The use of educational board games in training of healthcare professionals has proven to be a valuable tool, with the fundamental characteristics of games such as participation, individual interaction, the significance of rules, and the integration of emotions and knowledge, which play critical roles in the learning process. These features not only underscore the effectiveness of games as educational tools, but also satisfy the intrinsic psychological needs for autonomy, competence, and social connection [23].
In this study, Hedges’ g was used to calculate the effect size, with the following classifications: 0.2 was considered small; 0.5 was considered moderate; 0.8 was considered large; 1.2 was considered very large; and 2 was considered a huge effect [24, 25]. The improvements in the recall level score of the three groups all reached a large effect size. The effect sizes for the comprehension level score varied between groups, ranging from small to large, while the application score showed more variation, with effect sizes ranging from moderate to huge. The overall score indicated that the DH2019 group had a huge effect size, whereas the other groups (dental students and DH2020) had a large effect size.
The significant improvement in patient safety knowledge scores after the educational board game intervention compared with baseline scores across the three groups highlights its effectiveness as a teaching method. This finding is consistent with other studies that have demonstrated the efficacy of board game-based learning in increasing knowledge [12, 26, 27]. Medical education games provide instructors with valuable tools to create supportive and engaging learning environments. When well-designed and subject-specific, these games enable students to master materials more efficiently than traditional lectures [28]. Given the importance of patient safety in healthcare, including dentistry, and the lack of formal patient safety training for clinical dental interns during undergraduate education, it is essential to teach these concepts to undergraduate dental students and newly graduated dentists. The positive impact of game-based learning on patient safety concepts observed in this study corroborates the results of other studies that utilized gamified educational interventions to instill patient safety concepts in dentists with less than 5 years of work experience [3]. The scope of patient safety is extensive and multifaceted. This study was developed in alignment with the eight goals outlined in the “Hospital Patient Safety Annual Goals,” issued by the Ministry of Health and Welfare, in contrast to Song’s research [3], which focused on sentinel events predominantly observed in dental practice. The current study emphasizes the importance of patient safety awareness within the hospital system, aiming to enhance students’ understanding of patient safety culture and the measures in place to prevent medical errors during dental procedures. In addition, the board game demonstrated substantial efficacy for knowledge acquisition. Its design allows for its application across a large cohort of students, ensuring both cost-effectiveness and high teaching efficiency, thereby fostering self-directed learning. However, student feedback has highlighted areas for improvement, specifically the revision of game rules and augmentation of event card quantities. These enhancements are intended to increase the frequency of event cards, thereby further improving the pedagogical effectiveness of scenario-based questions within the game.
Tutors’ competencies also had a positive impact on student learning outcomes. Notably, the patient safety knowledge scores in the DH2019 group were significantly higher than those in the other groups postintervention, suggesting that learning under the guidance of experienced instructors had a greater effect on students. Under the instruction of dental hygienists, the correct rate of their knowledge application level score reached 90.25% post-intervention, which was far superior to other groups (20.25% and 18.00%) and closest to the educational goal of this serious game. This finding is in alignment with the evolving role of teachers as facilitators of learning [29], who use their professional knowledge to verify existing information and guide students in identifying key issues relevant to their future practices. Our findings are consistent with those of Van Berkel and Dolmans, who found that tutors promoting active, self-directed, contextual, and collaborative learning enhanced the use of problems and meaningful contexts in problem-based learning (PBL) and improved group functioning [30]. According to Davis, expert facilitators contribute to better student performance in small-group sessions than non-expert facilitators. In our study, experienced clinical personnel provided clearer descriptions and explanations of clinical scenarios, allowing students to develop a deeper understanding of real-world clinical practice. Their expertise helped bridge the gap between theoretical knowledge and practical applications, enhancing student ability to contextualize patient safety principles within authentic clinical settings [31]. Therefore, incorporating tutors’ skills into clinical faculty development is crucial as student satisfaction with clinical rotations is significantly correlated with their satisfaction with their tutors [32].
Serious games are practical educational tools that facilitate learning and enable individuals to reach higher levels of Bloom’s Taxonomy. Lean learning, guided by practice and objective elements, is often driven by active learning methodologies [33]. A previous serious game designed by our team has demonstrated that the knowledge and understanding gained through serious game learning can be applied or assessed to solve problems, reaching the intermediate levels of Bloom’s Taxonomy [22]. In this study, the board game significantly enhanced the acquisition of foundational knowledge, but the application of patient safety concepts in clinical settings was influenced by the guidance provided by the tutor. This study implies that students require the guidance and interaction of clinical instructors to perform tasks and acquire skills effectively, reaching intermediate levels of Bloom’s Taxonomy (applying). After participating in the board game, students identified the critical considerations during the preoperative, intraoperative, and postoperative phases of the dental surgical procedure. For example, the students learned the importance of verifying patient identity, confirming the surgical site, and ensuring that informed consent was signed by the patient before the procedure. The students from the DH2022 group reported lower ability improvements in “creating a patient safety culture and implementing incident management,” “preventing patient falls and reducing injuries,” and “improving tubing safety.” This may be correlated with students’ lack of clinical internship experience and the relatively insufficient clinical experience of the tutors. The DentSafe board game offers limited enhancement of non-cognitive skills, highlighting the need for students to participate in clinical observations and integrate these experiences into the board game-based curriculum.
This study had certain limitations. First, the study was conducted at a single university, which may have limited the generalizability of the findings. Additionally, patient safety concerns encompass both cognitive and non-cognitive dimensions, while the DentSafe board game primarily focuses on knowledge acquisition. Non-cognitive aspects, such as attitudes toward patient safety, showed positive outcomes but were not comprehensively addressed. Further educational interventions are required to reinforce and deepen the establishment of a strong patient safety culture. Moreover, the board game was developed as a foundational patient safety course for dental and dental hygiene students with varying levels of clinical experience. While this provides a broad introduction, future iterations can incorporate customized learning experiences tailored to role-specific competencies and clinical exposure levels. This would help maintain engagement among more experienced students while ensuring appropriate challenges for beginners. Furthermore, the variability in clinical experience among pre-licensed students may influence their engagement with the board game, their ability to process scenarios, and the applicability of lessons to real-world settings. Future studies should consider stratifying students based on their clinical exposure to enhance the generalizability of their findings. Despite these limitations, student participation in the board game has demonstrated enhanced engagement and improved learning outcomes. Future studies with larger sample sizes and multi-institutional participation are recommended to further explore its effectiveness and address these considerations.
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