Single-session card game linked to small immediate anatomy gains in medical students

A single-session card-based educational game was associated with modest, immediate improvement in functional anatomy test performance among first-year medical students in Ecuador, according to a mixed-methods study with quantitative priority. In the 60-student sample, median scores improved significantly in the “remember” and “understand” domains, while the study detected no statistically significant changes in “apply,” “analyze” or “evaluate.” Total median performance rose from 21 to 22 on a 35-item test, with the pre-test–post-test comparison yielding a p-value of 0.0192 and an effect size of r = 0.31. The findings provide evidence of a small short-term association, not proof that the game caused durable gains or improved higher-order reasoning.

The study enrolled 60 first-year medical students at a university in Ecuador who had completed the relevant functional anatomy course content. Their median age was 18 years, with an interquartile range of 18–19, and 51.7% of the participants were female. Researchers used a single-group pre-test–post-test design without a concurrent control group.

The same 35-item, single-best-answer multiple-choice test was administered immediately before and after students played the educational game. Questions were mapped to five Bloom’s taxonomy domains: remember, understand, apply, analyze and evaluate. Pre–post comparisons were performed with the Wilcoxon signed-rank test.

The most clearly measured change involved foundational cognitive domains. Median scores increased significantly in the “remember” and “understand” categories, indicating that students performed better on the test items designed to assess recall and comprehension immediately after gameplay. By contrast, the study found no statistically significant changes in the “apply,” “analyze” or “evaluate” domains.

The overall median Bloom score increased modestly from 21, with an interquartile range of 17–25, before the game to 22, with an interquartile range of 18.25–26, afterward. These findings distinguish the game’s immediate association with recall and understanding from the absence of a detected change in applying, analyzing or evaluating functional anatomy information. They also do not establish whether any additional knowledge was retained after the session.

An embedded qualitative strand examined learners’ experiences and their perceptions of the activity. After the intervention, students completed a five-point Likert-scale questionnaire adapted from the Technology Acceptance Model, and their perception scores were favorable. Six focus groups—three conducted before the intervention and three afterward—were analyzed using the Framework Method.

Participants identified immediate corrective feedback, repeated questioning, psychological safety and peer interaction as perceived mechanisms supporting learning. These are explanations offered by students rather than mechanisms directly demonstrated by the study. The design can document what learners believed was useful and how they experienced the activity, but the perceptions do not independently establish why test scores changed or whether the game would produce the same outcomes under different conditions.

The qualitative findings also identified potential downsides. Time pressure and competition were reported as stressors, showing that card-based learning could be perceived as both educational and uncomfortable. The study therefore examined test performance alongside students’ experiences rather than treating a favorable questionnaire response as evidence of educational efficacy.

The authors described the game as a potentially useful low-cost, low-stakes strategy for reinforcing functional anatomy after foundational teaching. That interpretation is consistent with the intervention’s placement and the measured pattern: students played after completing the relevant course material, and the significant gains were confined to remembering and understanding. Further controlled research would be needed to determine whether the immediate score difference is attributable to the game and whether its educational value extends beyond the immediate post-test.

Subject of Research: Mixed-methods evaluation of a card-based functional anatomy activity for first-year medical students

Article Title: Can a card-based educational game enhance functional anatomy knowledge in first-year medical students? A mixed-methods study

Article References: Villacrés Villegas, J., Villegas Villao, N., Arreaga-Yulan, A. R., Briones-Zamora, A. D., Gálvez López, A. A., Briones-Claudett, K. H., & Briones-Zamora, K. H. (2026). Can a card-based educational game enhance functional anatomy knowledge in first-year medical students? A mixed-methods study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10386-5

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10386-5

Keywords: medical education, functional anatomy, card-based learning, first-year medical students, game-based learning, pre-test–post-test study, Bloom’s taxonomy, focus groups, knowledge retention, student perceptions, card-based, educational