Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan.
Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan.
BMC Med Educ. 2023 Oct 28;23(1):813. doi: 10.1186/s12909-023-04808-x.
The gamification of learning increases student enjoyment, and motivation and engagement in learning tasks. This study investigated the effects of gamification using decision-making cards (DMCs) on diagnostic decision-making and cost using case scenarios.
Thirty medical students in clinical clerkship participated and were randomly assigned to 14 small groups of 2-3 medical students each. Decision-making was gamified using DMCs with a clinical information heading and medical cost on the front, and clinical information details on the back. First, each team was provided with brief clinical information on case scenarios. Subsequently, DMCs depending on the case were distributed to each team, and team members chose cards one at a time until they reached a diagnosis of the case. The total medical cost was then scored based on the number and contents of cards drawn. Four case scenarios were conducted. The quantitative outcomes including confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical costs were measured before and after our gamification by self-evaluation using a 7-point Likert scale. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using DMCs.
Confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical cost were significantly higher after the gamification. Furthermore, comparing the clinical case scenario tackled last with the one tackled first, the average medical cost of all cards drawn by students decreased significantly from 11,921 to 8,895 Japanese yen. In the content analysis, seven advantage categories of DMCs corresponding to clinical reasoning components were extracted (information gathering, hypothesis generation, problem representation, differential diagnosis, leading or working diagnosis, diagnostic justification, and management and treatment).
Teaching medical students clinical reasoning using DMCs can improve clinical decision-making confidence and learning motivation, and reduces medical cost in clinical case scenarios. In addition, it can help students to acquire practical knowledge, deepens their understanding of clinical reasoning, and identifies several important clinical reasoning skills including diagnostic decision-making and awareness of medical costs. Gamification using DMCs can be an effective teaching method for improving medical students' diagnostic decision-making and reducing costs.
学习游戏化可以提高学生对学习任务的享受程度、动机和参与度。本研究使用决策卡（DMC）通过病例场景来研究游戏化对诊断决策和成本的影响。
30 名临床实习医学生参与了这项研究，并被随机分配到 14 个 2-3 名学生组成的小组中。使用正面有临床信息标题和医疗费用、背面有临床信息详细信息的 DMC 对决策进行游戏化。首先，每个团队都获得了病例的简要临床信息。随后，根据病例向每个团队分发 DMC，团队成员一次选择一张卡片，直到他们对病例做出诊断。然后根据抽取的卡片数量和内容计算总医疗费用。进行了四个病例场景。通过 7 点李克特量表的自我评价，在游戏化前后测量了包括有效临床决策信心、诊断决策学习动机和对医疗费用的认识在内的定量结果。定性部分包括对使用 DMC 学习临床推理的好处的内容分析。
游戏化后，有效临床决策的信心、诊断决策学习的动机和对医疗费用的认识显著提高。此外，与处理的第一个临床病例场景相比，学生抽取的所有卡片的平均医疗费用从 11921 日元显著降低至 8895 日元。在内容分析中，从 DMC 中提取了对应于临床推理成分的七个优势类别（信息收集、假设生成、问题表示、鉴别诊断、主导或工作诊断、诊断证明和管理与治疗）。
使用 DMC 教授医学生临床推理可以提高临床决策信心和学习动机，降低临床病例场景中的医疗费用。此外，它可以帮助学生获得实践知识，加深对临床推理的理解，并确定包括诊断决策和对医疗费用的认识在内的几个重要的临床推理技能。使用 DMC 的游戏化是一种提高医学生诊断决策和降低成本的有效教学方法。
