Table 1.

Overview of outcome measures

	Indicative of	Derived from
Learning performance
Accuracy	Applied domain knowledge	Points are added for correct interventions executed in the game and subtracted for harmful interventions. To attain a high score, the player must demonstrate knowledge of the interventions that are and are not indicated for this patients’ condition
Speed (absolute)	Strength of cognitive strategies	Total time to scenario completion
Speed (relative)	Strength of cognitive strategies	The relative time it has taken the player to perform critical actions required for all scenarios: attaching the monitor, applying oxygen, and introducing oneself to the patient
Systematicity in approach a	Cognitive strategies – knowing how to approach an unfamiliar problem	Actions are labeled A, B, C, D, or E in chronological order. Using a Hidden Markov Model, a score ranging from 0 to 1 is calculated, indicating if the actions were performed in the appropriate order. The more the sequence resembles the correct order of A-B-C-D-E, the higher the score
Cognitive load
Paas’ mental effort scale		Questionnaire asking how much mental effort they invested in the task on a 1–9 scale, labeled from 1 = ‘very, very low mental effort’ to 9 = ‘very, very high mental effort’
Self-regulation
Self-monitoring		Number of times the player opens the checklist menu
Help-seeking		Number of times the player calls a medical specialist using the in-game telephone
Test performance
Immediate test performance		Live scenario-based skill assessment of the ABCDE approach
Delayed test performance		Live scenario-based skill assessment of the ABCDE approach
Game engagement		Questionnaire on participants’ experience using the game

^aSystematicity was used as a learning performance outcome measure and as input for the adaptive scaffolding algorithm