Learning Game Co-Design by Second-Year Nursing Students

and Its Effects on Knowledge

Sebastian Gajewski

, Nour El Mawas

and Jean Heutte

Univ. Lille, ULR 4354 - CIREL - F-59000 Lille, France

Université de Lorraine, Crem, F-57000 Metz, France

Keywords: Co-Design, Learning Games, Nursing Students, Knowledge.

Abstract: Previous research works show the role of game-based learning to improve student’s learning. Furthermore,

there are more and more game design tools. They are easy-to-use even by people without any technical skills.

This paper presents the experimentation of learning game co-design by the 110 second-year nursing students

of the Catholic Institute of Lille conducted from April to June 2022, and its effects on learning. To measure

the effects of the learning game co-design on learning, the students answered a knowledge questionnaire

before (pre-test) and after (post-test) the learning game co-design. The results highlight that the knowledge

score increased after the learning game co-design. However, no significant difference was found between the

students who co-developed successfully a playable game and those who didn’t.

1 INTRODUCTION

Previous research works show the role of game-based

learning to increase the students’ learning and

motivation (Tan et al., 2017). Game-based learning

includes gameplay-based learning and game design-

based learning (Kafai, 2006). In the gameplay-based

learning, students play a game to learn while in the

game design-based learning, they learn by designing

their own games. So, this paper is about game-based

learning and more specifically about game design-

based learning because (1) game design engines are

increasingly easier to use even by people without any

technical skills and (2) students learn better when

they are actively engaged in the construction of

concrete artefacts, as video games, they can share

with others (Papert & Harel, 1991).

This paper is a part of a thesis work where we

experimented a method of learning game co-deign

with second-year nursing students and assessed the

effects of this learning game co-design on students’

learning and motivation. However, in this paper, we

especially focus on its effects on learning.

This paper is structured as follows. Section 2

oversees the theoretical works which conduct us to

propose our method of learning game co-design and

https://orcid.org/0000-0002-0214-9840

https://orcid.org/0000-0002-2646-3658

to choose the game design tools the more suitable for

our needs. Section 3 details how we have

experimented the method of learning game co-design.

Section 4 presents the results which are discussed in

section 5. Section 6 concludes this paper and presents

further perspectives.

2 RELATED WORK

In this section, we first present the method of learning

game co-design we have developed (Gajewski et al.,

2020). Then, we present a guide to help teachers,

game designers, pedagogical engineers, and

researchers to identify the game design tool the more

suitable for their needs (Gajewski et al., 2022, 2023).

2.1 Our Method of Learning Game Co-

Design

Since nursing students are learning, they are novices

in the topic, and since they have not any programming

experience, we needed a method of learning game co-

design with pedagogical objectives, clear steps and

not requiring pedagogical and technical skills.

654

Gajewski, S., El Mawas, N. and Heutte, J.

Learning Game Co-Design by Second-Year Nursing Students and Its Effects on Knowledge.

DOI: 10.5220/0013212200003932

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 17th International Conference on Computer Supported Education (CSEDU 2025) - Volume 2, pages 654-661

ISBN: 978-989-758-746-7; ISSN: 2184-5026

Table 1: Comparison of game design methods.

Pedagogical

objectives

Clear steps Pedagogical skills

not require

Technical skills

not require

The six facets of

serious game

esign

LEGADEE

ARGILE

DODDEL

EMERGO

KTM Advance

The content-centric

development process

model

La méthode du jeu

cadre

Adventure Author

We have conducted a literature review on

methods of game design. Nine methods of game

design have been identified: the six facets of serious

game design (Marne et al., 2011), LEGADEE

(Marfisi-Schottman, 2012), ARGILE (El Mawas,

2013), DODDEL (McMahon, 2009), EMERGO

(Nadolski et al., 2008), KTM Advance (Ibanez et al.,

2009 ; Yusoff, 2010), the content-centric

development process model (Moreno-Ger et al.,

2008), la méthode du jeu-cadre (Sauvé, 2010), and

Adventure Author (Robertson & Nicholson, 2007).

As shown in Table 1, none were suitable for our

needs: Almost all require pedagogical or technical

skills. One of them has no pedagogical objectives.

So, we needed to develop our method of learning

game co-design.

From a literature review based on 20 papers on

game design-based learning, we developed a method

of learning game co-design (Gajewski et al., 2020).

