Gamified Neurology Grand Rounds

Gamification vs. Traditional Teaching in Neurology Grand Rounds: A Randomized Crossover Trial Integrating Cognitive Load Monitoring and Blockchain Incentives

The goal of this research study is to learn if a new, game-based way of teaching neurology grand rounds (called "gamified teaching") works better than the traditional lecture-based format for neurology residents. It will also test whether using wristbands that measure stress and attention can help teachers adjust their pace in real time, and whether earning digital achievement badges motivates residents to keep learning.

The main questions it aims to answer are:

Does gamified teaching help residents remember key information longer (up to 3 months) compared to traditional teaching?

Does it improve how efficiently residents make clinical decisions (for example, ordering the right tests without unnecessary extras)?

Do teachers who receive real-time feedback from the wristbands deliver sessions that feel less tiring and more engaging to residents?

Do residents find the digital badges useful, and do they encourage more self-study?

Researchers will compare the gamified teaching method to the traditional lecture method. Each resident will experience both formats at different times (a "crossover" design). An additional small group will only receive the traditional format to help rule out other factors.

Participants will:

Take part in eight neurology grand rounds sessions over two 4-week periods (four sessions per period)

Wear a research wristband during each session to measure their physiological responses (skin activity and heart rate)

Complete short quizzes right after each session and again three months later

Fill out brief questionnaires about their learning experience and motivation

Use a custom interactive platform during the gamified sessions to work in teams, make clinical decisions, and earn digital badges

All information collected will be kept confidential, and participants may leave the study at any time without any impact on their residency evaluations.

Study Overview

• Status: Active, not recruiting
• Conditions: Education, Medical; Grand Rounds
• Intervention / Treatment: Behavioral: Gamified Neurology Grand Rounds; Behavioral: Traditional Component

• Study Type: Interventional
• Enrollment (Estimated): 240
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Sichuan
    • Chengdu, Sichuan, China
      • West China Hospital of Sichuan University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Currently enrolled in postgraduate year 1 (PGY1), PGY2, or PGY3 of an accredited neurology residency program
• No prior formal participation in structured gamified neurology teaching programs focused on clinical reasoning
• Able to attend all eight scheduled grand rounds sessions across both study periods and all assessments (baseline, post-session, washout, and 3-month follow-up)
• Willing to provide written informed consent and comply with all study procedures, including wearing the Empatica E4 wristband during teaching sessions

Exclusion Criteria:

