Adaptive serious games assessment: The case of the blood transfusion game in nursing education

• The analysis of gameplay data from the Blood Transfusion Serious Game (BTSG) revealed crucial insights into the engagement, performance, and competency levels of participating nurses. • The study highlighted the efficiency of the adaptive assessment algorithm in determining competency indicators through gameplay activities. • Notable discrepancies existed between the game-embedded result and the adaptive assessment result, suggesting potential biases in the game result, which tended to overestimate the demonstrated competence.