Game-based blended learning versus traditional lecture for evidence-based medicine (EBM) competencies in undergraduate medical students: a quasi-experimental study

Evidence-based medicine (EBM) competencies are crucial for medical students, yet they are often not fully developed. The best teaching methods for cultivating these skills remain uncertain. This study aimed to compare the effects of a game-based blended learning approach versus traditional lecture-based instruction on the development of EBM competencies among undergraduate medical students. This quasi-experimental study was conducted at the Shahid Sadoughi University of Medical Sciences (SSU). Fifty-eight clerkship students were cluster-assigned to intervention (puzzle-based blended, n = 27) or control (interactive lecture, n = 31). The intervention group participated in the blended game-based learning, combining asynchronous pre-class learning with an in-person, puzzle-based game. The control group received interactive lecture-based sessions delivered by an EBM expert. EBM competency was measured pre/post with the Assessing Competency in Evidence-Based Medicine (ACE) tool. ACE consists of a short clinical scenario followed by 15 binary questions. Learners in the intervention and control groups participated in the ACE examination, which was administered one week before the training and one week after the training. Data were summarized using descriptive statistics, including mean (standard deviation) for continuous variables and frequency (percentage) for categorical variables. Independent t-tests and analysis of covariance (ANCOVA) were used to assess the intervention effect. A statistically significant result was considered 0.05. In the intervention group, the mean score for EBM competency increased significantly from 3.55 (SD = 1.71) before the intervention to 13.11 (SD = 2.24) after the intervention ( p < 0.001). In the control group, the mean EBM competency score rose from 4.12 (SD = 2.20) pre-intervention to 10.12 (SD = 2.23) post-intervention ( p < 0.001). After adjusting for covariates, the impact of the intervention on total EBM competency scores remained statistically significant (F (1, 53) = 21.46, p < 0.001), with a large effect size (partial η² = 0.292). The game-based blended learning is effective for teaching Evidence-Based Medicine because it organizes the sequential and interconnected aspects of the EBM decision-making pathway. Notably, the findings indicate that the method is effective in developing higher-order EBM skills that require critical thinking, integration, and clinical judgment. The game-based blended learning—a specific, low-technology game genre—is highly effective for EBM education, making it accessible to institutions with limited technological resources.