Abstract 4372936: King of Hearts: Effectiveness of a Card-Based Educational Tool for Electrocardiogram Teaching and Long-Term Retention in Medical Students

Abstract

Background: Electrocardiogram (ECG) interpretation is a core competency in medical education, yet remains a difficult skill for preclinical students to acquire and retain through traditional instruction. Serious games have emerged as promising tools to enhance engagement and long-term retention. However, few studies have rigorously evaluated their effectiveness using structured educational frameworks. Hypothesis: A card-based educational game improves ECG knowledge acquisition, retention, clinical application, and learner satisfaction compared to traditional lecture-based instruction. Methods: A longitudinal quasi-experimental study was conducted with 85 second- and third-year medical students without prior ECG training. Participants were assigned to either a card game group (n = 43) or lecture group (n = 42). Both received identical preparatory materials, followed by three 2-hour sessions over three weeks. Assessments included: (1) a 20-item test aligned with Bloom’s taxonomy (recall, comprehension, application, analysis) applied as pretest, post-test, and unannounced 2-week retention test; (2) a simulated clinical transfer task (Mini-CEX) at 3 months; (3) learner satisfaction using the Satisfaction Evaluation Survey in both groups and the MEGA (Medical Education Game Assessment) in the card group. Instruments were validated by experts (S-CVI = 0.92, α = 0.88). Between-group comparisons used t-tests and Mann-Whitney U tests. Repeated-measures ANOVA and Friedman test evaluated change over time. Results: Both groups improved from pretest to post-test. The card group scored higher at post-test (14.8 ± 2.1 vs 12.6 ± 2.3, p = 0.015) and retained more at two weeks (12.6 ± 2.0 vs 9.7 ± 2.8, p = 0.008). Clinical transfer performance at 3 months also favored the card group (7.6 ± 1.2 vs 6.2 ± 1.7, p = 0.006). Overall score changes over time were significant in both groups. In all four cognitive domains, the card group showed higher progression, particularly in application and analysis, and retained significantly more at two weeks. Satisfaction was higher in the card group (median 4.8 [IQR 4.5–5.0] vs 4.0 [3.8–4.3], p < 0.001), with MEGA scores highlighting clarity, engagement, and relevance. Conclusion: A card-based educational game significantly improved ECG learning, retention, clinical transfer, and student satisfaction compared to lecture-based instruction. This method shows promise for scalable, active and engaging alternative for medical education.