games can afford us the virtual experiences in a more cost-effective manner with provision to create and evaluate both positive and negative outcomes of the games.

These games include concepts and principles of adult learning; they encourage self-learning and greater participation in group learning activities along with enjoyment.

Consequently, by becoming actively involved in the learning process, the students' level of understanding and aptitude to integrate and synthesize material are enhanced.

醫學教育者目前面臨的挑戰是尋找新方法，使學習更具刺激性、動力和娛樂性。醫學教育領域的權威曾建議採用以學生為中心的主動學習策略，也稱為學習者中心教育的教學模式。遊戲作為教學工具的整合是教育領域中一種創新且具挑戰性的方法。將數位教育遊戲融入現有的醫學教育中，即遊戲化學習，是為醫學生設計的新平台。數位遊戲的現代技術可以以更具成本效益的方式提供虛擬體驗，並提供創建和評估遊戲的正面和負面結果的可能性。這些遊戲包含成人學習的概念和原則；它們鼓勵自主學習，並在團體學習活動中更多地參與，同時享受其中。因此，通過積極參與學習過程，學生的理解水平和整合和綜合材料的能力得到提升。

In addition, this technology provides a safe environment for learners to gain skills and self-confidence without harming patient's life, which otherwise might occur in everyday practice compromising the patients' safety

A wide variety of studies and reviews in GBL in medicine are available for different application scenarios and user-groups. Often used games in medical education are quiz games.

These studies have recommended the positive effect of games on medical students' knowledge

Previous studies have concluded that GBL encourages students to actively participate in the learning process, ability to integrate and synthesize material, promotes problem-solving skills and critical thinking.

Nevertheless, few authors have also stated that, due to the limited number of studies, their low-to-moderate methodological quality, and the inconsistent results, the evidence is less to support a general recommendation for the use of educational games in medical schools.

此技術提供了一個安全的環境，讓學習者獲得技能和自信，而不會危害患者的生命，否則可能會在日常實踐中發生，危及患者的安全。醫學領域中有許多關於遊戲式學習的研究和評論，適用於不同的應用場景和用戶群。醫學教育中常用的遊戲是問答遊戲。這些研究已經推薦了遊戲對醫學生知識的積極影響。先前的研究得出結論，遊戲式學習鼓勵學生積極參與學習過程，提高整合和綜合材料的能力，促進解決問題的能力和批判性思維。然而，少數作者也指出，由於研究數量有限，方法論質量低至中等，以及結果不一致，證據不足以支持對醫學院使用教育遊戲的一般推薦。

Given this, an educational game "who wants to be a physician" was conducted in the pharmacology department for Phase II MBBS students based on the popular television game show "Who wants to be a millionaire." To determine if GBL can meet all our expectations, the present study was planned focusing on a single topic 'Drugs acting on Autonomic Nervous System (ANS)' during tutorial hours. It is an active learning exercise, because answering the questions requires knowledge of ANS as well as application of drugs influencing ANS. Hence, the purpose of this study was to preliminarily evaluate the attraction, motivation, and learning experience of the medical students toward GBL. Hence, this study was planned with the following objectives.
在此基礎上，醫學二年級學生在藥理學系進行了一個名為“誰想成為醫生”的教育遊戲，該遊戲基於熱門電視遊戲節目“誰想成為百萬富翁”。為了確定遊戲式學習是否能滿足我們的所有期望，本研究計劃專注於教學時間內的一個主題“作用於自主神經系統（ANS）的藥物”。這是一個積極的學習活動，因為回答問題需要對 ANS 的知識以及影響 ANS 的藥物的應用。因此，本研究的目的是初步評估醫學生對遊戲式學習的吸引力、動機和學習經驗。因此，本研究設定了以下目標。

Objectives 目標

The primary objective was to evaluate the cognitive learning of students in GBL as compared to the traditional review sessions
主要目標是評估學生在遊戲式學習中的認知學習，與傳統的複習課程相比。
The secondary objectives were to assess the perception and feedback of students regarding GBL and conventional review sessions.
次要目標是評估學生對於 GBL 和傳統復習課程的感知和反饋。

Materials and Methods 材料和方法

A quiz, testing the important pharmacological aspects of cholinergic and adrenergic system, was designed using the format of the international popular television game show "Who Wants to Be a Millionaire."

