ArticleJMIR serious games2026
Serious Game-Assisted Teaching for Junior Operating Room Nurses in Unicompartmental Knee Arthroplasty: Quasi-Historical Controlled Trial.
Article in JMIR serious games, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Unicompartmental knee arthroplasty (UKA) requires precise intraoperative coordination from operating room nurses. Conventional teaching may be insufficient for junior nurses learning complex UKA surgical cooperation, particularly regarding self-efficacy and cognitive demands. Serious games have emerged as a promising educational tool for nursing training. Objective: This study evaluated whether adding a WeChat-based serious game to conventional UKA training was associated with improved theoretical knowledge, self-efficacy, preoperative preparation, intraoperative performance, and perceived cognitive load among junior operating room nurses. Methods: This quasi-historical controlled study compared 2 sequential, noncontemporaneous cohorts of newly recruited junior operating room nurses from a tertiary hospital in Xuzhou, China. Nurses recruited in 2023 were assigned to the conventional training group (n=21, 50%), whereas nurses recruited in 2024 were assigned to the serious game-assisted training group (n=21, 50%). Both groups received the same UKA curriculum, including theoretical teaching and supervised intraoperative practice, while the intervention group additionally used a mobile serious game. Outcomes included theoretical test scores, General Self-Efficacy Scale scores, National Aeronautics and Space Administration Task Load Index (NASA-TLX) cognitive load scores, and assessments of preoperative preparation and intraoperative performance. Results: Data from all 42 eligible participants were included. Compared with conventional training, serious game-assisted training was associated with higher theoretical knowledge scores (mean 96.86, SD 3.09 vs mean 92.38, SD 4.32; P<.001; Cohen d=1.19), preoperative preparedness (mean 4.19, SD 0.33 vs mean 3.49, SD 0.29; P<.001; Cohen d=2.27), intraoperative performance (mean 4.00, SD 0.30 vs mean 3.41, SD 0.28; P<.001; Cohen d=2.03), and overall preparedness and performance (mean 4.10, SD 0.23 vs mean 3.45, SD 0.20; P<.001; Cohen d=3.02). Self-efficacy was higher in the unadjusted analysis (mean 34.05, SD 2.87 vs mean 31.57, SD 3.43; P=.02; Cohen d=0.78), but this difference was attenuated after adjustment for age and education (adjusted mean difference 2.45, 95% CI -0.26 to 5.15; P=.08). The serious game-assisted group also reported higher NASA-TLX total cognitive load (mean 65.44, SD 12.00 vs mean 58.21, SD 6.05; P=.02; Cohen d=0.76). Conclusions: Serious game-assisted training was associated with better theoretical knowledge and procedural performance but higher perceived cognitive load among junior operating room nurses learning UKA coordination. The adjusted self-efficacy result, as well as the overall findings, should be interpreted cautiously rather than as definitive causal evidence because the study used a quasi-historical design without a contemporaneous control group.
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