Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Dec;30(1):2527175.
doi: 10.1080/10872981.2025.2527175. Epub 2025 Jul 10.

Impact of providing a customized guideline on virtual medical history taking in two serious games for medical education

Alexandra Aster  1 , Arietta Lotz  1 , Matthias Carl Laupichler  1 , Tobias Raupach  1
Affiliations
Randomized Controlled Trial

Impact of providing a customized guideline on virtual medical history taking in two serious games for medical education

Alexandra Aster et al. Med Educ Online. 2025 Dec.

Abstract

Background: Serious games are known as safe learning environments, allowing medical students to train their skills without endangering patients' safety. By integrating virtual patients via chatbots, serious games provide the opportunity to practice history taking. The study investigated the impact of self-directed learning by means of a customized guideline on history taking in two distinct chatbot systems embedded in serious games.

Methods: Fourth-year medical students (N = 159) were randomized to one of two serious games, each representing an emergency department and simulating different clinical scenarios. Students played the serious games at two measurement points and received a guideline between both sessions. The chatbots differed in the manner of query entry, with one requiring students to formulate history taking questions themselves, while the other provided a long menu of selectable questions. The dependent variables analyzed included the history taking data entered into the chatbots, represented as a quantified history score, as well as students' comparative self-assessments of their learning outcomes.

Results: Comparing only the first measurement point, students achieved higher scores in the free-entry chatbot (85.2 ± 27.7) compared to the long menu chatbot (78.8 ± 35.7). Students achieved significantly higher scores in the second than in the first session in the long menu chatbot (t(315) = -2.918, p = .004, d = -0.229) but not in the free-entry chatbot after receiving the guideline. In terms of students' self-assessment, no significant difference between both serious games was found.

Discussion: The results suggest that history taking benefits from self-directed learning in a long menu format relying on cued recall but not in a free-entry chatbot relying on free recall. Since serious games are partially artificial learning environments for training history taking, future studies should examine the extent to which students can transfer their learning in and out of serious games.

Keywords: Chatbot; history taking; medical education; self-directed learning; serious game.

PubMed Disclaimer

Conflict of interest statement

The author TR declares a financial conflict of interest as he holds shares in the company Yellowbird Consulting LTD that has developed the serious game DIVINA referred to in this article. No other author has competing interests.

Figures

Figure 1.
Figure 1.
Screenshots of the chat systems in EMERGE and DIVINA. The left screenshot represents the chat system in EMERGE, graphic by PatientZero Games GmbH. The right screenshot represents the chat system in DIVINA. The screenshots contain German questions, as the entire study was conducted in German.
Figure 2.
Figure 2.
Process of the derivation of the final data set. Each session is abbreviated with a capital letter referring to the serious game and a number referring to the respective session. Resulting in D1 for DIVINA session 1, D2 for DIVINA session 2, E1 for EMERGE session 1, and E2 for EMERGE session 2.
Figure 3.
Figure 3.
Course of the score improvements between the two sessions for each serious game. The proxy variable build for the analysis of the mixed ANOVA was also used for the creation of the figure.
Figure 4.
Figure 4.
Mean CSA gain values for each question of both serious game groups.
See this image and copyright information in PMC

References

    1. Fürstenberg S, Helm T, Prediger S, et al. Assessing clinical reasoning in undergraduate medical students during history taking with an empirically derived scale for clinical reasoning indicators. BMC Med Educ. 2020;20(1):368. doi: 10.1186/s12909-020-02260-9 - DOI - PMC - PubMed
    1. Peterson MC, Holbrook JC, Von Hales DE, et al. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med. 1992;156(2):163–11. - PMC - PubMed
    1. Manalastas G, Noble LM, Viney R, et al. What does the structure of a medical consultation look like? A new method for visualising doctor-patient communication. Patient Educ Couns. 2021;104(6):1387–1397. doi: 10.1016/j.pec.2020.11.026 - DOI - PubMed
    1. Skotzko CE, Vrinceanu A, Krueger L, et al. Alcohol use and congestive heart failure: incidence, importance, and approaches to improved history taking. Heart Fail Rev. 2009;14(1):51–55. doi: 10.1007/s10741-007-9048-8 - DOI - PubMed
    1. Schwitzguebel AJ, Jeckelmann C, Gavinio R, et al. Differential diagnosis assessment in ambulatory care with an automated medical history-taking device: pilot randomized controlled trial. JMIR Med Inform. 2019;7(4):e14044. doi: 10.2196/14044 - DOI - PMC - PubMed

Publication types

LinkOut - more resources