The game was designed for MBBS Phase II students having completed a section of 'Drugs acting on Autonomic Nervous System' of a pharmacology course through the didactic lectures. This game specially focused on "Drugs acting on ANS" For both the groups, identical four subtopics from ANS with the same learning outcomes were selected.
設計了一個測試藥理學中重要的膽鹼能和腎上腺素能系統方面的小測驗，採用了國際流行電視遊戲節目《誰想成為百萬富翁》的格式。這個遊戲是為已經通過藥理學課程中關於自主神經系統藥物作用部分的 MBBS 第二階段學生設計的，通過講授課程。這個遊戲專門聚焦於「作用於 ANS 的藥物」。對於兩組，從 ANS 中選擇了相同的四個子主題，具有相同的學習成果。

Ethical approval was obtained from the Institutional Ethical Committee (KAHER's JN Medical College, Belagavi, Ref: MDC/DOME /79 dated: 22/11/2017), and an interventional study was conducted over a period of 5 months (October 2017-February 2018) in the department of pharmacology. The MBBS Phase II students were orally informed about the nature of the study, in which a new instructional method was being evaluated and further informed that their participation was entirely voluntary, and the results will have no effect on their final results or grades. A total of 98 students were enrolled in the study and were randomly assigned to either a traditional teaching group, i.-e., control group (Group

) or GBL, i.-e., experimental group (Group B,

), and written informed consent from each student was obtained. For both the groups, a pretest and posttest was conducted, consisting of forty multiple-choice questions (MCQs) from the selected subtopics (ten questions from each subtopic) and correct answer carried " 1 " mark and wrong answer " 0 " marks. For the control group, the traditional method of tutorial was conducted by a tutor, and in the experimental
倫理審批已經從機構倫理委員會（KAHER的JN醫學院，Belagavi，參考：MDC/DOME/79日期：2017年11月22日）獲得，並在藥理學系進行了為期5個月的干預性研究（2017年10月至2018年2月）。MBBS第二階段的學生口頭被告知研究的性質，其中正在評估一種新的教學方法，並進一步告知他們的參與完全是自願的，結果將不會影響他們的最終結果或成績。共有98名學生參與了研究，並被隨機分配到傳統教學組，即對照組（組

），或GBL，即實驗組（組B，

），並獲得了每位學生的書面知情同意。對於兩組，進行了一項包括來自所選子題的四十道多選題（每個子題十道問題）的預測測試和後測，正確答案得分為“1”，錯誤答案得分為“0”。對於對照組，傳統的教學方法由導師進行，而在實驗组中進行了...
group, GBL was conducted. The GBL group was further divided into four small groups (12 students/group) randomly, and two facilitators played the role of the quizmaster to accomplish the quiz.
小組，GBL進行了。GBL小組進一步隨機分為四個小組（每組12名學生），並有兩名引導者擔任問答主持人完成問答。