• Scheduled off-service rotations, vacation, or other commitments that would prevent attendance at any study session or assessment
• Uncorrected severe visual or auditory impairment that would limit participation in multimedia-based gamified sessions or case presentations
• History of skin conditions or allergies that would preclude wearing the Empatica E4 wristband (e.g., contact dermatitis)
• Inability to provide informed consent (e.g., cognitive impairment or language barrier)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Sequence A: Gamified First, Then Traditional; Participants in this arm receive gamified neurology grand rounds during Period 1 (Weeks 1-2, four sessions), followed by a 4-week washout period with no neurology grand rounds, then receive traditional lecture-based neurology grand rounds during Period 2 (Weeks 7-8, four sessions). Gamified sessions use a custom web-based platform featuring team-based clinical simulations, real-time decision feedback, points, leaderboards, and blockchain-minted NFT achievement badges. Traditional sessions cover identical case content via instructor-led PowerPoint lecture with intermittent Q&A. All participants wear Empatica E4 wristbands for cognitive load monitoring during all sessions and complete post-session assessments and 3-month follow-up.	Behavioral: Gamified Neurology Grand Rounds; A web-based interactive teaching platform using team-based clinical simulation, real-time decision feedback, points, leaderboards, and blockchain-minted NFT achievement badges. Four 55-minute sessions delivered over 2 weeks. Cases cover stroke, epilepsy, movement disorders, neuroinfectious diseases, neurodegenerative disorders, neuro-ophthalmology, headache, and spinal cord disorders. Participants work in teams of 3-4, make sequential diagnostic/treatment decisions, and receive immediate feedback. Instructor delivers 15-minute expert debrief after 40 minutes of simulation.
Experimental: Sequence B - Traditional First, Then Gamified; Participants in this arm receive traditional lecture-based neurology grand rounds during Period 1 (Weeks 1-2, four sessions), followed by a 4-week washout period with no neurology grand rounds, then receive gamified neurology grand rounds during Period 2 (Weeks 7-8, four sessions). Gamified sessions use a custom web-based platform featuring team-based clinical simulations, real-time decision feedback, points, leaderboards, and blockchain-minted NFT achievement badges. Traditional sessions cover identical case content via instructor-led PowerPoint lecture with intermittent Q&A. All participants wear Empatica E4 wristbands for cognitive load monitoring during all sessions and complete post-session assessments and 3-month follow-up.	Behavioral: Gamified Neurology Grand Rounds; A web-based interactive teaching platform using team-based clinical simulation, real-time decision feedback, points, leaderboards, and blockchain-minted NFT achievement badges. Four 55-minute sessions delivered over 2 weeks. Cases cover stroke, epilepsy, movement disorders, neuroinfectious diseases, neurodegenerative disorders, neuro-ophthalmology, headache, and spinal cord disorders. Participants work in teams of 3-4, make sequential diagnostic/treatment decisions, and receive immediate feedback. Instructor delivers 15-minute expert debrief after 40 minutes of simulation.; Behavioral: Traditional Component; Instructor-led PowerPoint lecture covering identical case content as gamified sessions. Linear presentation: history → physical exam → localization → etiology → differential diagnosis → management. Intermittent Q&A encouraged. No game elements, simulation, points, leaderboards, or blockchain incentives. Four 55-minute sessions delivered over 2 weeks.
Active Comparator: Parallel Control: Traditional Only; Participants in this arm receive traditional lecture-based neurology grand rounds during both Period 1 (Weeks 1-2, four sessions) and Period 2 (Weeks 7-8, four sessions), with a 4-week washout period in between. All sessions cover identical case content used in the experimental arms, delivered via instructor-led PowerPoint lecture with intermittent Q&A. No gamified elements are introduced at any point. This arm controls for time effects (e.g., knowledge gains from residency progression) and testing effects (e.g., familiarity with assessment formats). All participants wear Empatica E4 wristbands for cognitive load monitoring during all sessions and complete post-session assessments and 3-month follow-up.	Behavioral: Traditional Component; Instructor-led PowerPoint lecture covering identical case content as gamified sessions. Linear presentation: history → physical exam → localization → etiology → differential diagnosis → management. Intermittent Q&A encouraged. No game elements, simulation, points, leaderboards, or blockchain incentives. Four 55-minute sessions delivered over 2 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Immediate Knowledge Acquisition (Post-Session Test Score)	Standardized 15-item multiple-choice quiz assessing comprehension of case localization, etiology, differential diagnosis, and management. Each item has one correct answer. Score is percentage correct (0-100%). Tests are administered immediately following each grand rounds session. Internal consistency confirmed via pilot testing (Cronbach's α ≥ 0.7).	Within 30 minutes after each grand rounds session (8 total sessions per participant; measured across both study periods, Weeks 1-2 and Weeks 7-8)
3-Month Knowledge Retention (Delayed Retention Test Score and Retention Rate)	Parallel-form 15-item multiple-choice test matching the immediate post-test in blueprint, difficulty, and internal consistency, but with different question wording and distractor options. Retention rate is calculated as (3-month test score / average immediate post-test score across both periods) × 100%. Higher scores indicate better long-term retention.	3 months (± 2 weeks) after completion of Period 2 intervention (Week 8)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diagnostic Redundancy Ratio	Efficiency of clinical reasoning measured as the ratio of actual diagnostic tests ordered by a participant/team to the minimal necessary tests defined by expert consensus. Lower ratio indicates more efficient test selection. For gamified sessions, data extracted from platform clickstream logs; for traditional sessions, recorded by research assistant during Q&A.	During each grand rounds session (8 total sessions; Weeks 1-2 and Weeks 7-8)
Time to Key Information Extraction	Speed of accurate clinical localization. For gamified sessions: number of click steps from case start to first correct localization decision. For traditional sessions: minutes from session start to first correct verbal localization response. Shorter time indicates more efficient reasoning.	During each grand rounds session (8 total sessions; Weeks 1-2 and Weeks 7-8)
Learner Engagement - Interaction Frequency	Frequency of voluntary learning behaviors. For traditional sessions: number of hand-raises, questions asked, or comments made (recorded by research assistant). For gamified sessions: clickstream depth (average interactions per minute, including decisions, feedback reviews, leaderboard checks). Higher values indicate greater engagement.	During each grand rounds session (8 total sessions; Weeks 1-2 and Weeks 7-8)
Flow Experience	Self-reported immersion and absorption during the learning session. Measured using a single-item slider question: "During this session, I felt completely immersed and lost track of time." Response range: 0 (not at all) to 100 (completely). Administered immediately after each session.	Within 10 minutes after each grand rounds session (8 total sessions; Weeks 1-2 and Weeks 7-8)
Subjective Cognitive Load	Perceived mental effort required to follow the session. Measured using the Paas 9-point Likert scale (1 = very low cognitive load, 9 = very high cognitive load). Administered immediately after each session.	Within 10 minutes after each grand rounds session (8 total sessions; Weeks 1-2 and Weeks 7-8)
Instructor Pacing Adjustment Effectiveness	Impact of real-time cognitive load alerts on group cognitive load. Measured as the change in Group Cognitive Load Index (GCLI) slope from 5 minutes before to 5 minutes after an instructor receives an adaptive alert (GCLI >80% or <30% for ≥2 minutes). Negative slope change indicates successful load reduction.	During gamified grand rounds sessions only (4 sessions per participant in crossover arms; Weeks 1-2 for Sequence A, Weeks 7-8 for Sequence B)
Perceived Value of Blockchain Badges	Usefulness and ease of use of the NFT achievement badge system. Measured using a modified Technology Acceptance Model (TAM) survey with 7-point Likert scales (1 = strongly disagree, 7 = strongly agree). Subscales: perceived usefulness (e.g., "Badges help me track learning progress") and perceived ease of use (e.g., "Digital wallet is easy to use").	At 3-month follow-up (Week 20, ±2 weeks)
Self-Directed Learning Behavior	Voluntary educational activities following study completion. Measured via: (1) frequency of neurology textbook/journal borrowing from institutional library, and (2) completion rate of optional online neurology courses recorded in the residency learning management system. Higher values indicate greater sustained motivation.	During the 3-month period following completion of Period 2 (Weeks 8-20)

Collaborators and Investigators

• Sponsor: West China Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2026
• Primary Completion (Estimated): August 30, 2026
• Study Completion (Estimated): August 30, 2026

Study Registration Dates

• First Submitted: February 12, 2026
• First Submitted That Met QC Criteria: February 12, 2026
• First Posted (Actual): February 19, 2026

Study Record Updates

• Last Update Posted (Actual): February 23, 2026
• Last Update Submitted That Met QC Criteria: February 19, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: gamification; clinical reasoning; wearable sensors; cognitive load; randomized crossover trial
• Other Study ID Numbers: WestChinaH-HX-2025-013

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No