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Background: Serious games have the potential to teach complex cognitive skills in an engaging way, at relatively low costs. Their flexibility in use and scalability makes them an attractive learning tool, but more research is needed on the effectiveness of serious games compared to more traditional formats such e-modules. We investigated whether undergraduate medical students developed better knowledge and awareness and were more motivated after learning about patient-safety through a serious game than peers who studied the same topics using an e-module., Methods: Fourth-year medical students were randomly assigned to either a serious game that included video-lectures, biofeedback exercises and patient missions (n = 32) or an e-module, that included text-based lectures on the same topics (n = 34). A third group acted as a historical control-group without extra education (n = 37). After the intervention, which took place during the clinical introduction course, before the start of the first rotation, all students completed a knowledge test, a self-efficacy test and a motivation questionnaire. During the following 10-week clinical rotation they filled out weekly questionnaires on patient-safety awareness and stress., Results: The results showed patient safety knowledge had equally improved in the game group and e-module group compared to controls, who received no extra education. Average learning-time was 3 h for the game and 1 h for the e-module-group. The serious game was evaluated as more engaging; the e-module as more easy to use. During rotations, students in the three groups reported low and similar levels of patient-safety awareness and stress. Students who had treated patients successfully during game missions experienced higher self-efficacy and less stress during their rotation than students who treated patients unsuccessfully., Conclusions: Video-lectures (in a game) and text-based lectures (in an e-module) can be equally effective in developing knowledge on specific topics. Although serious games are strongly engaging for students and stimulate them to study longer, they do not necessarily result in better performance in patient safety issues.

Background: Clinical experience is considered to affect medical students' career preferences. It is not known whether the sequence of the clinical rotations influences these preferences., Aim: To explore whether the first clinical clerkship has more impact on career preference than the second by examining the association between the first clinical clerkship and the choice of an elective sixth-year internship., Method: University Medical Center Utrecht students are assigned to either a surgical or a medical ward for the first third-year clerkship and to the other ward for the second clerkship. In a retrospective cohort study, internship data of 488 sixth-year students were related to their first clerkship 3 years earlier., Results: For the group as a whole, no association was found between third-year clerkship and sixth-year internship. However, male students who had been assigned to surgery first more often chose a surgical internship than those who had been assigned to medical clerkship first and vice versa (p < 0.02). Within the female subgroup, no association was found., Conclusion: A positive association between the nature of the clerkship and the sixth-year internship preference among male students suggest that the first clinical experience can affect later specialty preference.

Context: Ber's Comprehensive Integrative Puzzle aims to assess analytical clinical thinking in medical students. We developed a paediatric version, the MATCH test, in which we added two irrelevant options to each question in order to reduce guessing behaviour. We tested its construct validity and studied the development of integrative skills over time., Methods: We administered a test (MATCH 1) to subjects from two universities, both with a 6-year medical training course. Subjects included 30 students from university 1 who had completed a paediatric clerkship in Year 4, 23 students from university 2 who had completed a paediatric clerkship in Year 5, 13 students from both universities who had completed an advanced paediatric clerkship in Year 6, 28 paediatric residents and 17 paediatricians. We repeated this procedure using a second test with different domains in a new, comparable group of subjects (MATCH 2)., Results: Mean MATCH 1 scores for the respective groups were: Year 4 students: 61.2% (standard deviation [SD] 1.3); Year 5 students: 71.3% (SD 1.6); Year 6 students: 76.2% (SD 1.5); paediatric residents: 88.5% (SD 0.7), and paediatricians: 92.2% (SD 1.1) (one-way ANOVA F = 104.00, P < 0.0001). Students of both universities had comparable scores. MATCH 1 and 2 scores were comparable. Cronbach's alpha-values in MATCH 1 and 2 were 0.92 and 0.91, respectively, for all subjects, and 0.82 and 0.87, respectively, for all students., Conclusions: Analytical clinical thinking develops over time, independently of the factual content of the course. This implies that shortened medical training programmes could produce less skilled graduates.

Background: This study is the longitudinal sequel to a survey published by Custers and Ten Cate in December 2002 in which advanced medical students' attitudes towards the basic sciences were investigated. Students were enrolled in either a conventional or an innovative curriculum., Aims and Methods: The aim of the present study was to assess longitudinal development of students' attitudes by recording beginning and advanced clerks responses to nine disagree-agree statements concerning the basic sciences., Results: In general, most students in either curriculum acknowledge the importance of biomedical knowledge. Students in the conventional curriculum appear to assign a slightly more important role to the basic sciences than students in the innovative curriculum, and this difference is maintained over the clinical years. Surprisingly, advanced clerks in either curriculum are more likely than beginning clerks to support the view that many basic science facts should be learned before application in a clinical context., Conclusions: These findings suggest that students during their clerkships might experience regret having not paid more attention to factual basic science knowledge in their preclinical years. Finally, students in the innovative curriculum hold more favourable opinions about the way the basic sciences are taught in their curriculum.