For the experimental group, a laptop and projector were used to conduct the study. A total of 15 MCQs of gradually increasing difficulty that are valid in terms of clinical practice and meet the desired learning outcomes were prepared for selected topic of ANS. All questions were provided with a short abbreviated answer that was often followed with a detailed explanation. For each group of students, one student earned the right to become the first contestant (took the "hot seat") by answering and explaining the answer to the group task correctly. Once on the hot seat, the contestant continued answering questions until he/she was unable to select and explain the correct answer to a question. They were then replaced with a new contestant, and the game started with the same sequence of question for the new contestant. When ambiguous, contestants had three lifelines (assistance) to help them obtain the correct answer. They were allowed to ask a friend in the group, ask the audience or whole group, or have two incorrect answers removed, narrowing their choice. These lifelines were available only once to each contestant. Rewards were given at various stages. To assess the knowledge gained by students, the scores of MCQ pretest and MCQ posttest of both groups were compared [Table 1]. On completion of the sessions, students' perception regarding the tutorials/GBL as an educational method was measured with a questionnaire consisting of 14 questions using a Likert scale [Table 2-questionnaire on perception]. In addition, a general comment section was included for any additional suggestions or comments. And also, feedback from both the groups was obtained to know the students' opinion of the overall usefulness of either pharmacology instructional method using a dichotomous questionnaire consisting of 14 questions (yes scored as " 1 " and no scored as “ 0 ") [Table 3- questionnaire on feedback].
對於實驗組，使用筆記型電腦和投影機進行研究。為ANS的選定主題準備了總共15個漸增難度的選擇題，這些問題在臨床實踐方面是有效的，並符合所需的學習成果。所有問題都附有簡短的縮寫答案，通常後面還有詳細的解釋。對於每組學生，一名學生通過正確回答並解釋組任務的答案而贏得成為第一名參賽者（坐上“熱座”的機會）。一旦坐上熱座，參賽者將繼續回答問題，直到無法選擇並解釋正確答案為止。然後他們將被新的參賽者取代，遊戲將以相同的問題順序為新的參賽者開始。當存在歧義時，參賽者有三個生命線（協助）可幫助他們獲得正確答案。他們可以向組內的朋友求助，向觀眾或整個組求助，或者刪除兩個錯誤答案，縮小他們的選擇範圍。這些生命線每位參賽者只能使用一次。在不同階段會給予獎勵。為了評估學生所獲得的知識，比較了兩組學生的 MCQ 預測測驗和 MCQ 後測的分數[表 1]。在課程結束時，使用包含 14 個問題的 Likert 量表對學生對教程/GBL 作為教育方法的看法進行了測量[表 2-看法問卷]。此外，還包括了一個一般評論部分，用於任何額外建議或意見。同時，從兩組學生那裡獲得了反饋，以了解學生對藥理學教學方法的整體有用性的看法，使用包含 14 個問題的二分問卷（是得分為“1”，否得分為“0”）[表 3-反饋問卷]。

The results were expressed as mean

standard deviation. All the statistical analyses were carried out using SPSS software version 20.0 IBM corp. A comparison of within group was through paired '

' test and between group was through independent sample '

' test.

was considered statistically significant.
結果以平均值和標準差表示。所有統計分析均使用 SPSS 軟件版本 20.0 IBM corp 進行。組內比較使用配對 t 檢驗，組間比較使用獨立樣本 t 檢驗。被認為具有統計學意義。

Results 結果

The scores of pretests and posttests followed a normal distribution. From this study, we observed that the cognitive learning outcome measured with the pretest and posttest scores, students performed better in Group B (39.53%) than Group A (18.43%), and the difference was statistically highly significant

[Table 1 and and Figure 1]. The perception of the students toward the learning experience was measured using a questionnaire on the 5-point Likert scale, and the score was higher in the GBL group

compared to the control group [Table 1 and Figure 2]. Group B students' perception was more encouraging; they enjoyed the game as it made the learning more interactive, collaborative learning environment and felt more confident. The Group A students' perception was little supportive about tutorials, had less enjoyment or enthusiasm, felt monotonous, were less confident, and had little active participation. Feedback of the students was taken using a questionnaire, scores of the experimental group were more encouraging

