“<scp>Pancreata: The Keto Struggle</scp>”: an innovative educational tale‐based game for diabetic ketoacidosis revitalizes collaborative learning, learner's engagement among undergraduate medical students

Traditional didactic teaching methods in medical education, while foundational, often lead to passive learning and insufficient engagement. "Pancreata-The Keto Struggle," an educational tale-based game for diabetic ketoacidosis (DKA), was developed to address these challenges by promoting collaborative learning, enhancing student engagement, and improving knowledge retention through an interactive and narrative-driven approach. This study involved 150 first-year medical students divided into 25 small groups of 6 each. Participants were assessed before and after engaging with the game through a structured formative assessment, a validated questionnaire measuring engagement and learning effectiveness, and a confidence level questionnaire. In-depth small-group interviews were also conducted for qualitative feedback and thematic analysis was performed. Statistical analyses were performed using SPSS version 17. The introduction of "Pancreata-The Keto Struggle" resulted in significant improvements in students' formative assessment scores, from a mean of 19.2 ± 1.9 before the game to 39.3 ± 2.2 out of 50 after the game (p < 0.0001). Notably, students demonstrated the highest confidence gains in managing DKA and interpreting laboratory results. Qualitative analysis identified seven common themes reflecting the game's impact on learning: collaboration, retention of concepts, internal drive, self and peer assessment, joyful learning, beyond books, and aesthetic content. Over 95% of students reported increased engagement and learning effectiveness due to the game's intrinsic motivation, narrative, and group learning mechanics. "Pancreata-The Keto Struggle" effectively revitalizes collaborative learning in medical education by integrating game-based learning with traditional teaching methods. The game not only facilitates a deeper understanding of complex clinical conditions like DKA but also broadly improves students' clinical management skills and confidence. These findings underscore the potential of educational tale based games to enrich medical education and advocate for their broader application across curricula.