Board Game Boosts Medical Students’ Child Development Learning, Study Finds

A board game designed to teach child development to medical students has delivered measurable gains in knowledge, but a new study suggests that the excitement of play and the learning it produces may travel along surprisingly separate paths. The research, published in BMC Medical Education, followed 103 fifth-year medical students through a pediatric clerkship and found that those who played the game early in their rotation scored significantly higher on a post-test than classmates who had not yet played it. Yet when the researchers dug into how students appraised individual game elements and how deeply they entered a state of flow during play, those subjective experiences showed little connection to test performance.

The study, conducted across 13 clerkship blocks, took advantage of the natural sequencing of a curriculum rather than random assignment. Seven blocks received the game-based learning activity during the first or second week of the rotation, forming what the researchers called the game-based group, while six blocks followed conventional teaching until after the week-four post-test and only then received the game, serving as a delayed-exposure comparison group. All students sat the same pre-test and post-test, allowing the team to compare adjusted post-test scores between the two schedules using a linear mixed-effects model that accounted for pre-test performance and for clustering within clerkship blocks.

The results were striking. The adjusted mean post-test score was 3.671 in the game-based group against 2.635 in the conventional teaching group, an adjusted difference of 1.036 points with a 95 percent confidence interval running from 0.560 to 1.513 and a p-value below 0.001. In practical terms, students who encountered the game early in their clerkship retained substantially more child development knowledge at the end of the rotation than peers who had not yet played it. The authors are careful, however, to note the limits of this design: differences in assessment timing and the intervening clerkship exposure mean the advantage cannot be attributed to game-based learning alone.

What makes the study unusual is its second layer of analysis. Rather than treating the educational game as a single undifferentiated intervention, the researchers asked students to appraise ten distinct game elements individually and measured their flow states using the Flow State Questionnaire. Flow, a concept from positive psychology, describes the absorbing state in which challenge and skill are balanced, attention narrows, and time seems to dissolve. Educational theorists have long proposed that flow is a key mechanism through which games promote learning, making it a natural target for empirical scrutiny.

Students rated all ten game elements highly, indicating that the game was well received across the board. When the researchers examined how these appraisals related to flow, patterns emerged quickly. Nine appraisal-flow associations met the false discovery rate criterion set by Benjamini-Hochberg procedures: six involving enjoyment, two involving sense of control, and one involving engagement. In other words, the students who found particular game elements enjoyable, controllable, or engaging were also the ones most likely to report deep immersion during play. The experiential side of the game clearly worked as intended.

The cognitive side told a different story. Among models linking game-element appraisals to adjusted post-test performance, only one association reached statistical significance, and it ran in an unexpected direction. Teamwork appraisal showed an inverse marginal association with test performance, with a coefficient of -0.811, a 95 percent confidence interval from -1.283 to -0.339, and an FDR-adjusted q value of 0.0113. Students who rated the teamwork element more highly tended, if anything, to score slightly lower on the knowledge test. None of the Flow State Questionnaire subscales was significantly associated with post-test performance at all.

These findings lead the authors to a provocative hypothesis: experiential and cognitive outcomes of game-based learning may involve partly distinct processes. A game can succeed brilliantly at generating enjoyment, engagement, and flow while having little detectable relationship to how much factual knowledge students retain. This does not mean the flow experience is worthless in medical education, but it does challenge the common assumption that immersion is the engine of learning in game-based settings. The authors emphasize that this hypothesis requires prospective testing before firm conclusions can be drawn.

The course itself focused on child development, a core competency in pediatric training that includes developmental screening concepts such as those embodied in the Denver Developmental Screening Test. The content aligned with standards from the Council on Medical Student Education in Pediatrics, and the game was designed to let students apply developmental principles in a low-stakes, interactive format. The study protocol was approved by the Institutional Review Board of MacKay Memorial Hospital, with a waiver of written informed consent covering educational records generated between January 2024 and December 2025.

For medical educators, the study carries a double message. On one hand, it adds to the evidence that well-designed games can improve knowledge outcomes in demanding professional curricula, with an effect size that translated into a full point of adjusted difference on the post-test. On the other hand, it warns against evaluating games solely through the lens of learner experience. High ratings of enjoyment and strong reports of flow do not guarantee cognitive gains, and educators who want games to teach as well as entertain may need to design and assess the two dimensions separately.

The research team, drawn from MacKay Memorial Hospital, MacKay Children’s Hospital, and National Taiwan University College of Medicine, suggests that future work should prospectively test whether separating experiential from cognitive design goals improves both. As game-based learning spreads through medical schools worldwide, studies like this one provide a template for moving beyond the blunt question of whether games work toward the sharper question of which components of a game do the teaching, and which simply make the teaching enjoyable.

Subject of Research: Game-based learning and flow experience in medical education for child development

Article Title: Game element appraisals and learning outcomes in a game-based child development course for medical students

Article References: Ten, C.-W., Ko, M. H.-J., Peng, C.-C., Chiu, Y.-L., & Chen, H.-L. (2026). Game element appraisals and learning outcomes in a game-based child development course for medical students. BMC Medical Education. https://doi.org/10.1186/s12909-026-10461-x

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10461-x

Keywords: game-based learning, medical education, child development, flow state, pediatrics clerkship, board game, flow state questionnaire, medical students, BMC Medical Education, learning outcomes, false discovery rate, curriculum design