, they felt unbiased, and sessions were very well organized than compared to the
預測測驗和後測的分數呈正態分佈。從這項研究中，我們觀察到，通過預測測驗和後測的分數衡量的認知學習結果，學生在B組（39.53%）表現優於A組（18.43%），且差異在統計上非常顯著。學生對學習體驗的感知是通過5點李克特量表的問卷來衡量的，GBL組的分數比對照組更高。B組學生的感知更加鼓舞人心；他們喜歡這個遊戲，因為它使學習更具互動性，協作學習環境更好，並且感到更有信心。A組學生對教程的感知較少支持，缺乏樂趣或熱情，感到單調，信心較低，參與度較低。學生的反饋是通過問卷進行的，實驗組的分數更加鼓舞人心，他們感到公正，會議安排得非常好。

Figure 1: Effect of interventions on knowledge scores in control (Group A) and experimental group (Group B)
圖 1：對照組（A 組）和實驗組（B 組）在知識得分上干預效果

Table 1: Effect of interventions on knowledge, perception, and feedback scores in control (Group A) and experimental (Group B)
表 1：對照組（A 組）和實驗組（B 組）在知識、感知和反饋得分上的干預效果

Parameters	Time	Mean SD 平均值標準差
Parameters	Time	Control (Group A) 控制組（A 組）	Experimental (Group B) 實驗組（B 組）
Knowledge score 知識分數	Pretest			0.368
	Posttest

Perception scores 感知分數	Posttest
Feedback scores 反饋分數	Posttest

@ Paired

-test, "Independent

-test. SD=Standard deviation
@ 配對

-測試，"獨立

-測試。SD=標準差

Table 2: Questionnaire on students' perception about the tutorials/game-based learning in pharmacology
第二表：藥理學教程/基於遊戲的學習對學生對教程/基於遊戲的學習的看法問卷

Item number	Items
1	The questions asked were relevant 所提問題相關
2	Instructions given were clear and adequate 給予的指示清晰且充分
3	Time allocated was sufficient for each question 每個問題的時間分配都足夠
4	Questions were consistent with the teaching objectives 問題與教學目標一致
5	I enjoyed this session on ANS 我喜歡這個有關 ANS 的課程
6	The session built on my previous learning in relation to ANS 這次課程建立在我先前對 ANS 的學習基礎上
7	Exploring the topics in a collaborative environment with a group of colleagues was useful for learning 在與一群同事合作的環境中探索主題對學習很有幫助
8	The facilitator/tutor provided a learning environment, in which I felt confident to explore my understanding 導師提供了一個學習環境，讓我有信心探索自己的理解
9	of ANS
10	Personality, gender, and other attributes did not affect the scores 人格、性別和其他屬性並不影響分數
11	Faculty were approachable 教職員容易接觸
12	Timely feedback was given 及時反饋
13	The entire learning in the session was well coordinated and organized 本次學習過程整體協調且有組織性
14	The learning session was free of confusing or conflicting concepts and mechanism. 學習過程中沒有混淆或衝突的概念和機制
15	The use of hints/lifelines was helpful in answering the question 使用提示/生命線有助於回答問題

Likert scale: 5=Strongly agree, 4=Agree, 3=Uncertain, 2=Disagree, 1=Strongly disagree. Tick: Group A/Group B. ANS=Autonomic nervous system
Likert scale: 5=非常同意, 4=同意, 3=不確定, 2=不同意, 1=非常不同意。勾選: A 組/B 組。ANS=自主神經系統

Table 3: Questionnaire on students' feedback regarding tutorials/game-based learning, as a teaching-learning educational method in pharmacology
表 3: 有關學生對教程/基於遊戲的學習的反饋問卷，作為藥理學教學教育方法的主題

Theme of student responses
學生回應的主題

Student response: Yes/no
學生回答：是/否

Fun and enjoyable learning
有趣且愉快的學習

Opportunity to explore and explain answers/admit uncertainty
探索和解釋答案/承認不確定性

Group learning, collaborative teamwork
團體學習，協作團隊工作

Feel confident at the end of the session
在會議結束時感到自信

Novel style of learning
新穎的學習方式

Relaxed and informal learning environment
輕鬆和非正式的學習環境

Building on/using PBL 基於/使用 PBL

Novel/different approach to learning and testing knowledge
對學習和測試知識採用新穎/不同的方法

There is a thematic organization of content to develop higher level thinking skills
內容有主題組織，以發展更高層次的思考能力

