Can a card-based educational game enhance functional anatomy knowledge in first-year medical students? A mixed-methods study

Anatomy is a foundational yet cognitively demanding subject in undergraduate medical education. Although game-based learning has shown potential to enhance engagement and assessment performance, evidence remains limited for low-cost, single-session, card-based interventions designed to reinforce functional anatomy. This study evaluated whether a card-based educational game was associated with immediate changes in functional anatomy test performance in first-year medical students and explored learners’ perceptions, experiences, and perceived mechanisms of impact. We conducted a mixed-methods study with quantitative priority and an embedded qualitative component. The quantitative strand used a single-group pre-test-post-test design without a concurrent control group. Sixty first-year medical students at a university in Ecuador participated in a single-session card-based educational game designed to reinforce functional anatomy after completion of the relevant course content. Test performance was assessed using the same 35-item single-best-answer multiple-choice test mapped to five Bloom’s taxonomy domains. The baseline pre-test was completed before the intervention, and the post-test was administered immediately after gameplay. Pre–post comparisons were performed using the Wilcoxon signed-rank test. Learner perceptions were evaluated after the intervention using a 5-point Likert-scale questionnaire adapted from the Technology Acceptance Model. The qualitative strand included six focus groups, three pre-intervention and three post-intervention, analyzed using the Framework Method. Median age was 18 years (IQR 18–19), and 51.7% of participants were female. Significant score increases were observed in ‘Remember’ and ‘Understand’, while no significant changes were found in ‘Apply’, ‘Analyze’, or ‘Evaluate’. Total Bloom Score increased modestly from 21 (IQR 17–25) to 22 (IQR 18.25–26) ( p = 0.0192, r = 0.31). Learner perception scores were favorable, and qualitative findings identified immediate corrective feedback, repeated questioning, psychological safety, and peer interaction as key perceived mechanisms supporting learning, while time pressure and competition were potential stressors. The card-based educational game was associated with modest immediate gains in functional anatomy test performance, mainly in recall and understanding. It may be most useful as a low-stakes reinforcement strategy after foundational teaching. The findings do not establish improvement in higher-order reasoning or retention beyond the immediate post-test. Not applicable.