A Comparison of Game-Based Learning and Peer-Assisted Learning in Cardiovascular Physiology among First-Year Medical Students: A Randomized Controlled Crossover Trial

Direct comparisons between game-based learning and peer-assisted learning (PAL) in cardiovascular physiology remain limited despite growing emphasis on active learning in medical education. This randomized controlled crossover trial compared a novel educational board game, CardioLeague (Group A), with PAL (Group B) among first-year MBBS students. Thirty-six students who had completed cardiovascular physiology lectures were randomized 1:1 into two groups (n = 18 each). Knowledge was assessed via multiple-choice questionnaire at pre-test, immediately after intervention (post-test 1), one week later (post-test 2), and after crossover to the alternate method (post-test 3). Four participants in Group A and two in Group B were lost to follow-up before post-test 2 (n = 30 thereafter). Learner perception was assessed with an 18-item Likert-scale questionnaire (Cronbach’s α = 0.960). Both groups showed significant within-group knowledge gains after their initial intervention (Group A: 13.39 ± 4.82 to 16.56 ± 4.05, P = 0.0024**; Group B: 15.17 ± 5.73 to 17.83 ± 4.74, P = 0.0236*), with no significant between-group difference at any assessment point (all P > 0.05; Cohen’s d = −0.29 to 0.22). Knowledge scores declined significantly in both groups by post-test 3 (P < 0.0001***), consistent with expected forgetting. Learner perception favored CardioLeague over PAL across most domains, including engagement (4.61 ± 0.45 vs. 3.84 ± 0.70, P < 0.001***) and overall conclusion ratings (4.48 ± 0.98 vs. 3.56 ± 1.00, P = 0.009**). These findings indicate that no statistically significant difference in knowledge gains was detected between CardioLeague and PAL, while CardioLeague was associated with greater learner engagement and satisfaction.