Beyond Lectures: Leveraging Competition, Peer Discussion, and Real-World Scenarios in a Digital Card Game to Enhance Learning of Microbiology and Immunology Concepts

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Abstract

Teaching the complex interactions between hosts and pathogens is a fundamental yet educationally challenging aspect of life science and healthcare education. The intricate mechanisms of the immune system can pose significant barriers to students’ understanding of infectious disease diagnosis and treatment. To address this, we used a web-based digital whiteboard platform to design a card-based competitive game called Micro-Immune Battles, aimed at more actively engaging students with microbiology and immunology to better develop their knowledge and underlying concepts. The game facilitates learning through a series of infectious disease scenarios, providing student teams with "immune system response cards" that represent various immune elements. Working in teams, learners must construct sequential card cascades that correctly correspond to the specified pathogen in the scenario. This reinforces the temporal progression of immune responses, whilst encouraging the application of theoretical knowledge to practical cases. Scoring is determined by the accuracy and speed of card placements, incentivising rapid yet correct synthesis of knowledge. Points are deducted for incorrect placements, introducing an element of calculated risk-taking and critical reasoning. Analysis showed statistically significant improvements in microbiology and immunology knowledge after playing the game.

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  1. Thank you for you submission to Access Microbiology. This is an interesting piece of work that will add to the current narrative around the use of games in higher education. The reviewers and I feel the paper is in good shape and only requires minor amendments before its publication (please see below). Reviewer 2 has highlighted the a number of the their comments are in the spirit of further work, so please do not feel their is a requirement or request to undertake any further study for this manuscript to be published - this is not the case. I would recommend addressing such comments in the discussion. I'm looking forward to receiving a revised manuscript as I fee the reviewers comments with strengthen the work before its publication.

  2. Comments to Author

    This is an interesting paper about using a card game to teach immunology and microbiology to stage 1 medical students. Limitations are mentioned. From a methodology standpoint, I note that 132 students did the pre-quiz and 106 did the post-quiz, but only 103 took part in the feedback. Was the feedback also optional as only the quiz submission is mentioned as being non-mandatory? Were there any rules regarting the game itself? Was there a time limit? Who was in charge of scoring? If it was the academic leads, did this have any bearing on how people looked at the game? I.e. did the students treat it as game or was it seen as an extension of an assessment? This would be some interesting information in order to improve reproducibility. The results are nicely presented. Whilst the overall results are positive, it does some interesting that 33 % of the cohort felt "very unconfident" and "unconfident" in applying the concepts. This is increased to 57 % when you take into account those who were "unsure". It would be good if this could be addressed in the discussion especially as the final sentence is "When students feel confident, they are more likely to participate actively, ask questions, and take intellectual risks that are essential for deep learning." This is a great leap when only 43 % said to be "confident" and "very confident" in applying the knowledge. It would interesting to note if there was any statements supporting these figures in the free text comments. It is an interesting finding that students were wholly positive about the experience, but didn't feel confident in applying the knowledge. This could be due to a number of mitigating factors, including the stage of study that they are at. It would be good to see if this would be reproduced in later stages of the course (this is very much further work).

    Please rate the manuscript for methodological rigour

    Satisfactory

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  3. Comments to Author

    I am a big supporter of gamification and game based learning, and it is encouraging to see the effort that has been put into creating a game to reinforce knowledge in the notoriously complex field of immunology. Methodology Some additional information regarding the implementation of the game would be useful to improve reproducibility and help answer the 'what' as mentioned in your Future Work section. How long did students play the game for and was this the same for all students? If not, was there any correlation between duration of game-play and post-test scores? As the same cohort of students undertook the same test twice, did you account for any improvement in scores purely by repetition of the test? For example, was there a time delay between each testing session? Results and Statistics I do have a concern regarding the presentation of the results. A proportional z test is only appropriate when the two groups are independent of each other. As the same cohort of students are being tested twice, this is not the case here. A paired z test must be used instead. However, my understanding of z tests is that they must only be used for continuous data. As you are comparing the percentage difference between correct/incorrect responses, the McNemar Test may be more appropriate, as this is used when the variable is proportional or categorical. In Table 1, I am unsure whether the Z statistic is actually being reported, or just the p-value (twice). Both should be reported. As your title mentions peer discussion and competition, do you have any feedback from students which address these within the game setting? Some thematic or other qualitative analysis could bolster your overall assessment of the game's impact. As a large proportion of students voted neutrally in the feedback questionnaire, it would be useful to investigate whether the free-text comments provided any justification for this, or suggestions for improvement. General Comments Both figures, Figure 2 in particular, are hard to read and would benefit from a full-page spread. Very minor point; I don't understand the point system within the game, for example, why does the same phagocytosis card gain 1 or 2 points depending on the placement? It is heartening to see educators investing in the reinforcement and retention of knowledge, rather than relying solely on traditional, didactic techniques. I think Micro-Immune Battles shows great promise, but the statistics must be addressed.

    Please rate the manuscript for methodological rigour

    Good

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes