Effectiveness of Gamification for Electrocardiogram Interpretation Training Among Intensive Care Nurses: A Randomized Controlled Trial



Aminnasab D ; Ahmady S ; Rasouli D ; Hosseini M M ; Rozveh A K
Source: Journal of Medical Education Development Published:2026

Abstract

Background & Objective: Accurate ECG interpretation is a critical clinical competency for ICU nurses, yet conventional lecture-based training has shown limited efficacy in achieving durable skill acquisition. This study aimed to evaluate a gamification-based educational intervention for improving ECG interpretation competence among ICU nurses. Materials & Methods: This randomized controlled educational trial was conducted among 100 ICU nurses at Shariati Hospital, Tehran, Iran. Participants were randomly allocated to a gamification-based intervention group (n = 50) or a lecture-based control group (n = 50). The intervention was delivered over two weeks. ECG interpretation competence was assessed using a validated 20-item multiple-choice questionnaire at baseline and four weeks post-intervention. The questionnaire was developed through content validation by an expert panel (I-CVI ≥ 0.83, S-CVI/Ave = 0.92) and pilot testing with item analysis (difficulty index: 0.35–0.75; discrimination index: 0.30–0.55). Data were analyzed using independent and paired t-tests. Results: Baseline ECG scores were comparable between groups (intervention: 14.34 ± 1.18; control: 13.75 ± 1.22; p = 0.064). After the intervention, the adjusted post-test mean score was significantly higher in the gamification group than in the control group (15.43 ± 1.16 vs. 14.84 ± 1.12; p = 0.042; Cohen’s d = 0.52). Prior experience with educational games was a significant predictor of post-test performance in the intervention group (β = 0.63, SE = 0.27, 95% CI [0.11, 1.15], p = 0.019). Conclusion: Gamification-based education was more effective than traditional lectures in enhancing ECG interpretation competence among ICU nurses and may serve as a practical approach for continuing nursing education. © 2026 Zanjan University of Medical Sciences.