Interactive and supportive learning environment
互動和支持性的學習環境

Covered wide knowledge area
涵蓋廣泛的知識領域

It provides a chance for the application of knowledge to clinical practice
它提供了將知識應用於臨床實踐的機會

It is less stressful
它更少壓力

It should be continued in pharmacology as a method of education
它應該在藥理學中作為一種教育方法繼續進行

Tick: Group A/Group B. Scoring yes as "1" and no as "0" for data analysis. PBL=Problem-based learning
Tick: Group A/Group B。將得分是「1」和不是「0」用於數據分析。PBL=問題導向學習

control group [Table 1 and Figure 2]. Students enjoyed the quiz sessions and helped them deeper understanding of the ANS. In general comments, most of the students' commented that GBL was unique, active involvement, less stressful, fun, and novel style of learning. Overall, the comments about the GBL were promising, and students would look forward to incorporate this method of teaching in their curriculum.
對照組[表 1 和圖 2]。學生喜歡測驗環節，幫助他們更深入理解 ANS。在一般評論中，大多數學生評論 GBL 是獨特的，積極參與，減壓，有趣，並且是一種新穎的學習方式。總的來說，關於 GBL 的評論是令人鼓舞的，學生期待將這種教學方法納入他們的課程中。

Discussion 討論

In the present randomized control study, we compared the effectiveness of GBL to the traditional review sessions (tutorials), used to teach pharmacology for medical students, and also assessed the attitudes of students toward tutorials or GBL. This present study shows that students in the GBL group had a significantly higher cognitive learning outcome when compared
在這個隨機對照研究中，我們比較了以 GBL 教授藥理學給醫學生的傳統複習課程（教程）的效果，並評估了學生對教程或 GBL 的態度。這項研究顯示，GBL 組的學生在認知學習結果方面顯著較高，與教程組的學生相比。

Figure 2: Effect of interventions on perception and feedback scores in control (Group A) and experimental group (Group B)
圖 2：對控制組（A 組）和實驗組（B 組）在感知和反饋分數上介入效果的影響

with the students in the tutorial group. We believe that students in the GBL group had high enthusiasm, actively participating and probably had better retention, helped them to achieve better cognitive results in the posttest.
我們認為 GBL 組的學生熱情高，積極參與，可能保留更好，有助於他們在後測中取得更好的認知結果。

Furthermore the GBL group compared to the tutorial group had more fun, enjoyable learning and would like to learn more in this style. Students' comments were very enthusiastic and encouraging and also offered clear evidence for the beneficial effect of GBL on the students'knowledge and their attitudes toward their learning experience. Nevertheless, the long-term memory was not evaluated in our study.
此外，與教程組相比，GBL 組更有趣、更享受學習，並希望以這種方式學習更多。學生的評論非常熱情和鼓舞人心，同時也為 GBL 對學生知識和他們對學習經驗態度的有益影響提供了明確的證據。然而，在我們的研究中並未評估長期記憶。

Lifelines played an important role in the success of the game, involving more audiences actively. Lifelines kept everybody attentive since the audience could be called upon at any time and were rewarded. They were allowed to ask a friend in the group, ask the audience or whole group, or have two incorrect answers removed, narrowing their choice. These lifelines were designed to encourage the audience to answer questions when they were called upon for assistance by the contestant. Besides, by answering on their own, students could compare their answers with the contestant's response. In addition, the use of lifelines upholds the development of fundamental collective social interactive skills.

