a b s t r a c tThis research explores the educational impact of an online study aid-game for studying human vascular anatomy (n ¼ 24) versus a similar non-game study aid (n ¼ 22) and how it relates to medical students' demographic traits and voluntary use over a 35-day period. Hierarchical linear regression models revealed that study aid success rate (a metric for assessing performance through the study aids) was a significant predictor of anatomy test improvement with the game (b ¼ 0.41, p ¼ 0.05), but not for the non-game (b ¼ 0.14, p ¼ 0.56). Our analyses suggest that game mechanics encouraged more specific problem-solving strategies than did the control study aid, leading to greater predictability of learning outcomes. There was a non-significant trend among game treatment participants, who were more likely to complete study tasks than those assigned to the control treatment (p ¼ 0.11). It would appear that students' studying habits had the greatest influence (though opposite in both tools) on level of engagement in study aid use. However, contrary to expectations, self-reported gaming habits did not impact participation. Overall, these findings support the integration of game design into undergraduate study aids as a means of increasing use of supplementary educational tools and assessing knowledge.

The large improvement in test scores during a short period of study and the high level of satisfaction across all of the disciplines indicates that the application is a useful adjunctive tool for learning TEE. It is now being used in TEE training worldwide.

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