The motivation behind the project was twofold. First, the authors point to persistent challenges in undergraduate pediatric education, where students frequently arrive on the wards underprepared for the distinctive communication skills, developmental considerations, and family dynamics that caring for children demands. Second, pediatrics faces a worsening physician-workforce shortage, a trend that has alarmed department chairs across the United States. While no single curricular tweak can solve a workforce crisis, the research team reasoned that clerkship factors are modifiable, and that a thoughtfully redesigned clerkship could create conditions known from the literature to be associated with students’ specialty choices. In other words, if the pediatrics experience itself is engaging, well-organized, and supportive, more students may consider pediatrics as a career, and all students should leave better prepared to care for young patients regardless of the specialty they ultimately choose.

The structural changes were substantial. The clerkship’s length was increased, giving students more sustained exposure to pediatric patients and clinical teams. Before and alongside clinical duties, students received dedicated foundational-knowledge preparation, ensuring they approached patient encounters with the vocabulary and conceptual framework that pediatrics requires. The clinical experience itself was designed to be immersive and uninterrupted, minimizing the scheduling churn that traditionally pulls students out of patient care for lectures and administrative obligations. Perhaps the most distinctive element was the consolidation week, referred to by the abbreviation ARCC, standing for Assessments, Reflection, Coaching, and Community. During this week, students completed formal assessments, reflected on their clerkship experiences, received coaching, and participated in community service, all deliberately separated from the daily pressures of the wards.

To evaluate whether this ambitious redesign could actually be delivered in practice, the investigators measured process outcomes, specifically feasibility and acceptability, over three consecutive academic years. Required student-satisfaction surveys were distributed between February and December in the years 2022 through 2024. Satisfaction was quantified on a four-point scale ranging from one, indicating very dissatisfied, to four, indicating very satisfied. Beyond the numbers, students were asked to describe in their own words what was working well and what was not. The quantitative responses were analyzed with descriptive statistics, while the open-ended comments underwent inductive thematic analysis, a qualitative method in which themes emerge from the data itself rather than being imposed by a predetermined coding framework.

The participation rate alone was remarkable: 342 of 350 eligible students completed the surveys, a 97.7 percent response rate that lends considerable weight to the findings. Those students reported high levels of satisfaction with the new clerkship structure, including the quality of the clinical experiences and the overall clerkship. In the qualitative analysis, several consistent themes emerged. Students valued the increased length of the rotations, the clear organization and structure of the course, the opportunities for hands-on learning, the variety of clinical experiences offered, and, notably, the community service and reflection components. That students singled out reflection and service, elements often dismissed as soft additions in tightly packed curricula, suggests these touchpoints played a genuine role in helping students process the emotional and professional dynamics of caring for sick children and their families.

Satisfaction surveys capture perception, but critics of curricular innovation often ask a harder question: did students actually learn as much? To address this, the team collected mean equated percent correct scores on the pediatrics subject examination, a standardized National Board of Medical Examiners test administered nationally, for academic years 2022 to 2023, 2023 to 2024, and 2024 to 2025. Their students’ mean scores were at or above the reported national averages across those years. This is a critical technical point, because it demonstrates that the redesign did not trade knowledge acquisition for student comfort. The dedicated foundational-knowledge preparation and the protected immersive clinical time appear to have supported, rather than diluted, high-yield medical learning.

The authors frame these results through the lens of continuous quality improvement, an approach borrowed from industrial engineering and increasingly applied to medical education. Data collection was embedded in the Gateway Curriculum’s larger quality-improvement machinery, and the dissemination of process outcomes was reviewed by the Institutional Review Board at Washington University in St. Louis, which deemed the evaluation non-human-subjects research under federal regulations, since it constituted program evaluation rather than research on identifiable individuals. The study also adhered to the Declaration of Helsinki and relevant guidelines, and the team followed the DoCTRINE framework, Defined Criteria To Report INnovations in Education, which standardizes how educational innovations are described so that other institutions can evaluate and adapt them.

What makes this study resonate beyond St. Louis is its explicit theory of change. Rather than treating the pediatric workforce shortage as an intractable pipeline problem, the researchers targeted modifiable clerkship factors: time, structure, preparation, and reflective practice. The successful delivery of the redesigned clerkship supported students’ pediatric patient-care skill preparation and their perceived readiness to engage in clinical encounters, while simultaneously addressing areas known from the literature to influence specialty choice. A student who feels competent, supported, and intellectually engaged during a clerkship is more likely to view that specialty favorably, and the ARCC week’s coaching and reflection may further shape professional identity formation, the gradual process by which medical students come to see themselves as future physicians of a particular kind.

There are, of course, limits to what a single-institution process evaluation can establish. The study reports feasibility and acceptability, not long-term outcomes such as match rates into pediatrics residency programs, retention of knowledge over time, or patient-care quality attributable to the redesign. The subject-exam comparison relies on reported national averages rather than a randomized control group, and the satisfaction data, while overwhelmingly positive and drawn from nearly the entire student cohort, reflect one institution’s culture and resources. Reproducing a longer clerkship also requires institutional investment in scheduling, faculty coaching capacity, and community-service partnerships that not every medical school can readily muster.

Nevertheless, the findings offer a concrete, evidence-based template for institutions contemplating their own curriculum renewals. The message from WashU Medicine is that clerkship redesign, done systematically and evaluated rigorously, can simultaneously meet educational-programmatic goals and cultivate the positive experiences that may draw more physicians into pediatrics at a moment when children’s health care desperately needs them. As medical schools nationwide continue to overhaul their curricula for a new generation of learners, this pediatrics clerkship experiment stands as a compelling proof of concept: give students time, structure, preparation, and space to reflect, and they will not only learn more, they will appreciate the journey. The article is published open access, allowing educators everywhere to examine the model in detail and consider how its principles might translate to their own wards, clinics, and communities.

Subject of Research: Curriculum redesign and evaluation of the pediatrics clerkship in undergraduate medical education

Article Title: Feasibility and acceptability of an innovative curriculum redesign: the pediatrics clerkship at WashU Medicine

Article References: Pérez, M., Engle, D. L., Wyatt, A. T. M., Hall, L., Wallace, C. M., Bram, S., Emke, A. R., De Fer, T. M., & Colson, E. R. (2026). Feasibility and acceptability of an innovative curriculum redesign: the pediatrics clerkship at WashU Medicine. BMC Medical Education. https://doi.org/10.1186/s12909-026-10531-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10531-0

Keywords: medical education, pediatrics clerkship, curriculum redesign, undergraduate medical education, student satisfaction, feasibility and acceptability, clerkship structure, NBME subject exam, physician workforce shortage, reflection and coaching, community service, WashU Medicine

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