Su Min Joyce Tan ^1,2 Michael Coffey ^1,3 Katrina Blazek ⁴ Neela Sitaram ² Isabella Dobrescu ⁵ Alberto Motta ⁵ Sandra Chuang ^1,6 (Keith) Chee Yee Ooi ^1,3*

• ¹ Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
• ² Department of General Paediatrics, Sydney Children's Hospital, Sydney, NSW, Australia
• ³ Department of Gastroenterology, Sydney Children's Hospital, Randwick, Australia
• ⁴ School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
• ⁵ School of Economics, Business School, University of New South Wales, Sydney, New South Wales, Australia
• ⁶ Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, NSW, Australia

The COVID-19 pandemic necessitated the transition to online medical education. This study evaluated the efficacy of online case-based tutorials using a serious game tutorial (PlayMed TM (PM)), as compared to a traditional slideshow tutorial (TT).We performed a prospective, mixed-methods, randomised controlled trial on undergraduate medical students during the COVID-19 pandemic, from May 2020 to January 2021. Students were block randomised into the PM or TT groups. Tutors conducted online teaching on bronchiolitis and gastroenteritis cases using PM or TT to facilitate the presentation. Educational experience was assessed using a continuous interval scale (0 to 100; with pre-defined categories) and free text responses. Immediate and long-term knowledge acquisition was assessed using 6 multiplechoice questions (MCQ) for each case (total of 12 MCQ). A modified intention-to-treat mixed methods and a sensitivity per-protocol analysis were performed to compare outcomes between PM and TT groups.Results: In total, 80 PM and 73 TT participants attended at least 1 tutorial. Sixty-five (81%) PM and 52 (71%) TT participants completed at least 1 survey and were included for analysis. PlayMed TM students had an increased likelihood of completing the surveys, which included the MCQ (odds ratio (95% CI) of 2.4 (1.6 -3.8), p<0.00006). Regarding the immediate reactions post bronchiolitis and gastroenteritis cases, several responses were significantly more positive in the PM group compared to the TT group; e.g. "The learning activity was engaging" (medium effect size: d (95% CI) = 0.58 (0.32 -0.85), p < 0.0001). Higher proportions of participants in the PM group reported feeling safe in the gastroenteritis and bronchiolitis tutorials (96% and 89%), compared to the TT group (76% and 74%). PlayMed TM participants significantly outperformed TT participants on the bronchiolitis MCQs done immediately post tutorial, 4.1 (1.0) vs. 3.5 (1.0), respectively, p=0.004 (medium effect size: d (95% CI) = 0.54 (0.16 -0.91)).This study demonstrates the utility of a serious game (PlayMed TM ) as an online teaching tool for medical education. Students exposed to PM demonstrated superior engagement and feelings of safety. Utilisation of serious games may also facilitate knowledge acquisition, at least in the short term.