This method involves four different actors (the

game designer, the teacher, the researcher, and the

students), and is composed of 11 steps. In step 1, the

teacher specifies the pedagogical objectives. In step

2, the game designer identifies the game design

software the more suitable for his needs. In step 3 the

game designer identifies games with similar field. In

step 4, the students play games with similar field for

inspiration for their own games. In step 5, the teacher

delivers learning content to students. In step 6, the

students read, watch and listen the learning content.

In step 7, the game designer teaches students about

how to design a game. In step 8, the game designer

teaches students about how to use the game design

software. In step 9, the students co-design the game.

In step 10, the students co-develop the game. In step

11, the four actors (the game designer, the researcher,

the students, and the teacher) evaluate the game

(Gajewski et al., 2020). Table 2 illustrates our method

of learning game co-design.

2.2 Choice of the Game Design Tool

Since in step 2, the game designer identifies the game

design software the more suitable for his needs, we

have conducted a systematic literature review

following the PRISMA methodology between 2010

(2010-01-01) and 2020 (2020-12-18) from five

databases (IEEE Xplore, ScienceDirect, Scopus,

Springer, and Web of Science), with the search words

“game design tools” and its synonyms (Gajewski et

al., 2022, 2023).

From 302 identified research works, 18 have been

used for the discussion. And from eight game design

tools advised by a pedagogical engineer, three have

been used for the discussion. Figure 1 illustrates the

flow diagram of that systematic literature review.

Learning Game Co-Design by Second-Year Nursing Students and Its Effects on Knowledge

655

Table 2: Our method of learning game co-design (Gajewski et al., 2020).

Steps

Actions

Actors

Specify the pedagogical objectives

Teache

Identify the game design software

Game designe

Identify games with similar fiel

Game designe

Play games with similar field for inspiration

Students

Deliver learning content to students

Teache

Read, watch, listen the learning content

Students

Teach students about how to design a game

Game designe

Teach students about how to use the game design software

Game designe

Co-design the game

Students

Co-develo

the

ame

Students

Evaluate the game

GD / R / S / T

(

Game Desi

ner

)

/ R

(

Researcher

)

/ S

(

Students

)

/ T

(

Teacher

)

Figure 1: PRISMA flow diagram for a systematic literature review about game design tools from 2010-01-01 to 2020-12-18

(Gajewski et al., 2022, 2023).

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656

Overall, 12 game design tools have been

identified: Agentsheets, Alice, Celestory,

GameMaker, Gamestar Mechanic, Microsoft Kodu,

RPG Maker VX Ace, Scratch, Stagecast Creator,

Unity, Unreal Engine, and VTS Editor.

Those game design tools have been described and

compared according to nine criteria: programming

language, tool language, tutorials, scenes and

characters, game type, target audience-designer, 2D

or 3D modelling, prize, and export.

Regarding the programming language,

“programming a video game traditionally required

extensive typing in which the smallest syntax error

could offset game play” (Burke & Kafai, 2014, p. 8)

whereas other game design tools use a visual and

simple programming languages as “drag-and-drop”.

Regarding the tool language, some game design tools

are only in English. Others are in different languages

as in French. Regarding the tutorials, some game

design tools provide tutorials (manuals, videos, etc.);

others don’t. Regarding the scenes and characters,

some game design tools provide resources as

backgrounds for the scene and sprites for the

characters. If the game design tool doesn’t provide

resources, users have to draw them by themselves

(requiring skills and time) or ask a game design

character to do it for them. Regarding the game type,

some game design tools offer the possibility to

develop different game type (e.g., adventure, arcade,

racing); others are limited to just one. Regarding the

target audience-designer, some game design tools are

intended for adults or experts; others are suitable for

children or novices. Regarding the 2D or 3D

modelling, some game design tools allow users to

develop 3D games. “Compared to 2D environments,

the ability to create 3D games […] makes it visually

more appealing for young students” (Akcaoglu, 2016,

p. 115). Regarding the prize, some game design tools

are freeware; for others, users have to pay a fee to use

it. Regarding the export, the games developed by

some game design tools can be played offline; others

require an internet connexion. Table 3, which is a

guide to help teachers, game designers, pedagogical

engineers, and researchers to identify the game design

tool the more suitable for their needs, describes and

compares the 12 game design tools according the nine

criteria.

3 EXPERIMENTATION

Our method of learning game co-design has been

experimented with the 110 second year nursing

students of the Catholic Institute of Lille from April

to June 2022 which were divided into 21 groups.

3.1 Method

In step 1, the teacher specified the pedagogical

objectives. In our experimentation, the pedagogical

objective was to allow students to co-design a

learning game about liver cirrhosis for them to learn

about this topic.