生命線在遊戲的成功中發揮了重要作用，吸引了更多觀眾積極參與。生命線讓每個人保持專注，因為觀眾可以隨時被召喚並獲得獎勵。他們可以請求組內的朋友、問觀眾或整個團體，或者刪除兩個錯誤答案，縮小他們的選擇範圍。這些生命線旨在鼓勵觀眾在被參賽者請求協助時回答問題。此外，通過自己回答問題，學生可以將自己的答案與參賽者的回答進行比較。此外，使用生命線有助於培養基本的集體社交互動技能。

Our study results were similar to a study done by Boeker et.al., proved that game-based e-learning is more effective, and had a high positive motivational impact on learning and performance of students. It also concluded that students had more fun, and would like to learn more in this style.

Another study concluded in their study that the game show helped medical students to learn in a relaxed and supportive learning environment.

Moy et. al. used an educational game to review the pulmonary physiology concepts in the

year medical students, and they found comparatively higher audience and participation of the students in the game, approximately one-half of the class enrollment, suggest a strong interest in this educational tool.

The students reported that they found the educational tool extremely useful, well presented, thorough in its content, and valuable in the mechanisms it reinforced from their prior course in pulmonary physiology

In another study, the authors showed that the GBL method is comparable to the traditional learning method in general and in short-term gains, while the traditional lecture still seems to be more effective to improve students' short- and long-term knowledge retention.

我們的研究結果與Boeker等人的研究相似，證明基於遊戲的電子學習更有效，對學生的學習和表現有積極的動機影響。它還得出結論，學生更享受，並且希望以這種方式學習。另一項研究結論指出，遊戲節目幫助醫學生在輕鬆和支持性的學習環境中學習。Moy等人在醫學生中使用教育遊戲來複習肺部生理學概念，他們發現學生對遊戲的觀眾和參與比例相對較高，約為班級人數的一半，表明對這種教育工具有濃厚興趣。學生們報告說他們發現這個教育工具非常有用，呈現得很好，內容深入，並且在強化他們之前肺部生理學課程中的機制方面具有價值。在另一項研究中，作者們顯示 GBL 方法在一般和短期收益方面與傳統學習方法相當，而傳統講座似乎仍然更有效地提高學生的短期和長期知識保留。

A 2010 systematic review of Akl et. al. on educational games found only five studies with low-to-moderate methodological quality eligible for the analysis.

Of these RCTs, three suggested a positive effect of the games on medical students' knowledge. However, the authors concluded that, due to the limited number of studies, their low-to-moderate methodological quality, and the inconsistent results, the evidence is less to support a general recommendation for the use of educational games in medical schools.

These games may be futile for learners who resist to process information or who do not enjoy playing games.

Other shortcomings may be as only a small percentage of the class participated, while the remaining students were the game's audience, thus sometimes failing to engage the entire class.

2010年Akl等人對教育遊戲進行的系統性回顧發現，只有五個研究符合低至中等方法學質量的標準進行分析。這些隨機對照試驗中，有三個顯示遊戲對醫學生的知識有積極影響。然而，作者得出結論認為，由於研究數量有限、方法學質量低至中等、結果不一致，證據不足以支持在醫學院普遍推薦使用教育遊戲。這些遊戲對於抗拒處理信息或不喜歡玩遊戲的學習者可能是徒勞的。其他缺點可能是只有少數學生參與，而其餘學生則是遊戲的觀眾，因此有時無法吸引整個班級的參與。

Many previous studies stated that GBL encourages students to actively participate in the learning process, a role that promotes problem-solving skills and critical thinking.

By becoming actively involved in the learning process, the student's ability to integrate and synthesize material will be enhanced, and also student's knowledge to conceptualize systems and understand how they work will also be improved.

Ultimately, games absolutely suit millennials because games generate enthusiasm and stimulation throughout the educational process, as noted in the positive feedback from students as seen in our study and also previous study.

The main strength of games noted is that their ability to promote student-to-student interaction and peer learning and their excitement while playing.

