Development and validation of an ethical monopoly board game to teach bioethics to undergraduate medical students

BACKGROUND: Ineffective teaching practices of bioethics are responsible for the rampant incidents of litigation, reports of misconduct, and complaints of unethical behaviors among medical professionals in various healthcare settings. There is a limited body of research on the implementation of innovative approaches for teaching ethical reasoning. One such approach is game-based learning, with board games emerging as a cost-effective and accessible tool for bioethics education. AIM: To develop a board game to improve the teaching of bioethics and evaluate the effects of this board game on student satisfaction, engagement, and knowledge gain regarding bioethics. METHODS: The board game 'Ethical Monopoly' was developed and validated using a mixed-methods study design, following the steps of AMEE Guide 87. This study was conducted at the University of Lahore and Al-Aleem Medical College, from 2021-2023. The game's content, design, and mechanics were developed using the combined results of a literature review and four focus group discussions with 16 undergraduate medical students and 11 faculty members. Situational Judgment tests were designed to familiarize the players with ethical dilemmas. A panel of 16 multidisciplinary expert judges evaluated the content validity of the Ethical Monopoly in a single round of the Delphi technique. The response process validity of the game was measured through observation and cognitive interviews with a group of eight undergraduate medical students. RESULTS: The Ethical Monopoly game was validated using a data collection instrument comprising 55 items on Game Rules (15 items), Game Design (four items), Game Cards (12 items), Game Relevance and Satisfaction (24 items). The content validity index, Scale-Level Content Validity Index Average (S-CVI/Ave) for board games was 0.93. Qualitative analysis of the cognitive interviews showed excellent response process validity. Students appreciated the user-friendly and colourful game design and the use of diverse and realistic scenarios in Situational Judgment tests. CONCLUSION: Expert judges positively received an ethical monopoly prototype. It is a valid board game for teaching ethics with relevant learning objectives, attractive design, and game mechanics that are suitable for improving student motivation, interaction, and interest in learning bioethics.