In step 2, the game designer identified the game

design software the more suitable for his needs. To

identify the game design software, we used the

summary table (Table 2) of the different game design

tools. We decided to use VTS Editor because it

doesn’t require any technical skills. Indeed, VTS

Editor uses a drag-and-drop interface. VTS Editor

interface is in French making the game design tool

easier to use. VTS Editor provides tutorials. VTS

Editor provides backgrounds for scenes and

characters. VTS Editor allow users to develop

simulation games which are suitable because

“nursing students are generally well acquainted with

visually realistic game environments” (Koivisto et

al., 2016)

In step 3, the game designer identified games with

similar field. In our experimentation, the learning

field is about nursing and clinical reasoning. Different

games were identified, as The blood typing game or

eMergenSIM.

In step 4, the students played those games for

inspiration for their own learning games.

In step 5, the teacher delivered learning content to

students. The learning content was uploaded on our

Learning Management System (LMS) Moodle. The

learning content was an eBook with the anatomy and

the physiology of the liver, the definition, the

pathophysiology, the clinical signs and the treatments

of the liver cirrhosis, etc. (Figure 2), videos, and

exercises (case studies).

Figure 2: Screenshot of the eBook created in Moodle.

Learning Game Co-Design by Second-Year Nursing Students and Its Effects on Knowledge

657

Table 3: Comparison of game design tools according to 9 criteria (Gajewski et al., 2022, 2023).

Programm

ing

lan

Language Tutorials

Scenes

and

characters

Game

Type

target

audience-

desi

2D or 3D

modelling

Prize

Export

Agentsheet

Drag and

drop

English

French

English



- For kids 3D Free Online

Alice

Drag and

drop

English



For

anyone

3D Free Locally

Celestory

Drag and

drop

English

French

English

French



≠ types of

games

Free or

Fees

Various

GameMak

Code or

Drag and

drop

English

French

English

French



≠ types of

games

beginners

and

profession

als

Free or

fees

Various

Gamestar

Mechanic

Drag and

drop

English English



≠ types of

games

7 to 14-

year old

children

2D Free Online

Microsoft

Kodu

Visual by

tiles

English

French

English



≠ types of

games

9 to 10-

year old

children

3D Free Online

RPG

Maker VX

Point and

click

English

French

English



RPG

For

anyone

Free (30

days)

64,99 €

Windows

Scratch

Drag and

snap

English

French

English

French



≠ types of

games

8 to 16

years old

2D Free

Locally or

online

Stagecast

Creator

Point and

click

English

French

English



≠ types of

games

8-year old

children

Demo

(120 days)

Locally or

Online

Unity Code English English

asset store

Not for

free

≠ types of

games

For

profession

als

2D or 3D

Free

conditiona

Various

Unreal

Engine

Code or

visual

English English Templates

≠ game

templates

For

profession

als

Free

conditiona

Various

VTS

Editor

Drag and

drop

English

French

English

French



Simulation

games

2D and 3D

Trial or

fees

Various

In step 6, the students read, watched, and listen to

the learning content for them to understand them. In

this step, the students could help each other. They

could compare their understanding of the learning

content.

In step 7, the game designer taught students about

how to design a game (What is a learning game? What

are the benefits of using games at school? What are

game mechanics? Etc.).

In step 8, the game designer taught students about

how to use the game design software. Firstly, in half

group, while the teacher created a project on VTS

Editor, students reproduced it by mimicry. Secondly,

students had to watch the tutorials uploaded on our

LMS. Thirdly, students had to realize exercises on the

use of VTS Editor. Finally, students explored in depth

VTS Editor for them to discover all its functionalities.

Figure 3 is an overview of the VTS Editor’s interface.

Figure 3: Screenshot of the VTS Editor’s interface.

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658

In step 9, the students co-designed the game. The

students were asked to create a paper prototype of

their game. To do that, they had to describe the game

storyline, the characters, the rules of the game, the

sound effects and the music, the gameplay, the game

mechanics, the aim of the game, the pedagogical

objectives, etc.

Figure 4: Screenshot of the learning game of one of the

groups.

In step 10, once the paper prototype was over,

students could co-develop their games by using VTS

Editor. Figure 4 is an example of one learning game

developed by one of the groups.

In step 11, the game was evaluated. The students

were encouraged to look at and to test the games of

the others groups, so that they could get inspiration

for their own games, and give feedbacks to the other

groups to help them to improve their games. The

game designer evaluated the playful aspects

introduced into the games. Is the game playable?