In view of the advancement of the medical education technology and enthusiasm among millennial students, there is a call for designing computer-based educational games that will cater to the needs of new generation medical students. Conversely, limitations of this study were, long-term memory of students could have been evaluated, a large number of students were unable to involve in the game, as some of the students were the game's audience, thus sometimes failing to engage the entire class, and also teachers opinion about GBL could have been obtained with the purpose of adding in this student-centered learning method in their future curriculum.
許多先前的研究指出，GBL 鼓勵學生積極參與學習過程，這種角色促進了問題解決能力和批判性思維。通過積極參與學習過程，學生整合和綜合材料的能力將得到增強，同時學生概念化系統並理解其運作的知識也將得到提高。最終，遊戲絕對適合千禧一代，因為遊戲在整個教育過程中產生熱情和刺激，正如我們的研究和先前研究中學生的積極反饋所示。遊戲的主要優勢在於它們促進學生之間的互動和同儕學習，以及他們在遊戲中的興奮。鑒於醫學教育技術的進步和千禧一代學生的熱情，有人呼籲設計符合新一代醫學生需求的基於電腦的教育遊戲。相反，這項研究的局限性在於，學生的長期記憶可能已經被評估，許多學生無法參與遊戲，因為其中一些學生是遊戲的觀眾，有時無法使整個班級參與，而且教師對於遊戲式學習的看法可能已經獲得，目的是將這種以學生為中心的學習方法納入未來的課程中。

Conclusions 結論

GBL should be taken sincerely into account as an alternative instructional method on topics where student motivation might be a problem. Our objective in doing this study was to provide a fun, interactive, and innovative method of learning for students. The total posttest scores for all the four sessions were higher for the GBL group, indicating that GBL is more effective than conventional teaching during tutorials in understanding not only basics but also deeper aspects of the subject. GBL also showed that students had more fun, and would like to learn more with this concept of active learning. We would, therefore, recommend that GBL should be used to teach pharmacology, which involves active-learning strategies, student centered, an interactive learning environment to develop interpersonal, communication, and problem-solving skills.
應該認真考慮 GBL 作為一種替代教學方法，特別是在學生動機可能成為問題的主題上。我們這項研究的目標是為學生提供一種有趣、互動和創新的學習方法。所有四個會議的總後測分數對於 GBL 組都更高，這表明 GBL 在教學中比傳統教學更有效，不僅能理解基礎知識，還能理解主題的更深層次。GBL 還表明學生更享受學習，並且希望通過這種主動學習的概念學到更多。因此，我們建議應該使用 GBL 來教授藥理學，這涉及主動學習策略、以學生為中心、互動學習環境以發展人際、溝通和解決問題能力。

Acknowledgment 致謝

The authors acknowledge the support of Dr. Nayana K. Hashilkar (Professor) and all other faculties and postgraduates of the department of Pharmacology, J N Medical College, Belagavi, in conduct of this study.
作者感謝 Belagavi J N 醫學院藥理學系的 Dr. Nayana K. Hashilkar（教授）以及所有其他教師和研究生對這項研究的支持。

Financial support and sponsorship
財務支持和贊助

Nil. 無。

Conflicts of interest 利益衝突

There are no conflicts of interest.
沒有利益衝突。

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How to cite this article: Gudadappanavar AM, Benni JM, Javali SB. Effectiveness of the game-based learning over traditional teaching-learning strategy to instruct pharmacology for Phase II medical students. J Edu Health Promot 2021;10:91.
如何引用本文：Gudadappanavar AM，Benni JM，Javali SB。遊戲化學習相對於傳統教學策略對指導第二階段醫學生藥理學的有效性。J Edu Health Promot 2021;10:91。

Effectiveness of the game-based learning over traditional teaching-learning strategy to instruct pharmacology for Phase II medical students 遊戲化學習相較於傳統教學策略對於教授第二階段醫學生藥理學的效果