Comparative Effects of Simulation-Based Education and Gamification on Nursing Students’ Knowledge, Attitudes, and Performance in Applying the Emergency Severity Index (ESI), Fifth Edition

To compare the effects of simulation-based education and gamification versus usual education on nursing students’ knowledge, attitudes, and performance in applying ESI-V5 at baseline, post-intervention, and one-month follow-up.

A three-arm, parallel-group randomized educational trial involving 72 nursing students, with variable block randomization (sizes 3 and 6). Outcomes will be assessed at baseline, post-intervention, and one-month follow-up. The performance assessor will be blinded; participant and intervention-provider blinding is not feasible.

The study will involve 72 students at Ahvaz Jundishapur University of Medical Sciences, randomly allocated to three groups. Knowledge, attitudes, and performance will be assessed at three time points by a blinded performance assessor.

Participants will be undergraduate nursing students at Ahvaz Jundishapur University of Medical Sciences enrolled in the theoretical Emergency Nursing course; inclusion criteria: informed consent, no prior formal ESI-V5 triage training, and no participation in advanced triage courses outside the university curriculum; non-inclusion criteria: failure to meet the eligibility criteria or unwillingness to participate.

Seventy-two nursing students will be allocated to three groups (n=24 each): simulation-based education (one 60-minute lecture and three 60-minute simulation sessions); gamification (one 60-minute lecture and three 60-minute scenario-based sessions with points and immediate feedback); and usual education (lectures and discussion). All groups will cover ESI-V5 content.

Primary outcomes are knowledge, attitude, and performance scores in ESI-V5 application, measured at baseline, post-intervention, and one-month follow-up across the three study groups.

Individual randomization will be performed using a 1:1:1 allocation ratio. Permuted block randomization with variable block sizes of 3 and 6 will be used to maintain balance in the number of participants across the three study groups. Randomization will be conducted separately in each of the two academic semesters, with academic semester serving as the stratification factor. In each semester, following sample selection and confirmation of eligibility, participants will be randomly allocated to one of three groups: simulation-based education, gamification-based education, or the control group receiving usual education, with 12 participants assigned to each group per semester. The random allocation sequence will be generated using random-number generation software by an individual independent of intervention delivery and outcome assessment. To ensure allocation concealment and prevent prediction of subsequent group assignments, the allocation sequence will not be accessible to the researcher delivering the interventions until each participant enters the allocation process. Following confirmation of eligibility, obtaining informed consent, and assignment of a study identification code, each participant will be allocated according to the predetermined randomization sequence.

Due to the nature of the educational interventions, blinding of participants and the researcher delivering the interventions is not feasible, as participants will be aware of the type of education they receive and the researcher will be responsible for delivering the intervention assigned to each group. However, to reduce assessment bias, participant performance will be evaluated by an independent assessor who is not involved in delivering the educational interventions and is unaware of participants’ group assignments. Each participant will be assigned a study identification code, and information regarding group allocation will not be made available to the assessor. Performance assessment forms will be completed using study identification codes only, without indicating the educational group. The assessor will also remain unaware of participants’ previous assessment results to the extent possible. Therefore, blinding will be implemented at the outcome assessor level to reduce the risk of bias in performance assessment.

Due to participant confidentiality and research data protection requirements, individual participant data will not be shared.

The final study protocol, statistical analysis plan, and informed consent form, with identifying information removed, will be made available upon request to the principal investigator after study completion, subject to applicable requirements.

Access to the documents will begin six months after publication of the main study results and remain available for three years.

Academic and scientific researchers may submit a justified request to access the documents.

The documents may be used for research and educational purposes only. Requests will be reviewed, and access will be subject to research ethics and confidentiality requirements.

Requests may be directed to the principal investigator at Ahvaz Jundishapur University of Medical Sciences.

Requests should specify the research objectives, requested documents, and intended use. They will be reviewed for scientific merit, ethical compliance, and confidentiality, and applicants will be notified of the decision.

Document sharing will comply with research ethics principles, university regulations, and intellectual property rights. No individual participant data will be made publicly available, even after de-identification. Access to the documents will be provided only after review and approval of the request.