What are the game mechanics introduced into the

games? Etc. The teacher evaluated the serious aspects

introduced into the games. Did the game meet the

pedagogical objectives? Did the students discuss all

the aspects of the liver cirrhosis? Is the knowledge

introduced into the games true? The researcher

evaluated the method of learning game co-design. Is

it suitable? What are the effects of the learning game

co-design on learning?

3.2 Instrument

One of the aims of this study was to measure the

effects of the learning game co-design on the

students’ knowledge.

A 20-item questionnaire was developed by the

researcher to assess the students’ knowledge on liver

cirrhosis. Each question was marked on one point.

The questionnaire was therefore marked on 20 points.

4 RESULTS

As shown in Figure 5, there was a significant

difference between the pre-test (M = 6.77) and the

post-test (M = 9.78) mean score on knowledge (p <

.001) with an increase of 3.01 points (out of 20) in the

post-test in comparison with the pre-test.

However, as shown in Table 4, no significant

difference was found in the post-test between the

students who co-developed successfully a playable

game and those who didn’t. Indeed, there was a

significant difference between the pre-test (M = 6.72)

and the post-test (M = 9.62) mean score on

knowledge within the students who co-developed

successfully a playable game (p < .001) with an

increase of 2.90 points (out of 20) in the post-test in

comparison with the pre-test. In the same way, there

was a significant difference between the pre-test (M

= 7.13) and the post-test (M = 10.85) mean score on

knowledge within the students who didn’t succeed in

co-developing a learning game (p < .05) with an

increase of 3.72 points (out of 20) in the post-test in

comparison with the pre-test.

Figure 5: Pre-test and post-test mean scores on knowledge.

5 DISCUSSION

As shown in Table 4, no significant difference was

found in the post-test between the students who co-

developed successfully a playable game and those

who didn’t. Indeed, the students who co-developed

successfully a playable game and those who didn’t

have increased their mean score on knowledge in the

post-test in comparison with the pre-test. We can

conclude that co-development a learning game didn’t

improve students’ knowledge. The mere participation

in the learning game co-design activity even if

students didn’t succeed in co-developing a learning

game increased mean score on knowledge.

6,77

9,78

pre-test post-test

Learning Game Co-Design by Second-Year Nursing Students and Its Effects on Knowledge

659

Table 4: Mean scores on knowledge within the students who co-developed successfully a playable game and those who didn’t.

Total

Yes

Difference

Pre-test

M = 6.77

SD = 2.14

M = 6.72

SD = 2.06

M = 7.13

SD = 2.82

Post-test

M = 9.78

SD = 3.13

M = 9.62

SD = 3.07

M = 10.85

SD = 3.70

Difference

3.01 (+ 44 %)

p < .001

2.90 (+ 43 %)

p < .001

3.72 (+ 52%)

p < .05

Furthermore, even if no significant difference was

found in the post-test between the students who co-

developed successfully a playable game and those

who didn’t, the post-test mean score on knowledge

within the students who didn’t succeed in co-

developing a learning game is higher than those who

co-developed successfully a playable game. In the

same way, the post-test mean score on knowledge

further increased within the students who didn’t

succeed in co-developing a learning game than within

the students who co-developed successfully a

playable game. We can suppose that students who

didn’t succeed in co-developing a learning game

focused more on serious aspects to introduce into the

game than playful aspects.

6 CONCLUSION AND

PERSPECTIVES

This paper is about game-based learning and more

specifically about game design-based learning.

We first have presented the method of learning

game co-design we have developed (Gajewski et al.,

2020). Then, we have presented a guide to help

teachers, game designers, pedagogical engineers, and

researchers to identify the game design tool the more

suitable for their needs (Gajewski et al., 2022, 2023).

We finally have presented the experimentation of a

learning game co-design activity by using our

method.

The results highlight that the knowledge score

increased after the learning game co-design.

However, no significant difference was found

between the students who co-developed successfully

a playable game and those who didn’t. We could

conclude that the mere participation in the learning

game co-design activity even if students didn’t

succeed in co-developing a learning game increased

mean score on knowledge.

In terms of perspectives, it could be interesting to

let the students explain their games during a showcase

to evaluate if they are able to articulate the knowledge

introduced into their games, as other authors have

already done (Khalili et al., 2011).

Furthermore, it could be interesting to conduct a

second experimentation with control groups (playing

a game or taking a lecture) to evaluate the relevance

of game design-based learning in comparison with

other pedagogical methods.

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