Evaluating TESLA-G, a Gamified, Telegram-delivered, Quizzing Platform for Surgical Education in Medical Students

Study Overview
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Brief Summary
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Telegram Education for Surgical Learning and Application Gamified (TESLA-G) is an online, gamified quizzing platform for surgical education in medical students.The main objective of this pilot study is to assess the feasibility and acceptability of carrying out a full randomised control trial involving TESLA-G. A pilot randomised controlled trial involving 50 undergraduate medical students will be conducted. They will be randomised into an intervention group and an active control group. Feasibility will be determined by participant enrollment, retention rate, and quiz completion. Acceptability will be measured quantitatively via a post-intervention learner satisfaction survey and qualitatively via semi-structured interviews. Additionally, participants' scores for pre- and post-intervention knowledge tests will be compared.

Detailed Description
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Online multiple-choice question (MCQ) quizzes are a well-established summative assessment tool in medical education. However, they suffer from high drop-out rates, attributed to waning user motivation over time. Various studies have shown that incorporation of gamified elements into learning can promote engagement and motivation. In this pilot study, we will assess the feasibility and acceptability of a novel gamified quizzing platform, Telegram Education for Surgical Learning and Application Gamified (TESLA-G), to determine the possibility of a future larger-scale randomised controlled trial. This study entails a randomised controlled trial with two arms, an intervention group (TESLA-G) and an active control group (conventional quizzing platform). 50 first to fifth year medical students from Lee Kong Chian School of Medicine, Nanyang Technological University will be randomised into the two arms with a 1:1 allocation ratio, stratified by year of study. Participants will use the assigned quizzing platform to attempt questions on a specific topic (endocrine surgery) over a period of two weeks. At the end of the study period, several outcomes will be assessed. Feasibility will be determined by participant enrollment, retention rate, and quiz completion. Acceptability will be measured quantitatively via a post-intervention learner satisfaction survey and qualitatively via semi-structured interviews. Additionally, participants' scores for pre- and post-intervention knowledge tests will be compared.

Official Title
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Evaluating TESLA-G, a Gamified, Telegram-delivered, Quizzing Platform for Surgical Education in Medical Students: a Protocol for a Pilot Randomised Controlled Trial

Conditions
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Surgical Education in Medical Students

Intervention / Treatment
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* Other: Gamified online quizzing platform
* Other: Conventional quizzing platform


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Currently enrolled in a full-time 5-year undergraduate programme in the medical school that leads to the Bachelor of Medicine and Bachelor of Surgery (MBBS) Willing and able to provide consent for participating in the entire duration of the study including all pre- and post-study assessments Exclusion Criteria: NIL

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This is an online, pilot randomised controlled trial consisting of two parallel active groups - an intervention group and an active control group. Participants will be randomised into each group with a 1:1 allocation ratio, stratified by year of study.
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TESLA-G<br>Participants will be randomised into the two arms with a 1:1 allocation ratio stratified by year of study. There will be 25 participants in this arm. | Other: Gamified online quizzing platform<br>* TESLA-G is a novel gamified quizzing platform designed based on Bloom's taxonomy of learning domains. Questions will be created in blocks, where each block will test a specific topic within a specialty (endocrine surgery has been selected for this study). Each block has 5 questions, and each question corresponds to each level of Bloom's taxonomy and each level in game. For this study, we aim to create 56 blocks of 5 questions, totalling 280 questions. All questions will be created by two board-certified general surgeons and one endocrinologist, and validated by the research team. The aim of the game is for players to get as many points as they can before the timer runs out. Gamification elements include levels, countdown timer, lives, a point multiplier system, leaderboard rankings and a personalised dashboard. Participants in the intervention group will be provided with a link to access TESLA-G, sent from an automated Telegram bot; this access will be provided for 14 days.<br>|
| Active Comparator: Control<br>Participants will be randomised into the two arms with a 1:1 allocation ratio stratified by year of study. There will be 25 participants in this arm. | Other: Conventional quizzing platform<br>* The conventional quizzing platform will be a modified version of TESLA-G with all gamification elements removed. The same set of questions as the gamified version will be used. Upon entering the quiz, a question stem and five choices will be shown. When an option is selected, the right answer along with its explanation will be indicated. The next question will then be sent, and this process repeats until the participant leaves the platform or has answered every question. Questions will be queued in blocks, with each block corresponding to a particular topic in endocrine surgery. Unlike the gamified version, questions within each block will be randomised, regardless of their level on the Bloom's taxonomy. Participants will also not be informed of the level of Bloom's taxonomy for individual questions. The access link to the platform will be sent to participants from an automated Telegram bot, and this access will last for 14 days.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility of intervention | The feasibility of the intervention will be evaluated quantitatively. These are the objectives: Enrollment of 50 participants Retention of at least 75% of the enrolled participants Individual quiz completion rate of 80% Achieving all of these goals will prove that it is feasible to conduct a full-scale randomised controlled trial (RCT), while achieving two out of three goals will indicate that it is probably feasible. Achieving less than two goals will suggest that a full-scale RCT is not feasible with the current procedure. | 14 days | 
| Acceptability of intervention | Acceptability of the intervention is measured quantitatively via a post-intervention learner satisfaction survey and qualitatively via semi-structured interviews. | Post-intervention (14 days) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement of surgical knowledge | Scores of pre- and post-intervention quizzes will be compared. The quizzes, which are on endocrine surgery, will be drafted by two board-certified general surgeons and one endocrinologist. All questions will also be validated by the research team. It should be noted however, that the power of study will be inadequate in identifying the comparative effectiveness between the control and intervention groups in terms of improvement of surgical knowledge. Hence the analysis will be primarily conducted to identify any potential adverse effects and increase in the surgical knowledge within each group, and secondarily between groups. This will be done using a confidence interval of 95% using a small effect size of 0.2. | Pre and post-intervention (14 days) | 
| Participant satisfaction | All participants will also complete a post-intervention learner satisfaction survey, in the form of a Likert scale adapted from the System Usability Survey (SUS) (Brooke et al., 1996) and the Student Evaluation of Educational Quality (SEEQ) Questionnaire. The survey will assess if students in the intervention group are more satisfied with their experience than students in the control group. | Post-intervention (14 days) | 
| Retention of surgical knowledge | After another 14 days, participants will sit for a follow-up knowledge test, which once again consists of 20 MCQs on endocrine surgery conducted over 30 minutes. At this point, participants in both control and intervention groups will no longer be able to access the learning platforms. The difficulty level of the follow-up test will be similar to that of the post-intervention test as described earlier. The difference in test scores (post-intervention and follow-up) will indicate participant retention of surgical knowledge. | 14 days after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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surgical education, medical students, quiz, gamification, randomised controlled trial