Gamified Learning in a Virtual World for Undergraduate Emergency Radiology Education: Quasi-Experimental Study

Abstract

Background: Emergency radiology is essential for future doctors, who will face urgent cases requiring radiologic diagnosis. Using virtual simulations, gamified clinical scenarios, and case-based learning enhances practical understanding, develops technical and communication skills, and fosters educational innovation.

Objective: This study aimed to assess the feasibility of learning emergency radiology in the virtual world Second Life (Linden Lab) through a gamified experience by evaluating team performance in clinical case resolution, individual performance on seminar assessments, and students' perceptions of the activity.

Methods: Teams of 3-4 final-year medical students, during a 2-week radiology clerkship, had access to 7 clinical cases in virtual clinical stations and were randomly assigned 2 to solve and submit. They later discussed the cases in a synchronous virtual meeting and attended an emergency radiology seminar. The experience was repeated over 2 consecutive years to assess reproducibility through comparison of learning outcomes and students' perceptions. Learning outcomes were evaluated through team-based case resolution and individual seminar assessments. Students' perceptions were gathered via a voluntary questionnaire including 5-point Likert scale items, cognitive load ratings, 10-point evaluations, and open-ended comments.

Results: In total, 182 students participated in 2020-2021 and 170 in 2021-2022, demonstrating strong team-based case resolution skills with mean scores of 7.36 (SD 1.35) and 8.41 (SD 0.99), respectively (P<.001). The perception questionnaire had a 90.6% response rate. The highest cognitive load was observed in avatar editing (median 7, 95% CI 6.56-6.96). Case-solving cognitive load was significantly lower in 2021-2022 compared with 2020-2021 (median 6, 95% CI 5.69-6.21 vs 5.10-5.66; P<.001). The students rated the experience highly, with average scores exceeding 8.0 out of 10 across various aspects. Notably, the highest-rated aspects were the teaching staff (9.13, SD 1.15), cases (8.60, SD 1.31), project organization (8.42, SD 1.67), and virtual rooms (8.36, SD 1.62). The lowest-rated aspect was internet connectivity (6.68, SD 2.53). Despite the positive scores, all aspects were rated significantly lower in 2021-2022 compared with 2020-2021. These year-to-year comparisons in performance and perception support the reproducibility of the experience.

Conclusions: This study demonstrates that a game-based learning experience in the Second Life virtual world, combining virtual clinical scenarios and team-based tasks, is feasible and reproducible within a radiology clerkship. Students showed strong performance in case resolution and rated the experience highly, within a playful context that integrated asynchronous and synchronous activities. Lower ratings in the second year may reflect contextual differences, such as changes in COVID-19 pandemic restrictions.

Keywords: case-based learning; computer simulation; emergency radiology; game-based learning; medical students; radiology education; virtual worlds.

Figure 1.. Various scenes during the Second Life virtual world experience. (A) Aerial view of Medical Master Island with a flying avatar in the foreground. In the background, the main building, where the synchronous seminars were held, can be seen. (B) Example of an Objective Structured Clinical Examination station set up as a radiology room, with a team of students reviewing a head computed tomography case. The description of the clinical situation and the tasks to be performed are displayed on the wall. (C) Scene during a synchronous meeting with a student group, reviewing one of the Objective Structured Clinical Examination cases. (D) Screenshot submitted by a team of students as part of the competition.

Figure 2.. A chest x-ray corresponding to case number 3 shows complete opacification of the left hemithorax due to atelectasis of the left lung caused by bronchial carcinoma.

Figure 3.. Scoring of the different components of the Rainbow-Game educational experience. OSCE: Objective Structured Clinical Examination; SL pics: Second Life pictures.

Figure 4.. Bar chart with the average score obtained for each case over 2 consecutive years. Each year, 6 teams evaluated the cases, except for case 1, which was evaluated by 8 teams. Error bars represent the SD. Statistically significant differences, with P<.05, are identified with the letter “a.” OSCE: Objective Structured Clinical Examination;

Figure 5.. Diagram showing the degree of agreement, expressed as a percentage, reached each year in the responses to the experience evaluation questionnaire, which used a 1‐5 Likert scale. OSCE: Objective Structured Clinical Examination;