運用遊戲式學習於醫學生兒童發展課程：遊戲元素與學習成效之探討

Abstract

正確掌握兒童發展里程碑與及時辨識發展遲緩，已被美國小兒科醫學生教育委員會與英國皇家兒科與兒童健康學院列為醫學生核心學習目標。在我國從醫學生、畢業後一般醫學訓練到兒科專科醫師訓練，兒童發展都被列為重要的學習項目。早期偵測並介入兒童發展異常亦是我國臨床醫療的重要任務。惟現行醫學生多以短期背誦學習，成效有限。本研究以桌遊進行遊戲式學習，期望強化學習成效，並探討可能影響知識增長、心流與團體效能的遊戲元素。 此研究受試者為五年級至兒科輪訓之馬偕醫學院醫學生，依授課時段分為遊戲教學組與傳統教學組。遊戲教學組於課前後各施行五題測驗，並於課後填寫心流（樂趣、控制感、專注度三構面）、團體效能及遊戲元素學習效用問卷；傳統教學組則於傳統課堂、病房與門診教學前後完成相同知識測驗。本研究旨在探討遊戲式學習應用於醫學生兒童發展課程中的成效與影響因素。首先，評估遊戲式學習相較於傳統教學方式，是否能有效提升醫學生對兒童發展相關知識之掌握程度。本研究將進一步分析不同遊戲元素對學習成效之影響，學習成效涵蓋知識增長、心流狀態（flow state）與團體效能（collective efficacy）三個層面。進一步將探討上述三項學習成效間之相互關聯性，以理解其潛在交互影響。最後整理學生主觀認為對學習具有益處之遊戲元素。 本研究納入遊戲教學組48 人、傳統教學組29 人。兩組前測成績無顯著差異（2.10 ± 1.22 vs. 2.28 ± 1.33，p = 0.56）。使用共變數分析控制前測後，遊戲教學組後測成績（3.60 ± 0.98）顯著優於傳統教學組（2.59 ± 1.09）[p < 0.001, η²=0.200]。相較於傳統教學（14%），遊戲教學組有更高比例的學生在後測取得 ≥ 2 分的進步（46 %）。 研究中進一步使用逐步多元迴歸來分析學生在學習過程中，對於各個遊戲元素重要性的看法。以知識增長為依變項：「團隊合作」為負向預測，「公平」為正向預測。若以心流—樂趣為依變項，結果顯示「明確遊戲目標」與「規則簡單明確」為正向預測；「失敗壓力低」為負向預測。以心流—控制為依變項時，遊戲元素中的「計分競爭」為正向預測。若以心流—專注為依變項，則發現遊戲元素中的「具挑戰性」為正向預測。而以團體效能為依變項，研究發現「逐漸增加難度」為正向預測。 進一步分析三項學習成效的相互關係，僅發現團體效能與心流—控制呈中度正相關。學生認為最具學習助益的遊戲元素依序為：快速回饋、明確遊戲目標、桌遊為主的玩法、團隊合作及規則簡單明確。 本研究對醫學教育的貢獻：(1)遊戲式學習可顯著提升醫學生在「兒童發展」的知識表現，優於傳統課堂教學。(2) 「明確遊戲目標」與「規則簡單明確」是促進心流的關鍵元素，也是學生認為對學習有助益的元素。「團體合作」對高知識進步者可能感受較差，提醒教師在規劃遊戲式學習時須取得平衡。（3）本研究也提供初步量性研究實證，後續可透過質性方法深究學習行為與遊戲元素的交互作用。

Mastery of child development and prompt recognition of developmental delay are competencies stipulated by the Council on Medical Student Education in Pediatrics (USA) and the Royal College of Paediatrics and Child Health (UK). In Taiwan, learning child development is also considered essential across various stages of medical training, from undergraduate to postgraduate and pediatric training. Because medical students in Taiwan typically rely on rote memorization for this topic, we designed a board game–based learning approach to enhance learning and to explore how specific game elements influence knowledge, flow stats and collective efficacy. This study aims to investigate the effectiveness of game-based learning in a course of child development for medical students. First, the study examines whether game-based learning, compared to traditional instruction, can enhance medical students’ knowledge acquisition related to child development. Second, it analyzes the impact of various game elements on learning outcomes, including knowledge gain, flow stat, and collective efficacy. Third, it explores the interrelationships among these learning outcomes to better understand their potential interactions. Finally, it identifies which game elements are perceived as most beneficial to learning, providing insights for future design and refinement of the curriculum. Fifth-year medical students on their pediatrics rotation were allocated by teaching schedule to a Game-Based Group (GBG, n = 48) or a Traditional Teaching Group (TTG, n = 29). Both groups completed a five-item pre-test and post-test on child development. After the intervention, the GBG also filled out questionnaires assessing flow (enjoyment, sense of control, engagement), collective efficacy, and the perceived learning utility of 11 game elements. Baseline pre-test scores did not differ between groups (2.10 ± 1.22 vs 2.28 ± 1.33; p = 0.56). After adjustment, the GBG achieved significantly higher post-test scores than the TTG (3.60 ± 0.98 vs 2.59 ± 1.09; F(1,74)=18.49, p < 0.001, η² = 0.200). A ≥ 2-point improvement occurred in 46 % of GBG students versus 14 % of TTG students. Stepwise regression revealed that knowledge gain was negatively predicted by teamwork and positively by fairness. Flow—enjoyment was positively predicted by clear goals and simple rule, but negatively by freedom to fail. Flow—sense of control was positively predicted by scoring competition. Flow—engagement was positively predicted by challenging tasks. Gradually increasing difficulty was a positive predictor for collective efficacy, Analysis of the interrelationships among three learning outcomes revealed that collective efficacy correlated moderately with flow-sense of control. Students ranked the most helpful game elements as rapid feedback, clear goals, board-game designs, teamwork, and simple rules. In conclusion, we designed a board-game–based learning activity on child development for medical students and demonstrated that it significantly outperforms traditional instruction in immediate knowledge acquisition on child development. Clear goals and simple rules are key elements that enhance enjoyment, whereas teamwork is perceived as less beneficial by high- performing students. Our findings offer evidence-based guidance for designing future game-enhanced medical curricula and for further studies exploring learning behaviors.